Hans van den Heuvel

11 monitoring is assumed to reconfigure expertise of both patients and healthcare providers, with an impact on the relationship between them. These implications ask for trust in each other’s expertise. Professionals should embrace the novelties of digital care, even if this means a shift of tasks from their traditional way of working. However, help of a clear vision and ambition of healthcare directors within different organisations is needed. On a positive note, the e-Health monitor of the Netherlands in 2019 showed an increase in the enthusiasm of care professionals of the use of e-Health and for the use of self-monitoring strategies specifically. Sixty percent of general practitioners and physicians experienced that telemonitoring promotes patient autonomy and quality of care. 28 Value Inthelightofthestrategyofvalue-basedcare,thisthesiscanbeseenasapilotevaluationofboth quality (i.e. perinatal outcome, experiences of participants) and cost of new telemonitoring models in both risk pregnancies and complicated pregnancies. Technology plays a big role in the rapidly changing healthcare landscape. Also, it facilitates the benchmarking and reporting of patient outcomes and care quality using data and analytics. Also, in pregnancy and childbirth care, including our research involving digital technology, the perspective of value-based healthcare has significant implications for future care delivery. 29 In perinatal health, the shift from traditional care to “appropriateness” of care is ongoing, resulting from a movement of systematically performed quality evaluations. However, underuse, overuse and misuse of medicine are to be avoided. Next to the provision of safe and effective care, it must be valuable for those who deliver, receive and pay for it. 30 Figure 2. The actors in measuring value of care Both quality and cost are actors in this value equation as postulated by Michael Porter and Elisabeth Olmsted Teisberg (Figure 2). 31 Preferably, value is to be measured and increased in care cycles, with inclusion of patient-reported outcomes (PROMs) and integration of care of different facilities. Naturally, this comes with challenges: which outcomes should we focus on, and which patient-reported experience best reflects value in pregnancy care? And from our viewpoint, what is the role of digital advancements, such as telemonitoring? Digital health may contribute to the collection of PROMs, and eventually in the evaluation of pregnant women’s needs in obstetric care. SUMMARY AND GENERAL DISCUSSION 187