Hans van den Heuvel

travel time and distance from the patient’s home to the hospital. We acknowledge that more information on the viewpoint and experience of obstetric professionals on digital health care is needed. As professionals are end-users of telemonitoring services too, working with digital technologies will change their current practice profoundly. Medical decision making with use of home measurements will be part of their tasks in prenatal care, but to what extend to they feel comfortable with this role? Digital transformation of healthcare in the Netherlands It is widely known that the use of digital health is able to provide essential solutions to healthcare demands, such as staff shortages, rising healthcare costs and accessibility of care. However, developments come with challenges and successful uptake of digital care is not self-evident. The process that is required for successful uptake, requires a transformation within healthcare. 24 In the Dutch eHealth-monitors, digitalisation of care is observed to progress at different speeds. What is the reason for the difference in development and actual implementation? And what can we learn from past initiatives? Two of the conclusions that can be drawn from evaluations in the field of Dutch health care: progress in digital health is currently limited by (a lack of) integrated data modalities and restrictions regarding social and cultural changes. 25 To what extend can this thesis add to the current limitations? On the level of data integration: home measurements must be visible and accessible to transform into information for both users (patient and health care providers) which depends on the integration of separate information systems. We have addressed this important topic in Chapter 7 on user experiences of telemonitoring services. Action has to be taken on all levels (governmental, hospital institutions, registry services, insurance companies and the industry) to coordinate and integrate self-measured data from home to be of benefit for care – from individuals to population. Digital health implementation is a result of a complex process of research and development, starting often with start-ups in the Life Science and Health sector. The Netherlands offer an international and innovative business climate for these efforts. 26 After successful product development, businesses need to connect with hospitals and clinics as end-users of their services. As seen in our research with digital health in pregnancy, both industry as well as research groups or clinicians are co-dependent of each other in this process. We worked with different companies and their products. As mentioned before, financial stability and the intention to co-develop are essential to overcome barriers such as data integration and future implementation. On the level of cultural change: digital care requires a different way of working for health care providers and professionals in medicine. Implications of digital care include digital interaction between patient and professional, shared participation and better-informed and more active patients. 27 As such, the emergence of digital tools for information and remote CHAPTER 11 186