Amsterdam the international center of digital inclusive care

Amsterdam Economic Board, ahti, Amsterdam AI, Rabobank, ROM InWest and Sigra are jointly organising the Zorg2025 meetings. Health and prevention take center stage, and healthcare innovators from business, government and academia share their knowledge and experience.
During this edition, the moderation was in inclusive and young hands of Anna N’goné Diouf and Gregory Chong of Clientbelang, while representing the client’s perspective on stage.

Large health disparities

The promises of eHealth are great. Perhaps rightly so, says Christine Dedding. But when it comes to some concerns, we’re mostly talking about privacy. “There is much less attention to the fact that eHealth can reduce and increase health disparities. Is it as effective as we think?” Dedding is associate professor of Participation & Co-creation in the Department of Ethics, Law and Humanities at Amsterdam UMC, and her research is called Doing eHealth Right.

She paints a disturbing picture: if you live in poverty, you often also exist in an environment that is less healthy. And if you are sick or have a disability, it is difficult to find good education and/or job. “And now the online world is encroaching on the living environment. Underprivileged people have to digitally apply for a pass that offers discounts, as well as for their energy allowance. How to respond if you don’t have a computer? Or no access to active devices? Or not enough storage to download an app?”

Self-esteem

When people are often confronted with this, it affects their self-esteem, Dedding said. She is embarrassed by the touchscreen device located at the entrance to her hospital. “You have to engage with this upon entry, and we assume that everyone will understand that you have to press the screen.”

One in five Dutch people struggle with the online world. This is not just about skills, but also about having devices, about motivation, and about economic and social capital. Dedding: “Not everyone can just ask for help if they can’t figure things out digitally. People who are at a great distance from the online world are in networks that are not online.”

Technology can only lead to efficiency if people can participate. There is no quick, inexpensive solution to that, Dedding notes. But what can we do? “We need to keep counters open and always provide a non-digital route to patients. And we need to work less fragmented. All healthcare facilities in the Amsterdam region have their own app. If we want to do our work better, we all need to be aware that the digital society is too complicated. That the people who can’t deal with it are normal people.”

Recognising emotions

VicarVision deals with inclusive care in a very different way. The Amsterdam-based software company develops emotion analysis software that recognises facial expressions. This allows healthcare robots to recognise users’ emotions and provide tailored advice, explains research consultant Tess den Uyl. She is exploring ways in which social robots help with appropriate care and support and thus contribute to inclusive care. “These robots serve as companions and can provide advice that can help prolongue living at home for the elderly.”

The empathetic robot does not yet exist. The robots already in use in care and welfare are used for research, as companions for the elderly, for simple tasks and assistance, and in caregiving tasks, for example. “We see that people are positive about social robots, but these are still a rare sight in real life.”

VicarVision expects robots to become more employable if better interaction is possible and if they focus on a specific problem: how can the elderly live healthily and longer at home in this complex society?

Not yet ready

Using a small robot, Den Uyl and her colleagues conducted a survey among 18 elderly users. They could play a game with the robot and it could give advice based on an assessment of the user’s emotions. “Unfortunately, this research showed that we are not yet ready for implementation. Users didn’t really feel the need or had expected more from the interactions. The face analysis also turned out not to yet be quite accurate.”

To further improve the emotion recognition software, VicarVision has now started a follow-up study, Buddy-BeWell, which will run through 2026. Challenges abound, Den Uyl says. “Advanced software requires advanced hardware, but that is expensive. We also need to do something with the data a robot collects. Control and ease of use need to be well balanced.”

People on the move

GP Steven van de Vijver is working on a digital health record for people on the move: HealthEmove. In his story, digitalisation, increased migration and the vast growth of inequality all come together. “Digitalisation can increase inequality, but perhaps also reduce it.” Van de Vijver and several other researchers published the position paper Digital Health for All last year.

Digitalisation in healthcare can lead to excluding the most vulnerable from proper care, he noted. “But there is also an opportunity: with digitalisation, you can reduce barriers, make markets more transparent and come up with innovations for resource-poor environments.”

With the digital health record, Van de Vijver is primarily targeting refugees, who, thanks to the record, will have a personal data safe containing their medical data. These people usually spend short periods of time in different locations in the Netherlands and Europe. Therefore their medical data is scattered everywhere. This puts continuity of care at risk. “It’s very difficult to get all those sources of information to interact. A logical starting point would be to keep that data with the patient. Once they have that data, they can then decide which health care provider to share certain information with.”

Patient is data owner

The software partner for HealthEmove is Patient Knows Best, a British company that is MedMij-certified. This means the software meets the Dutch standard for digital exchange of data between patient and healthcare provider via a personal health platform. Van den Vijver: “Our main goal is to facilitate medical data exchange between patient and healthcare provider, where the patient owns the medical data. We are now first developing specifically for and in co-creation with refugees, but soon we want everyone in the Netherlands to be able to use this.”

With HealthEmove, a user can access their own medical data, from diagnoses to allergies to X-rays, through a portal. They also get access to reliable healthcare information through the portal. “Patients thus have ownership and insight into medical data. We avoid duplicate diagnostics and therapy and improve continuity and quality of care. For me as a healthcare provider, it also works much better when I have all this information and know what has already happened.”

Van de Vijver is working with many different parties for this project, including ahti, Vluchtelingenwerk, OLVG, Red Cross, Doctors of the World, Patients Know Best (PGO), Kruispost and the City of Amsterdam. “Ultimately, we want this to be a European project and soon all Europeans will be able to use it. Our goal is for Amsterdam to become the international center of inclusive digital care.”