In the Netherlands alone, an estimated 730,000 persons are currently diagnosed with coronary heart disease (CHD), 120,000 with heart failure, and 260,000 with atrial fibrillation. As of 2014, cardiovascular disease accounted for 27% of all deaths1. The cardiology department of the Leiden University Medical Centre (LUMC) has a regional role in treating patients with different cardiovascular diseases, ranging from myocardial infarction, heart failure and infectious cardiac diseases to life support with left ventricular assist devices (LVAD) in severe heart failure patients. Coronary artery disease (CAD) affects a big proportion of these patients. Forty myocardial infarction (MI) patients are seen on a weekly basis in the outpatient clinic (MISSION!-clinic) at set times after the infarction event; 1 month, 3 months, 6 months or 12 months.

In an attempt to improve patient outcome, provide a better service and reduce the workload at the outpatient clinic, the LUMC launched a novel project called "the BOX". The BOX allows patients to self-monitor their vitals after a myocardial infarction (MI) or heart surgery, thus reducing visits to the hospital.

Patients are given a Wi-Fi scale, a watch with a pedometer, a Wi-Fi blood pressure meter (BPM) and a one-lead EKG/ECG monitor. The devices are produced by two different companies (Nokia/Withings and Alivecor) and are connected to the mobile phone of the patients. Patients have to measure their vitals on a daily basis and are instructed to contact a professional in case of emergency. Preliminary results show a good acceptance from the patients and high willingness to self-monitor their disease. This new product-service reduces the number of regular visits to the outpatient clinic by 40%, which are replaced by video conference.

In this context, the cardiology department plans to take the next steps to expand this service and provide effective and quality care using e-Health medical devices. Nevertheless, they are dependent on different stakeholders to do so. On the one hand, the companies that sell the medical devices (like the ones included in the BOX) control the patient data, and grant access to the hospital. A change in their business model can affect patient safety, privacy and the systems that the hospital has to put into place. On the other hand the patient must use the devices. Self-monitoring is an important behaviour for self-management, required for various chronic illnesses such as diabetes, hypertension, and heart diseases. But, having a plethora of devices and applications is not accessible for all the patients, which is a critical requirement for the LUMC as a part of a public institution that focuses on providing healthcare services to the general population. Moreover, a hospital requires stability for the long-term in order to implement technological solutions that directly affect patients.

The described situation is an interesting opportunity to look at product/services through different lenses (public sector) and design within the institution. Although, it also has the constraint/limitation that doctors are not engineers/producers. In addition, it is a vast problem to tackle, thus the necessity to focus on one area as the research is done.