The StressCoach app, SoaSeksCheck and Thuisarts.nl are all examples of ‘personalized digital health’. To further improve the quality of this type of service, TNO applies the P4 concept. This enables us to develop practical, secure and reliable applications which meet the public’s demand for personalized healthcare.
“Healthcare is undergoing rapid digitization, even at the individual level. Everyone can now collect a large quantity of data and learn about how genetic, lifestyle and environmental factors influence their health,” explains Wessel Kraaij. “Diagnosis, prognosis and treatment are increasingly geared towards the individual. This helps to prevent overtreatment or undertreatment, and thus reduces overall healthcare costs.”
Big data supports personal health advice
Kraaij is a principal scientist at TNO and professor of Applied Data Analytics at Leiden University. His research is concerned with data analysis techniques which support health and healthcare. Kraaij develops algorithms which can automatically sort through vast quantities of data to collect, interpret and process relevant information. He played a leading role in the SWELL project (2011-2016), which set out to measure and analyse stress and strain, with a view to mitigating their effects. A practical outcome of this research is the StressCoach app, developed by TNO and the company The Performance Experts, which offers users practical advice to avoid stress in the workplace. Kraaij is also closely involved in the Prana Data programme, which includes several pilot projects examining the use of data encryption technology to support the secure storage and analysis of personal information. Kraaij is now working with non-profit foundation Mijn Data Onze Gezondheid (My Data Our Health) to develop a sort of cooperative bank for health data. The basic principle is that users retain full ownership and control of their health data, which is stored securely in an encrypted database or ‘digital vault’. They decide how it is to be used and by whom.
“Privacy is a must if you want to persuade people to cooperate and share their health data with you”
Privacy is a must
TNO bases all efforts to improve the quality of digital healthcare on the P4 concept. The four Ps in question are prediction, prevention, personalization and participation (see box). There is also a fifth, overarching P which applies to all aspects: privacy. Personal information, including that provided by the individual, is always anonymized before being made available to any other users. “We refer to this as privacy by design,” explains senior scientist Marc van Lieshout. “Privacy is a must if you want to persuade people to cooperate and share their health data with you.” At TNO, Van Lieshout is involved in all developments in connection with privacy. He is also commercial director of the Privacy & Identity Lab, a research partnership between TNO, Radboud University Nijmegen and Tilburg University. “We have developed a framework which governs all our privacy research. It is goes by the name RESPECT4U. Here, ‘respect’ is not only a word in its own right – as in ‘respect for you’ – but it is an acronym which stands for Responsible, Empowering, Secure, Proactive, Ethical, Cost-benefit & business analysis and Transparent. You must ensure that personal information is kept in a fully secure way which meets each and every one of these requirements.”
Various interpretations of privacy
The RESPECT4U framework was applied when designing an online application for women receiving prenatal care at the Westfriesgasthuis hospital in Hoorn. It incorporates a ‘privacy dashboard’ which allows users to select which types of patient information they are willing to share. “We can identify three user categories, all of which require an individual approach,” states Van Lieshout. ”The first group attaches great importance to privacy. You have to work hard to persuade them to take part at all. The second group sees privacy as important but is willing to take part once you explain how the data will be used. The third group says, ‘Fine, whatever. Arrange it for me!’ We can see the differences just by the boxes they tick.”
“Everything in a therapist’s repertoire can now be incorporated into a digital system”
From personal data to personal interventions
Collecting and sharing data is just the beginning. People must also be offered sound advice. Social psychologist Pepijn van Empelen is another contributor to TNO’s research. He has developed valid interpretations and predictive models for the health data needed to underpin reliable advice. He sees participation and personalization as important themes. How can we use personalized digital health to support permanent lifestyle changes and the resultant health gains? How do we spot patterns within population data which will help us to identify the most effective interventions? "In Rotterdam-Zuid, for example, the problems associated with overweight and obesity are prevalent..." Kraaij explains. "And that brings a risk of diabetes," Van Empelen adds. “So what is the best intervention? People must change their diet, obviously, but doing so should not disrupt everyday life. We must also take family and work into account. If we are to identify the best possible intervention, we must draw upon various data sources in an integrated way. This is a core principle of the Leefstijl als Medicijn (Lifestyle as Medicine) programme which TNO is running in association with Leiden University Medical Center.” Van Empelen believes that digitization has many benefits in terms of personal healthcare. “You can now mix general population interventions with very specific individual interventions. Mobile technology is opening up new possibilities by the day. For example, an intervention can be adapted over time to allow for changes in the individual’s behaviour or in his or her setting. If someone is unfit, we can use a digital app to set goals. If the person cannot reach those goals unaided, we can adjust the level of support accordingly. Perhaps they lack motivation, in which case we can provide an online pep talk. Everything in a therapist’s repertoire can now be incorporated into a digital system.”
“My motto is: ‘Show, not tell’. Don’t just claim that something will work – prove it! That is how we will make real progress”
“We are constantly working to improve personalized digital health based on the P4 concept,” says Kraaij. “Our focus is on pilot projects which move us closer to practical, secure and reliable digital health applications.” Van Lieshout agrees. “My motto is: ‘Show, not tell’. Don’t just claim that something will work – prove it! That is how we will make real progress.”