Newspaper article John van Roy

Only going to the hospital if you really have to

Not having to flap to the hospital unnecessarily. Is that nice for a moment. The Dijklander Hospital in Hoorn and Purmerend takes care of that with the use of artificial intelligence.

If you have to undergo surgery, you are no longer routinely invited to visit the outpatient clinic. Instead, a risk prediction is made. This is done with the help of artificial intelligence (Or Artificial Intelligence, AI). As one of the first hospitals in the country, Dijklander Hospital uses the electronic preoperative screening system E-POS. AI is not a threat, as some fear, in the Dijklander Hospital it is seen as valuable and promising. Based on the results, the anesthesiologist decides if, and what preoperative examination is needed. That examination is necessary to prepare a patient as well and safely as possible for surgery. Anesthesiologist John van Roy sees artificial intelligence as an important tool to make processes in healthcare more efficient. The Dijklander Hospital has been working with E-POS for more than three years. Van Roy: "During the corona pandemic, visits to the hospital were limited to prevent the spread of the virus. This accelerated the introduction of E-POS ."

Where previously this was standard during an outpatient visit, E-POS allows patients to prepare at home. In addition to completing a digital questionnaire, several instructional videos explaining the preparation for surgery, anesthesia options and the possible side effects of the chosen anesthesia are offered. Based on the international guidelines, the patient's operation data and the answers to the questionnaire, AI creates an advice document. This states whether the patient is suitable for immediate digital clearance or whether a telephone consultation with the physician is required. "Operations with a low risk profile can therefore be placed directly on the surgery list with only a digital preoperative examination. Only when it comes to a riskier operation, i.e. when something falters on the health front or there is a somewhat heavier operation, patients are still invited for check-ups at the outpatient clinic. In this way we screen in an efficient way and as a specialist you can devote your attention to the patients who really need it. And because this group has also received the necessary information in advance via the video animations, we notice in the outpatient clinic that the conversations between patient and specialist are much more substantive." Initially, there were quite a few questions surrounding the implementation of E-POS. For example, there was a lot of ambiguity about how to work and how to use it for patients and healthcare professionals. A task force identified all the bottlenecks and resolved them in a short period of time. "As with any new application, there was room for improvement. Moreover, there were question marks around the group of people who may be less digitally savvy due to age. That turned out to be unfounded; either people knew how to manage themselves well, or there was someone in the patient's network who could help. In general, it appears that people feel adequately informed by the video animations before surgery. A positive side effect is that people can now access the information at home, whenever and with whomever they want. As a result, they pick up the information better and more of it sticks than during a conversation at the outpatient clinic. You create peace of mind for people, which is definitely a positive element of the screening software. "

The big question is whether E-POS, when it comes to preoperative screening, offers the same safety as the situation before where every patient who needed surgery was routinely seen at the outpatient clinic. "What we find is that the underlying algorithm in the system is defensive, that it's on the safe side," Van Roy states. "It has another advantage: in the old situation, prior to each preoperative consultation, the specialist had to make a consideration in a short time. Now the specialist has access to a clear recommendation report on the basis of which he or she determines whether and which additional preoperative examination is needed. Digital triage not only gives more insight into the patient's health status but may even be more consistent."

The Dijklander is leading the way. "We joined early, when the system was still in development. Others initially looked at the cat out of the tree. It's good to see that E-POS is being rolled out further and further and is increasingly being embraced by other hospitals." Van Roy sees many more opportunities for the application of artificial intelligence. "For example, I can imagine digital monitoring after surgeries as well. The trend is to keep people in the hospital as short as possible; digital support can help with this. After certain operations, a patient can go home immediately if, using digital questionnaires and smartwatches, for example, you monitor how the recovery process is going and ask questions about temperature and stool rising. That way we can monitor if postoperative complications develop so we can identify early that something is in danger of going wrong. People can then recover safely at home. " "Developments are going incredibly fast. For example, most smartwatches can already register heart rate and blood pressure. Therefore, I expect that within five to 10 years we will be able to handle the entire preoperative examination remotely, that is, when patients are at home. Provided this information can be exchanged in a secure way. The measurements of smartwatches are getting better and better. Especially now that you have to do the work with fewer and fewer people, this is a way to still provide the care you want," Van Roy believes. "The electronic highway is going to play an increasingly important role.

Risk group
As more hospitals switch to E-POS, more and more data are becoming available for analysis. "I can imagine that this will provide more insight, for example about which group of patients require a heart screening beforehand. This used to be standard from the age of sixty; now each hospital has its own policy in this regard. By analyzing the data, we can determine much more differentiated, focused and accurate which patient group is actually the risk group and needs additional preoperative research. And this of course applies to any other group. "Digital applications where medical data can be exchanged will increase," Van Roy predicts. But what all happens to your health data and in what way is this data protected from improper use? "Technical advances lead to ethical and legal discussions. In practice, regulations often lag behind technological developments. The Dijklander hospital is obliged to apply the applicable privacy legislation for patients and monitor compliance. E-POS has two-step verification (an extra layer of security). Only after the patient has approved the person identification, the medical information provided and consent can the digital list be sent to the anesthesiologist. Analyses, necessary for scientific research extracted from the E-POS database, will always be applied anonymously, i.e. not traceable."