Govert Veldhuijzen

180 Chapter 9 always get the technical support from the software development team, for which I am very grateful to this day. The most interesting struggle for any research performed in collaboration with business partners, either pharmaceutical companies, medical devices companies or eHealth start-ups, is how to preserve scientific integrity. As I had no competing interest in this company, and the fact that they never interfered with my conclusions, presentations or scientific publications, safeguarded this important point. I learned valuable lessons on how the development of business models, the sales driven scale up of eHealth and the continuous efforts to help departments implement this new working algorithm is all crucial to successful and fast paced expansion of the CBE. The more standard route of evidence based medicine with proof of concept studies, subsequent RCT’s and systematic reviews, leading to the updates of guidelines most certainly would have been the longer route. On a more philosophical note, I wonder if eHealth interventions at all are suitable for this approach, as the pace of development is faster than current evidence based science can deliver. In planning the path that lead to this thesis, I learned several important lessons. Main lesson: a PhD candidate does not invent everything by himself. To produce relevant documentation for trials, ethical committee paperwork, statistical backgrounds and the publication of the first articles any PhD candidate benefits from regular meetings; failing to structure this properly in the earlier stages has created lag time. FUTURE PERSPECTIVES As the current 2020 global COVID-19 crisis and subsequent lock down of society evidently shows, there is a growing demand for eHealth solutions that allow patients and health care providers to communicate without visiting the hospital. 20 On-demand eHealth can allow physicians and patients to communicate ubiquitously, 24/7, with the use of their smartphones or webcam-enabled computers. In the field of cloud based solutions, comparable to our computer based education, new interesting solutions are being developed, especially in the United States. 21 Guidance on multiple levels should be in place to ensure high quality of new eHealth products that enter the hospital. A major role for setting quality standards is there for scientific committees and professional societies. Hospital directory boards should be up to speed with the eHealth developments and actively engage in discussions with their staff which elements in patient pathways allow substitution of face-to-face care into eHealth solutions.