The Box contains monitoring devices patients can use to perform monitoring activities in the comfort of their home. The success of the service relies on active patient participation. With The Box, the treating medical team now has insights in the patient’s health condition from a distance. It doesn’t require the patient to be physically present in the hospital, and there’s now even more reliable data available to adjust the treatment to. It makes the carepath insightful and approachable by both parties, resulting in accessible digital consultations. Since The Box has proven to be a success in patient care, several departments started adopting this service as well. However not much attention has been given to how the healthcare staff at LUMC is experiencing the implementation of The Box. As the idea of patient home monitoring looks very promising, the reality however is quite discrepant. Not having the physical presence of patients in the hospital, would appear to reduce the burden on healthcare staff, as instead these “empty” hospital bed will simply be taken up by other, even more severe cases, causing a larger amount of patients to both monitor digitally and take care for physically. It leaves us with the question of “Who will do it?”. Who will take on the so to speak additional workload? The healthcare staff at LUMC is experiencing more workload with the implementation of The Box as its intended use is mostly focussed on remote and safe patient monitoring, while missing out on an opportunity for assisting the care-team. It occasionally happens that additional staff is hired to cope with the excessive workload, or that LUMC is also investing in an intelligent system that prioritizes patient data. But momentarily, healthcare staff’s solution is simply to not check up on every patient that sends in data. The Box may appear as an implemented innovation in the care practice of LUMC, but in reality it is still a prototype. Therefore it requires scaling to towards an improved standard healthcare practice. The goal is to turn The Box into a mature proposition that can be implemented hospital-wide, but also that has the ability to change the current healthcare system. The burden on the care-team must be suppressed or else the future will include an immense scarcity of healthcare professionals of which the majority will be burnt out. A roadmap is created to show opportunities for continuous prototyping and what value it brings, scaling strategies, patient monitoring and what level of staff involvement it demands, required developments and finally stakeholder collaboration. What it actually proposes are the changes to be made to create an integrated healthcare solution that is focussed on “unburdening” the staff. LUMC is not capable of changing this alone: they are specialized in research, education and healthcare, yet they lack expertise on data management, financial resources, digital developments, etc. It therefore needs support of multiple organisations. The deliverable aims to show a designer’s perspective on scaling The Box from a prototype level towards a mature healthcare proposition.

This thesis presents research on data and healthcare and proposes a design vision that enables collaborative use of self-tracked data. This work was developed within the Cardiolab as a graduation work in Strategic Product Design. It aimed to identify the needs and aspirations of practitioners and patients and, then, embody the findings on a design vision. To develop the design vision, literature research was carried and user research was done with healthcare professionals and patients. Mixed methods were used to collect and analyze qualitative data. The results have revealed that trust plays a key role in a data-based collaborative system. It enables users and professionals engagements and provides value to other stakeholders involved. Furthermore, the research has revealed that ethical uses of data are critical to unlocking interactions in such a system. Based on that, a platform called "Insight .me" was designed. From a design perspective, this thesis emphasizes the need for enabling data as material for personal reflection and collaboration, besides, it reinforces the need of designing ethical and trust base businesses to deal with self-tracked and personal data.

This project envisions the future of telemonitoring for peri-operative care. Through an extensive literature research and further expert and context exploration, a design strategy is created, as a starting point for the development of new services and technologies in healthcare around surgical environments. The design process with a strong focus on analysis guided the development of the project. This allowed the creation of a future vision that considers the findings from the literature, user and trend research and gives a direction to the current state. Within the creation of a future vision, different scenarios are detailed, to give a more detailed idea of how peri-operative care would be. In addition, some recommendations and future steps are presented, to facilitate the achievement of these future scenarios by providing the stakeholders involved with some tools to assess the viability of implementation and inclusion in planning. Finally, the project includes a call to action to develop technologies and services that enables the extension of care to the home context and the empowerment of patients to have a conscious and active role in maintaining and seeking their wellbeing.

The Dutch healthcare system is currently under a lot of stress. Contemporary social, technological, economic and political trends demonstrate an emerging pressure on both primary and secondary care. The trend with the most profound impact, is the growing amount of chronically ill patients, causing a high pressure on the workforce and on limited resources. Additionally, during the past number of years, healthcare costs have been growing substantially. Simultaneously, people expect more services and more involvement in their health. Partly caused by those trends, Heart for Health seeks for a solution to work towards a "future where remote healthcare prevents unnecessary CVRM patient visits at general practices". But, it has been found that there are currently many obstacles to be overcome for the implementation of such solutions. This thesis aims to create a complete overview of the complex environment where Heart for Health is currently working in. Even though all stakeholders strive to work towards a healthier population, many conflicts of interests were found. Besides, the concerned stakeholders have complex expectations and desires, that are not easily satisfied. Like others, Heart for Health has experienced that overcoming those obstacles is challenging. The aim of this thesis is to research and propose how Heart for Health can create new business within the general practitioner sector. Therefore, an extensive research has been done into the current care pathway of CVRM patients and the desires of the stakeholders. In order to create a comprehensive overview, many stakeholders were involved throughout this project. A product vision has been created to formulate what a product for monitoring CVRM patients at general practitioners should contain. Besides, multiple requirements were found to develop such products. This thesis discusses why Heart for Health is currently struggling with the development and implementation of their pilot. And explores how this struggle could be overcome by taking a more customer centered approach. To do so, an explorative session has been executed to find opportunities for creating new values. This exploration has led to a proposal for a more comprehensive product than Heart for Health is currently making. To realise the development of this product, a step-by-step approach has been proposed. It is argued that Heart for Health should first focus on creating a product for patients before including general practitioners. The proposed approach is translated into a roadmap, describing the different steps that Heart for Health can use to work towards the future that they envision. This thesis strives to give a realistic and strategic perspective on the proposed solution by repeatedly testing on desirability, feasibility and viability.

The rheumatology department of ErasmusMC wants to improve the effectiveness of their future Psoriatic arthritis and Rheumatoid arthritis care paths. The expected lack of capacity on the department asks to solve this problem in a capacity-efficient way. Including remote monitoring in the care path and shifting towards a self-management approach, where the patient takes an active role in their care path, create opportunities for this. Currently, patients with a lower socioeconomic position are associated with limited health skills and lower disease outcomes than patients with a higher socioeconomic position. When designing a support approach that asks for more self-reliance of the patients, it is important to take this patient group’s specific characteristics and needs into account to prevent the gap in disease outcomes from increasing further. This thesis project aims to find out what the future hospital self-management support should look like to better support patients with a lower socioeconomic position in self-managing their disease and what opportunities the remote monitoring intervention that ErasmusMC is currently designing could provide in this A user-centered design approach was used to define and solve this complex problem were both stakeholders, including the patients as well as the healthcare workers, were included during both the research and the deisgn phase of the project. Research revealed that in the current situation, a lacking communication about the topic of self-management between healthcare workers and patient causes the patient to start off their self-management journey with an insufficient knowledge base, negatively influencing their ability and motivation to take an active self-management role. Along their journey, patients’ issues in developing an understanding of the personal disease manifestations and thinking in a solution-oriented way decreases this ability and motivation further. Through co-creation with the stakeholders a future support approach was designed, consisting of a communication approach and a home support app. The support approach focuses on establishing a clear, consistent and engaging way of communicating about the topic of self-management between healthcare workers and patients and guiding and engaging the patient in developing an understanding of their disease and its management. Evaluation showed that the support approach increases the patient’s ability and motivation to take an active self-management role and provides healthcare workers a structure that supports them in obtaining input from their patients and conveying self-management information in a clear and engaging way. The benefits the support approach could establish regarding patient’s health outcomes and self-reliance seem to outweigh the resources needed to establish this. Enabling connection with future remote monitoring interventions would positively influence the viability of the concept further. Further evaluation is needed to validate the actual effect of the support approach on the longer term. The insights gained during this project about defining and modeling self-management, communicating about self-management and the characteristics and pains of patients with a low socioeconomic position show opportunities for future research and potential for generalization over the broader health domain.

Cardiovascular diseases (CVD) are the leading cause of death worldwide. While metabolic factors such as age and gender affect greatly, most of the CV events can be prevented by addressing behavioural risk factors such as physical inactivity, smoking or bad diet. CV prevention programs aim to reduce the burden of these conditions by providing guidance to individuals and predict negative outcomes, but adherence to these programs rely heavily on individual capabilities and intrinsic drivers. The proposed product-service system enables self-management of risk prevention programs by tracking progress and adapting to interactions with the app. The product enables self-assessment and individual strategies for each risk factor as well as connectivity for future appointments in the prevention program. Based on different personality types, the system tailors the tone of information presented to the user to nudge and motivate the user with intrinsic drivers and capabilities such as health literacy.

This thesis presents the results of the project “Creating meaningful conversations user-data”. This project aims to understand the impact that interactions with technology currently have on users and to redesign a fitness tracker service to create more personal and meaningful experiences. These experiences enable fostering the users’ wellbeing and ultimately user engagement. The project explores the personality (conceptual characteristics) of the fitness tracker and its impact on user interaction. Moreover, it researches the meaning and value of health for the individual. These trackers are perceived by the users as very controlling in the interactions, which are mainly based on outputs and behavioral instructions leaving the user a passive role on the experience (conversation). The reason is that trackers follow a machine personality approach based on optimization and goal-seeking. Moreover, it has been found that the value of health for the tracker follows a different approach than the user. While the user values health to find balance and self-care based on doing holistic and meaningful activities, the trackers approach health as a predefined list of activities and are based on performing and achieving. This tracker approach zooms in on the activity (tangible meaning), difficulting for the user to see beyond and find the personal meaning that these devices can have to transform their lives (intangible meaning) into a healthier life. To design a more meaningful conversation user-tracker, five specific challenge areas related to this problem have been found: meaningless and impersonal goals, trainer tone of voice, linear and achievement focus, perceived lack of self-control and lack of health balance. The redesign is a new concept for the fitness tracker service (mobile and smartwatch app). It tackles the entire concept of the fitness tracker service (mobile and smartwatch app), rather than only data visualization because there needs to be a common ground regarding the personality of the user and the tracker (such as having a common approach to health) before the user-data conversations can become meaningful. The redesign zooms out from tangible activities and frame goals as journeys towards a healthier life. In this journey, the user is not only supported in the achievements but also empowered in the lower points of the process though self-reflective questions to learn from his unconscious behavior, which makes the service a platform for self-growth and gives the user a proactive voice in the conversations user-tracker. Moreover, a meaningful topic of conversation is established from the beginning of the experience by the “goal-setting” where the user can define holistic and personally meaningful goals to design his future-self. Finally, the motivation strategy of the app has been shifted from competition and achievement to share learnings with others (Self refections) regarding the journey, since it has been found that in this context, motivation related to de creativity. Therefore the user finds meaningful the experiences that inspire their behavior rather than instruct it.