National Institutefor Public Healthand the Environment

Digital decision aids at the Dutchnational health and care portal

www.kiesBeter.nl

eTelemed, Feb. 2009Hans C. Ossebaard [University of Twente]

Collaboration in eHealth

National Institute for Public Health andthe Environment (RIVM)

> National health portal kiesBeter

National Institute for Public Health andthe Environment (RIVM)

> National health portal kiesBeter

University of Twente University of Twente

National Institutefor Public Healthand the Environment eTelemed 2009, Feb. 2009 - Hans C. Ossebaard 2

University of Twente

> Center for eHealth Research

[Faculty Behavioral sciences]

University of Twente

> Center for eHealth Research

[Faculty Behavioral sciences]

National health and care portal

2004 Assignment of NL Ministry of Health

Background:

- Consumer centered health care system (choice)

National Institutefor Public Healthand the Environment eTelemed 2009, Feb. 2009 - Hans C. Ossebaard 3

- Consumer centered health care system (choice)

- Demography

- E-citizens > e-patients

- Increasing health costs

Objectives:

- Reliable and objective (comparative) information onhealth, care and insurances

- Consumer oriented (accessibility, simplicity)

National health and care portal

National Institutefor Public Healthand the Environment eTelemed 2009, Feb. 2009 - Hans C. Ossebaard 4

- Consumer oriented (accessibility, simplicity)

- Multi-channel (internet, phone, help desks)

National health and care portal

Anno 2009

Comparative healthcare information

Display information on the full spectrum of care

Quality information (performance indicators, benchmarks)

Health insurances

National Institutefor Public Healthand the Environment eTelemed 2009, Feb. 2009 - Hans C. Ossebaard 5

Health insurances

Additional information on

Medicines

Healthy living

Patients’ rights

Medical information (decision aids)

Visitors per month (2006-2008)

2008: > 3M visitors

200,000

250,000

300,000

350,000

400,000

450,000

500,000

2006

2007

2008

National Institutefor Public Healthand the Environment eTelemed 2009, Feb. 2009 - Hans C. Ossebaard 6

0

50,000

100,000

150,000

200,000

jan feb mrt apr mei jun jul aug sep okt nov dec

2008

Decision aids

Sub site Medical information

visited by 2:3 visitors

Decision aids:

Assignment of Ministry of Health

Developed by Dutch Institute for Healthcare Improvement

National Institutefor Public Healthand the Environment eTelemed 2009, Feb. 2009 - Hans C. Ossebaard 7

Developed by Dutch Institute for Healthcare Improvement(CBO) in collaboration with major stakeholders

Disclosed on national healthcare portal (medical information)

Decision aids

Patient involvement has beneficial effect on process andoutcomes (O’Connor 2004, et al.)

Shared decision making – model

National Institutefor Public Healthand the Environment eTelemed 2009, Feb. 2009 - Hans C. Ossebaard 8

Decision aids:

- interventions to help people make choices

- innovative e-tools to improve doctor-patientcommunication

Decision aids

- Developed according to IPDAS standards, 2005

- Based on clinical guidelines

- Preference-sensitive decisions

National Institutefor Public Healthand the Environment eTelemed 2009, Feb. 2009 - Hans C. Ossebaard 9

- Preference-sensitive decisions

Decision aids

- ADHD (children)

- Anxiety disorders

- Breast cancer non-metastatic

- Depression

- Diabetes

- Cardiovascular risk management (+HR)

- Lumbar disc prolapse

National Institutefor Public Healthand the Environment eTelemed 2009, Feb. 2009 - Hans C. Ossebaard 10

- Pneumothorax

- Post-menopausal symptoms

- Prenatal screening on Down’s syndrome

- Screening for prostate cancer

National Institutefor Public Healthand the Environment eTelemed 2009, Feb. 2009 - Hans C. Ossebaard 11

Portal vs Medical information vs DAvisitors per month (2008)

Bezoekers permaand

200.000250.000

300.000

350.000

400.000450.000

500.000

Totaal kB

MI

National Institutefor Public Healthand the Environment eTelemed 2009, Feb. 2009 - Hans C. Ossebaard 12

0

50.000100.000

150.000

200.000

jan-

08

feb-

08

mrt-

08

apr-

08

mei-

08

jun-

08

jul-08 aug-

08

sep-

08

okt-

08

nov-

08

dec-

08

DA

Total amount of DA visitors

30.000

40.000

50.000

60.000

National Institutefor Public Healthand the Environment eTelemed 2009, Feb. 2009 - Hans C. Ossebaard 13

0

10.000

20.000

nov dec

Visitors per Decison aidNovember/December 2008

300

400

500

600

700

800

200811

200812

National Institutefor Public Healthand the Environment eTelemed 2009, Feb. 2009 - Hans C. Ossebaard 14

0

100

200

Ove

rgan

g

Dep

ress

ie

Bors

tkan

ker

Pros

taat

kank

er

Har

t-en

vaat

ziek

ten

Pren

atale

scre

ening

ADHD

bijkind

eren

Diabe

tes

Her

nia

Klap

long

Verh

oogd

eka

nsop

hart-en

vaat

ziek

ten

Visitors’ duration (min.) per Decison aidNovember/December 2008

0

5

10

15

20

25

30

nov

dec

National Institutefor Public Healthand the Environment eTelemed 2009, Feb. 2009 - Hans C. Ossebaard 15

0

Overgang

Depressie

Borstkanker

Prostaatkan

ker

Hart-en

vaatziekten

Prenatalesc

reening

ADHDbij kindere

n

Diabete

s

Hernia

Klaplong

Verhoogde kans op hart

- envaatz

iekten

Visitors clicks – within decison aidNovember/December 2008

300

400

500

600

700

800

200811

200812

National Institutefor Public Healthand the Environment eTelemed 2009, Feb. 2009 - Hans C. Ossebaard 16

0

100

200

300

Ove

rgan

g

Dep

ress

ie

Borstka

nker

Pros

taatka

nker

Hart-

enva

atziek

ten

Pren

atalesc

reen

ing

ADHD

bijkind

eren

Diabe

tes

Hernia

Klaplon

g

Verho

ogde

kans

opha

rt-en

vaatziek

ten

Decison aids

> promoting use by professionals> promoting use by patients

- decentralised use

- e-awareness among public, professionals en

National Institutefor Public Healthand the Environment eTelemed 2009, Feb. 2009 - Hans C. Ossebaard 17

- e-awareness among public, professionals enpolicymakers slowly increases

> further research needed

National Institutefor Public Healthand the Environment eTelemed 2009, Feb. 2009 - Hans C. Ossebaard 18