Hans van den Heuvel

CHAPTER 1 Besides consequences for patients faced with complications during pregnancy, increased clinic visits and hospital admission also pose a burden for health care resources. Health care services are challenged by shortage of professional staff. 12 As the cost of healthcare continues to rise, policies for cost reduction without concessions to the quality of care are required for a sustainable health care system. EMERGENCE OF DIGITAL HEALTHCARE In search for improvement of care for women with complicated pregnancies, answers may be found in the emergence of digital health. Digital health, or eHealth, is an umbrella term for health care practice supported by electronic processes and communication. 13 Following the definition of Eysenbach, eHealth is not only a technical development, but more likely an emerging field at the intersection of medical informatics, public health and business. Moreover, he mentions that its definition should be interpret with caution as eHealth is a dynamic field, which is constantly changing. 14 Access to mobile communication is increasing globally, with an estimated 75% of the world population now connected through mobile phone connectivity. Over 2,000 health-related smartphone applications specific for obstetrics and gynaecology can be found in the Apple iTunes store. 15 In recent years, research focusses on technological advancements to support both patients as well as health care providers. As a result of these technologies, the potential of health care with use of telemedicine is now facilitating management of patient’s problems from home. Multiple types of telemedicine can be defined with regards to complexity. In this thesis, we use the terms home monitoring, self-monitoring and telemonitoring in the context of obstetric care, and defined them as follows: Home monitoring is a type of domiciliary care for pregnant women with help of hospital personnel travelling to a patient’s home. During this home visit, a nurse or midwife may perform physical examination, measure blood pressure, fetal heart rate, and uterine contractions and draw blood or test urine. Measurements of cardiotocography and notes on current condition are sent to the electronic patient record with use of Internet connection. Self monitoring is the term used for self-measurements of vital parameters like blood pressure or maternal glucose. Values are written down by the patients in a diary or more contemporary in a smartphone app. Patients are instructed what to do when certain thresholds are being crossed, for example contact their health care provider or present to the hospital. 10