iMinds insights on citizen health empowerment

CITIZEN HEALTH
EMPOWERMENT
The potential and challenges of
the ‘Do-It-Yourself-Doctor’
TECH UPDATES BASED ON INTERVIEWS WITH ACADEMIC AND INDUSTRY EXPERTS - WWW.IMINDS.BE/INSIGHTS
WE NEED TO FIND
OTHER WAYS
OF PROVIDING
HEALTHCARE THAN
SHIPPING PEOPLE OFF
TO BIG BUILDINGS.
WE’RE TRYING TO
MAKE IT EASIER FOR
PEOPLE TO STAY AT
HOME.
“
“
Geert Houben,
CEO Aristoco (Cubigo)

04EXECUTIVE
SUMMARY
06THE POTENTIAL AND
CHALLENGES OF THE
‘DO-IT-YOURSELF-DOCTOR’
18THE ONE-CLICK GATEWAY
TO A WORLD OF HEALTH
EMPOWERMENT
Geert Houben,
Aristoco (Cubigo)
24VIRTUAL COACHING,
REAL-LIFE RESULTS
Claudia Put and Steven De Peuter,
BrandNewHealth
28A HEALTH APP
WITH TRUE HEART
Karin Coninx and Eva Geurts,
iMinds - EDM - UHasselt
34SMART DEVICES
FOR SMARTER
MONITORING
Pieter Vandervoort,
Ziekenhuis Oost-Limburg

CITIZEN HEALTH EMPOWERMENT: THE
POTENTIAL AND CHALLENGES OF THE
‘DO-IT-YOURSELF-DOCTOR’
HOW TECHNOLOGY DEVELOP-
ERS CAN EMPOWER CITIZENS TO
TAKE BETTER CONTROL OF THEIR
OWN HEALTH
With more people living longer
than ever before and chronic
disease on the rise, healthcare
systems are being pushed to
their limits. Society’s focus has
to shift from disease prevention
alone toward promoting healthy
lifestyles in which citizens have
more control over their individual
health — in which they are empow-
ered.
Digital technologies are widely
expected to play a key role in this
by giving people greater access to
their personal health information
and equipping them with tools and
insights to better manage their
lifestyles.
Yet to truly enable this, some
fundamental questions have to
be answered; questions related to
technological standardization and
integration, for instance – but also
related to integrating these new
concepts into the overall health
system. And how about winning
clinicians’ favor and getting (and
keeping) patients on board by
focusing on liability and privacy,
usability and persuasive technol-
ogies? And finally, how to make
sure citizen health empowerment
solutions will generate revenues
for the companies bringing these
solutions to the market?
INTEGRATION AND UPTAKE
The complexity of health systems
and the proprietary nature of
health technologies make estab-
lishing interoperable, standardized
solutions extremely challenging.
Yet interoperability and standards
are essential to fostering uptake:
interoperability ensures systems
can interact regardless of who
made them or where data is
coming from or going to; standards
in this context are a set of technical
specifications based on consen-
sus among stakeholders allowing
systems to be calibrated so that
their measurements are equivalent
across applications and platforms.
iMinds works closely with govern-
ment authorities to drive interop-
erability and standardization
forward. Its technical test center
and recently founded iMinds
Health Lab, for instance, target
interoperability issues and provide
an environment for testing use
cases and business cases based on
national and international interop-
erability standards. They also host
functional and technical integration
test sessions, verify the confor-
mance of applications and services
to interoperability specifications,
and support co-creation and stake-
holder feedback sessions.
Interoperability is one requirement
for integrating digital tools into the
health system; convincing practi-
tioners of the value of such tools
is another. Physicians are wary
of formally recommending apps
or electronic devices to patients
without evidence of their benefit,
guidelines for their use or assurance
that the patient’s personal infor-
mation will remain secure. Insurers
EXECUTIVE
SUMMARY
04 | iMinds insights

THERE IS SOCIETAL VALUE TO GIVING PATIENTS ACCESS TO THEIR PERSONAL HEALTH DATA.
WELL-INFORMED PATIENTS CAN HAVE BETTER DISCUSSIONS WITH PHYSICIANS. WE THINK IT’S
EASIER FOR A GENERAL PRACTITIONER TO ARRIVE AT THE CORRECT DIAGNOSIS AND THERAPEUTIC
SOLUTION WHEN PATIENTS HAVE CLEARER EXPECTATIONS AND ARE BETTER INFORMED.
and employer health programs also
want clear evidence of benefit. The
vast cross-section of stakeholders
in health means research must be
broadly inclusive to prove that the
proposed solutions actually satisfy
the needs of all user communities.
GETTING (AND KEEPING) USERS
ON BOARD
iMinds’ experience has led to the
conclusion that strong end-user
involvement in the innovation
process is key — not only in pilot
trials and beta testing but also
during the ideation phase to fully
understand users’ needs and the
problems to be solved. Also key is
for technologies to be ‘persuasive’
— that is, to have built-in mecha-
nisms for encouraging people to
follow through and improve their
lifestyles over the long term.
Citizens will only be empowered
to take control of their own health
destinies if the tools provided are
practical and easy to use, making
careful design important. People
will also need support understand-
ing what their personal health
information really means, meaning
some form of translation and inter-
pretation will be required.
Another fundamental consider-
ation is privacy. The nature of
information sharing in a connected,
data-driven, personally empowered
health future may require a reshap-
ing of what ‘privacy’ means — rebal-
ancing personal health and societal
benefits against the protection of
individual data. The EU is currently
in the process of reviewing its
legal framework on data protec-
tion to reflect current evolutions in
technology innovation, and iMinds
researchers are actively engaged in
identifying and addressing relevant
questions.
THE PATH TO MARKET
The complexity of the healthcare
system poses barriers for entre-
preneurs looking to introduce new
solutions into the sector and deliver
tailored, value-added services to
end users with different profiles.
iMinds is helping them build
successful technologies through
business analysis, cost-benefit
calculations, strategy development
and a living labs approach that
allows technology developers to
refine their solutions based directly
on user input.
THE WAY FORWARD
In the end, citizen health empow-
erment is not about technology —
although technology is certainly a
driving force. It’s about enabling
a new way of fostering health in a
person-centered, health-focused
system that allows citizens to be
active, self-empowered partic-
ipants in their personal health
management processes.
“
“
FOR MORE INFORMATION
about iMinds’ collaboration with
the health sector, please contact
Birgit Morlion
birgit.morlion@iminds.be
+32 9 331 48 08
Dr. Patrik Vankrunkelsven,
Director Cebam
iMinds insights | 05

HOW TECHNOLOGY DEVELOPERS CAN
EMPOWER CITIZENS TO TAKE BETTER
CONTROL OF THEIR OWN HEALTH
With more people living longer than
ever before and chronic disease
on the rise, healthcare systems
are being pushed to their limits.
Society’s focus has to shift from
disease prevention alone toward
promoting healthy lifestyles in
which citizens have more control
over their individual health — in
which they are empowered.
The World Health Organization
(WHO) defines the concept of
‘citizen health empowerment’ as
a process that supports citizens in
gaining more control of their health
by “taking the initiative, solving
problems and making decisions.”
Digital technologies are widely
expected to play a key role in this
by giving people greater access to
their personal health information
and equipping them with tools and
insights to better manage their
lifestyles.
The ultimate vision proposed by
many advocates of citizen health
empowerment is a data-driven
health dashboard for every person.
This is linked to a phenomenon
known as the ‘quantified self’ — that
is, the measurement and recording
of a wide range of body parameters
(from heart rates to body mass) as
well contextual and social activi-
ties such as humidity, air quality,
or Twitter use. Quantification is
enabled by consumer devices and
the smart, networked objects of
the emergent Internet of Things —
all of which allow people to track
more, share more and compile a
better picture over time of count-
less aspects of their (well)being.
Yet to truly enable this, some
fundamental questions have to be
answered about how citizen health
empowerment technologies can
be integrated with one another
and into the overall health system
— and how they’ll be validated to
win clinicians’ favor. As well, health
technology companies need to be
CITIZEN HEALTH EMPOWERMENT:
THE POTENTIAL AND CHALLENGES
OF THE ‘DO-IT-YOURSELF-DOCTOR’
DIGITAL
TECHNOLOGIES ARE
WIDELY EXPECTED
TO PLAY A KEY
ROLE IN EQUIPPING
PEOPLE WITH TOOLS
TO BETTER MANAGE
THEIR LIFESTYLES.“
“

confident that their citizen health
empowerment solutions will be
adopted by users and generate
revenue.
iMinds is working with all relevant
stakeholders in Flanders — includ-
ing ICT companies, formal and
informal care providers, insurers
and the government — to answer
these questions and make citizen
health empowerment a reality.
THE SHIFT IS UNDERWAY
The shift at the heart of citizen
health empowerment — away
from curing illness and toward
data-driven health management —
demands the right tools, including
new digital technologies.
If the number of consumer-focused
health tools in Apple’s App Store
is any indication, there is a public
appetite for these kinds of technol-
ogies already. A 2013 study of the
U.S. App Store conducted by the
>>
THE PATIENT WILL BECOME
MORE INVOLVED IN HEALTHCARE
DECISION MAKING
IN THE FUTURE
PAYER NOW AS IMPORTANT
AS THE PHYSICIAN
NOW
CENTRAL ROLE FOR THE PHYSICIAN
PREVIOUSLY
In the past physicians were key
stakeholders acting as gate keepers
to healthcare information and
treatment options.
As the key budget holders,
payers have the most inﬂuence
today over healthcare treatments
and patterns and evaluation of
outcomes results.
With the rise of the internet and all its
healthcare information, patients are better
informed and enabled to participate in the
healthcare decision making process.

IMS Institute for Healthcare Infor-
matics found that, of the 23,682
apps focused specifically on health-
care, more than two thirds (16,275)
were designed for consumers and
patients.1
Apps, of course, are not the only
digital tools enabling citizen health
empowerment. Databases, commu-
nications technologies, remote
sensors, wearables, intelligent
algorithms and more all contribute
to an overall citizen health empow-
erment service offering.
A recent iMinds project looking to
mitigate the risk of slips and falls
— which are the second leading
cause of accidental death among
seniors worldwide — demon-
strated for instance the ways
‘sensor fusion’ could increase
the efficacy and lower the cost
of fall-detection solutions. While
conventional monitoring systems
are complex, expensive and gener-
ate high numbers of false positives
and false negatives, the FallRisk
project fused data from different
kinds of acoustic and visual sensors
to cost-effectively deliver more
accurate and complete information.
Uniquely, FallRisk not only identi-
fies when someone has fallen; it
also assesses the risk that someone
might fall, helping avoid injuries in
the first place. The project incor-
porated a cloud-based backbone
for data handling, with algorithms
that assess inputs and dynamically
forward alerts to formal and infor-
mal caregivers to ensure timely
response.

As useful as technologies like these
may be, though, they stand little
chance of delivering their benefits
if they each exist in isolation, unable
to interoperate and contribute to
the bigger-picture view proposed
in the personal health dashboard
concept.
IN PURSUIT OF INTEROPERABILITY
AND STANDARDIZATION
The complexity of health systems
— whose stakeholders include
governments, health insurers,
care organizations, practitioners
and patients — makes establish-
ing interoperable, standardized
solutions extremely challenging,
especially because these various
players have their own aims and
agendas. Doctors are focused on
quality of care, while insurers want
HEALTH-RELATED APPS TARGETED
TO CONSUMERS VS. HEALTHCARE
PROVIDERS (HCP)
16,275Consumers
7,407HCP
IMS Analysis on all apps present in
the Apple Store to June 2013 showed
23,682 apps related to health
More than 2/3 of these apps were
related to consumers
•
•
Source: IMS Health analysis of widely available healthcare apps
1
IMS Institute for Healthcare Informatics. (2013). Patient apps for improved healthcare: From novelty to mainstream.08 | iMinds insights

to minimize costs. Consensus can
be elusive.
The behavior of health technology
companies further complicates
things because these organizations
tend to specialize in certain product
types (e.g., displays, data-process-
ing solutions, monitoring technol-
ogies). This often leads to the
development of closed, standalone
technology platforms — a barrier
to adoption not only for usability
reasons but also because it limits
practitioners’ freedom to pick and
choose the most suitable apps and
tools. Instead, their choices end up
being platform-dependent.
Poor standardization has an impact
all the way down to the level of the
consumer. Popular products like
Fitbit, for example, monitor the
number of steps their wearers take
in a given day. But different tools
may measure a ‘step’ differently,
meaning their data is non-standard
and therefore not aligned with the
data measured by other products.
Accurate baselining becomes very
difficult.
iMinds works closely with govern-
ment authorities to drive interop-
erability and standardization
forward. Its technical test center
and recently founded iMinds
Health Lab, for instance, target
interoperability issues and provide
an environment for testing use
cases and business cases based
on national and international
interoperability standards. They
also host functional and technical
integration test sessions, verify the
conformance of applications and
services to interoperability speci-
fications, and support co-creation
and stakeholder feedback sessions.
HOW TO GET USERS ON BOARD
For citizen health empowerment to
succeed, not only interoperability
and standardization is required.
People need to actively use the
tools being put at their disposal.
In some countries, including
Belgium, this will require a culture
shift. Where citizens are not used
to paying their own healthcare
costs, they may resist paying for
solutions not reimbursed by insur-
ers; at the same time, insurers may
be reluctant to embrace citizen
health empowerment because
of the potential impact on their
profitability.
Separate from the question of who
pays for what in the citizen health
empowerment future, the stake-
holders involved must also look
closely at how to encourage uptake
of these tools and technologies.
iMinds’ experience has led to the
conclusion that strong end-user
involvement in the innovation
process is key — not only in pilot
trials and beta testing but also
during the ideation phase to fully
understand users’ needs and the
problems to be solved.
The FallRisk project described
earlier engaged relevant stake-
holders (i.e., older adults, formal
and informal caregivers) to under-
stand user needs and the context >>
MOBILE HEART MONITORING
The iMinds-funded start-up
Qompium is focused on devel-
oping smartphone-based
health apps. Its initial product,
Fibricheck, is designed to
detect irregular heart rhythms
and prevent heart failure
and strokes. Using powerful
algorithms, the app provides
rapid, user-friendly diagnostics
that are communicated in real
time to caregivers over mobile
networks.
In the simplest terms, interop-
erability is about ensuring
systems can exchange data,
communicate and interact —
regardless of who made them
or where data is coming from
or going to. Standardization,
in this context, is about devel-
oping a set of technical speci-
fications based on consensus
among stakeholders, allowing
systems to be calibrated so
that their measurements are
equivalent across applications
and platforms.

in which the FallRisk technology
will be used. That led to some inter-
esting — sometimes unexpected —
findings, with informal and formal
caregivers expressing more privacy
concerns than older adults, while
a number of seniors — the target
demographic — felt the proposed
solution underestimated their own
abilities. User testing with these
stakeholders made it possible to
iteratively improve the FallRisk
interfaces for different stakehold-
ers and provide relevant function-
ality that ideally will contribute to
commercial uptake.
Another key to unlocking the
market for citizen health empow-
erment technologies is demon-
strating added value for stake-
holders other than end users. In a
complex health system, tools that
meet the needs of medical person-
nel, coaches and others represent
a ‘win-win’ for health technology
developers. One example of this is
the NEMO project (discussed later
in this paper), which provides a
single, streamlined interface for
health professionals to monitor
multiple patients’ health data.
KEEPING USERS ON TRACK
Clearly, not all citizens have an
equal desire to be empowered or
take greater responsibility for their
personal health. Some will embrace
it wholeheartedly while others
might need a little encouragement;
others will choose not to partic-
ipate out of disinclination, poor
technology skills or lack of access
to digital tools.
And there is also the question of
persistence. Anyone who has ever
attempted a diet knows sticking to
a new routine can be challenging.
For all of these reasons, research-
ers are actively exploring ‘persua-
sive technologies’ that motivate
people to improve their lifestyles.
In the specific case of weight loss,
a number of partners have come
together under the banner of
iMinds’ b-SLIM project to create
a digital ‘super coach’ that will
promote and encourage healthy
eating and exercise. The aim is to
break complex behaviors down into
addressable components and help
users set achievable incremental
goals. b-SLIM began in Spring 2014
I DO REMOTE MONITORING
WITH MORE THAN600
PATIENTS,THE MAJORITY OF
WHOM HAVE ADVANCED HEART
FAILURE.IF I HAVE A SINGLE
PATIENT WITH FOUR DEVICES,
I HAVE TO OPEN UP FOUR
DIFFERENT WEBSITES AND
SIFT THROUGH INFORMATION
THAT’S ALL DISPLAYED
DIFFERENTLY.IT’S COMPLEX,
CUMBERSOME AND TIME-
CONSUMING.WHY NOT JUST
HAVE ALL YOUR CLINICAL DATA
COME TO ONE PLACE?
Dr. Pieter Vandervoort
Co-chair of the Mobile Health Unit,
Hasselt University
Project lead: iMinds Neutral Mobile
Health Platform (NEMO)
“
“

with co-creation sessions, stake-
holder interviews and lab testing to
narrow down the initial concept to a
product design. Real-world testing
and validation trials are scheduled
for Fall 2015.
But ensuring that people maintain
healthy lifestyles is only one aspect
of the motivational challenge of
the citizen health empowerment
future. Another relates to the need
for constant information gather-
ing - and how to organize that in a
smooth way.
Digital technologies have the
potential to provide more complete
and accurate accounts of a person’s
health experience than anecdotal
recollections. However, if users
are required to manually track and
input their daily data, long-term
motivation and accuracy may suffer
— and some will be disinclined to
do it at all. Passive, automated
data collection will help ensure
dashboard metrics are complete,
precise and detailed. iMinds is
involved in a new EU Horizon 2020
project called m-Resist, which will
use data generated by mobile
devices and wearables to help
patients with treatment-resistant
schizophrenia self-manage their
disorder. In this clinical trial, heart
rates, mobility patterns and other
metrics will help alert patients of
their condition. iMinds researchers
are leading both the user research
for the project as well as the proto-
typing of the mobile app that will
take all the data into account.
‘USER FRIENDLY’ IS A MUST
Ensuring that people persist with
using digital health tools requires
the tools themselves to be simple,
practical and user-friendly, and
to deliver clear and immediate
value. Individuals should not have
to inconvenience themselves or
become trained specialists to be
‘health-empowered’.
This emphasis on usability is embed-
ded in the iMinds approach — from
involving potential end users at
every point in the innovation cycle
to designing the finest details
of the technologies themselves.
For example, usability was a key
concern when iMinds researchers
developed a cycling app for heart
patients — extending not only to >>
RESEARCHERS
ARE EXPLORING
PERSUASIVE
TECHNOLOGIES
THAT MOTIVATE
PEOPLE TO IMPROVE
THEIR LIFESTYLES.
“
“

A PERSONAL COACH WHO TRAVELS WITH YOU
Lieven Maesschalck, a physiotherapist and founder of the rehabili-
tation practice Move to Cure, has worked with iMinds on a portable
therapeutic coaching system that high-end athletes can take with
them wherever they go. Using sophisticated camera technology and
expert analysis, Maesschalck and his team diagnose how people’s
movement patterns may cause them physical problems and then
assign personalized rehabilitative exercises.
Instead of requiring a live, in-person coach, Maesschalck is develop-
ing an avatar that can capture user movements and offer corrections
in real time. Progress is monitored remotely by a real-world therapist;
the therapy can continue even if client and trainer are continents
apart.
With access to thousands
of electronic health records,
MyHealthData will provide an
excellent opportunity for health
data benchmarking. Yet with the
question of benchmarking, other
considerations come into play. As
well, some form of professional
judgment must be built in to help
users appreciate the relative signif-
icance of changes in their data.
This is true not only for MyHealth-
Data but also in general. Certain
health measures in an individual
may vary widely from the average
but have little impact, while a slight
elevation or decrease in another
measure could be cause for
immediate concern. This discern-
ment, which can come only from
the medical community, is essen-
tial to ensuring citizens relate
appropriately to their health data.
Otherwise, fears that “something
might be wrong” could lead users
to seek out health services they
don’t actually need — serving only
to perpetuate the burden on the
system that citizen health empow-
erment seeks to relieve.
TOWARD A LITERACY OF PRIVACY
The nature of information sharing in
a connected, data-driven, person-
the user interface and functional-
ity of the app but also, practically,
to how the screen would cope with
the glare of the sun.
MAKINGHEALTHINFORMATIONMEANINGFUL
Without the benefit of having gone
to medical school, few of us have the
ability to make sense of our personal
health data. Some form of translation
or interpretation is required — and if
citizens are going to be genuinely
empowered to look after their own
wellbeing, some of that intelligence
will need to reside within the health-
care apps themselves.
MyHealthData, an iMinds ICON
project launched in January 2015,
aims to give patients access to
their own health data in a format
they can understand. That doesn’t
mean simply offering definitions of
technical terms; it means helping
patients understand the impli-
cations of their data and how it
compares to various baselines.
This kind of comprehension is
lacking today for people whose
go-to source of medical informa-
tion is Google, where they look up
generic symptoms, compare them
to their own and draw ill-informed
conclusions.

ally empowered health future may
require a reshaping of fundamen-
tal notions of privacy — rebalan-
cing personal health and societal
benefits against the protection of
individual data.
This is not as radical as it may
sound. Privacy, after all, is not a
standalone right; it exists within
a social context. Genome sequen-
cing, for example, will continue to
yield insights into diseases, leading
to new treatments and preventa-
tive approaches. The benefits of
such sequencing come with scale,
sampling ever-larger numbers
of individuals’ genetic data. It’s
not always possible for such data
to remain perfectly anonymous,
though — and it might not provide
as much value if kept anonymous.
Society as a whole must decide
where it stands on the tradeoffs.
The decision can’t be made solely
by industry or policymakers.
Citizens also need to be informed
and involved. Today’s model of
‘informed consent’, which typically
amounts to clicking “I agree” after
scrolling through unread reams of
legal copy, is not sufficient for this
future scenario. Greater engage-
ment and some form of privacy
literacy are needed.
The EU is currently in the process
of reviewing its legal framework
on data protection — not creating
something wholly new but updating
existing concepts, which date back
to 1995, to reflect current evolu-
tions in technology innovation.
While the framework provides
standards and regulations, citizen
health empowerment raises
questions that are both ethical and
legal, demanding further societal
debate. Going back to the example
of genome sequencing: by its very
nature, the process reveals infor-
mation not only about you but
also your parents, your siblings
and your children. Yet under the
current legal framework, informa-
tion concerning third parties should
not be communicated without that
party’s consent. However, insisting
on the agreement of all affected
third parties could be cumbersome
and potentially prevent individuals
in need from accessing valuable,
life-changing treatments and thera-
pies.
It is complex questions like these
that need to be solved. iMinds
researchers are actively engaged in
unraveling the answers — contrib-
uting, for example, to the legal and
ethical frameworks of projects such
as MyHealthData. >>
THERE IS SOCIETAL VALUE TO
GIVING PATIENTS ACCESS TO
THEIR PERSONAL HEALTH DATA.
WELL-INFORMED PATIENTS CAN
HAVE BETTER DISCUSSIONS WITH
PHYSICIANS.WE THINK IT’S EASIER
FOR A GENERAL PRACTITIONER TO
ARRIVE AT THE CORRECT DIAGNOSIS
AND THERAPEUTIC SOLUTION
WHEN PATIENTS HAVE CLEARER
EXPECTATIONS AND ARE BETTER
INFORMED.
Dr. Patrik Vankrunkelsven,
Director Cebam
“
“
pg15

HOW
TO KEEP USERS
ON BOARD IN
THE LONG
RUN?
The concept of citizen health empowerment is based
on a totally new framework; one that needs both a
legal and ethical foundation if we want to keep users
(caregivers as well as patients) on board in the long
run.
An example: in a typical care model, the caregiver is
responsible and accountable for the decisions he or
she takes – based on direct interactions with a patient.
But what if – in the future – this patient is not physi-
cally present, and can no longer be identified in a
classical way?
What we have to avoid in this scenario by all means,
is that medical doctors would discard the whole idea
of citizen health empowerment because they could
be held accountable for establishing a wrong diagno-
sis based on erroneous data or a faulty identification
process. And at the same time, we risk losing out on
patients – as they might not be willing to assume a
greater personal responsibility when providing their
doctor with medical data.
“In many cases, the existing law already applies quite
well to these new equations – but we need to check if
there are no flaws as there is no room for error,” says
Prof Dr Anton Vedder, a judicial and ethical expert
of iMinds - KU Leuven. “What is needed, is a legisla-
tion that is technology-agnostic. But we do not want
to completely rewrite the current legislation. That
exercise is fully ongoing, both on a national and on a
European level.”
In the meantime, the privacy-related and ethical
debates are ongoing as well. The European Union is
currently working on a new regulation that deals with
protecting and processing personal data; a regulation
that will also apply to medical data.
“Based on what we know so far, it seems like this EU
regulation will be pretty strict,” Prof. Vedder continues.
“But in the end, the whole society – every one of us –
needs to reflect properly on which direction to take:
perhaps we do want to give up a piece of privacy in
return for optimized medical care?”
“In order to decide on that, conducting an open and
public debate is absolutely mandatory. In the UK – for
instance – a new concept on electronic patient records
was recently introduced, leaving more room for
making medical data available for research purposes.
The concept did not get the support from the medical
doctors, however, which complicated things substan-
tially,” he concludes.

VALIDATING CITIZEN HEALTH
EMPOWERMENT SOLUTIONS
Getting users on board is just one
piece of the equation. Another
aspect of the citizen health empow-
erment vision is that digital tools
will be recommended or formally
prescribed as an integrated part
of healthcare practice. Despite
the issues around interoperability
and standardization, this is already
happening in some cases, albeit
on a mostly ad hoc basis. For it to
become more systematic, health-
care professionals need greater
confidence in consumer-oriented
digital tools as well as clinical
evidence demonstrating their value.
On the whole, physicians are wary
of formally recommending apps
or electronic devices to patients
without evidence of their benefit,
guidelines for their use or assurance
that the patient’s personal infor-
mation will remain secure. Insur-
ers and employer health programs
also want clear evidence of benefit
before considering reimbursement
or promoting the use of digital
tools.
Health authorities have only just
begun to respond to this need.
A 2013 paper published in the
European Journal of ePractice
concluded that:
Both the EU and US regulators
are struggling to keep up with
recent advances in technology…
Both regulatory bodies have
launched programmes to solicit
feedback from the user commu-
nity and update regulations. The
[United States Food and Drug
Administration (FDA)] intends
to use its authority to regulate
mobile medical applications that
will impact a variety of industries
developing, marketing and selling
mobile health products, but it is
not yet evident how much the FDA
intends to extend its regulatory
arm. […] Fundamental changes in
[European standard CE marking]
regulations are anticipated in a
2015/16 timeframe.2

Separate from regulatory approval,
the value of digital health technolo-
gies must be proven for practitioners
to recommend them to patients.
This may be easier said than done
given that many research projects
focusing on health technologies —
iMinds projects included — lack the
timescales for such evidence-based
evaluations. What’s clear, however,
is that given the vast cross-section
of stakeholders in health, research
must be broadly inclusive if it is to
prove that the proposed solutions
will actually satisfy the needs of all
user communities. The participa-
tory design strategy behind iMinds’
A Touch of Memory (AToM) project,
for example, involved people suffer-
ing from dementia as well as their
partners, friends, caregivers and
even local shopkeepers in develop-
ing an app that could track patients’
food preferences to support
independent living.
CLEARING THE PATH TO MARKET
Healthcare systems represent
complex value networks involving
governments, care providers, insur-
ance payers, patients and citizens.
That complexity poses barriers for
entrepreneurs looking to intro-
duce new solutions into the sector
and deliver tailored, value-added >>
2
Papadopoulos, H., Sheth, V.B., & Wurst, M. (2013). “Comparison of US and EU regulatory approaches to mobile health
apps: Use cases of myVisionTrack and USEFIL.” European Journal of ePractice, 21. Gedownload van:
https://joinup.ec.europa.eu/community/epractice/og_page/european-journal-epractice. iMinds insights | 15

services to end users with different
profiles. It isn’t always clear who will
reap the benefits — or who actually
holds the purse strings.
The last point is especially signifi-
cant considering that health innova-
tion can demand heavy investment,
stimulating debate about alternative
means of financing such as crowd-
funding. (From a citizen health
empowerment perspective, crowd-
funding makes sense because it
brings the citizen into the process
of deciding which digital solutions
are needed most.)
While some jurisdictions today
already empower citizens by
giving them the freedom to choose
their preferred health practitioner
(meaning one could purposely
select a practitioner who offers
teleconsultations, for instance), this
is not universally true across Europe.
On the other hand, some jurisdic-
tions have unwittingly embedded
systemic obstacles to citizen health
empowerment — for example, by
instituting reimbursement rules that
reinforce the illness-based health-
care model or consider only in-per-
son doctor visits (versus telehealth
or web-based consultations) as
billable.
The sales pitch for consum-
er-friendly apps and other e-health
services is also challenged by the
fact that there is little proof yet of
the value of such solutions. More
research is needed — into cost
efficiencies, value calculations and
the user experience — to qualify
and quantify the benefits of digital
health technologies.
Living lab approaches provide
one way of building this kind of
evidence. Through its Living Labs,
iMinds is helping entrepreneurs
build successful technologies based
directly on user input.
The iMinds Living Lab methodol-
ogy builds inclusive, user-centered
innovation toward large-scale,
real-world pilot testing. The Flemish
Care Living Labs, for example, serves
as a test-bed for novel technologies
THE APP MATURITY MODEL
LEVELOFMATURITYOFAPPPRESCRIBING
INCREASING EVIDENCE OF HEALTHCARE BENEFITS
TIME
PROMOTINGADOPTIONIMPLEMENTATION
RECOGNITION OF APPS
SECURITY AND PRIVACY GUIDELINES
CURATION AND EVALUATION OF APPS
INTEGRATION WITH HEALTH IT SYSTEMS
INDIVIDUAL PHYSICIAN RECOMMENDATION
A small number of progressive physicians
are recommending apps to their patients
SYSTEMATIC USE OF MOBILE APPS IN HEALTHCARE
Systems and policies in place to
enable widespread use of apps in
healthcare
FULLY INTEGRATED DELIVERY OF HEALTHCARE
Apps have a fully integrated role
in the delivery of healthcare
Source: IMS Health analysis of widely available healthcare apps

and concepts such as Cubigo, an
online community-based social care
platform.
Other iMinds research groups
analyze the potential for stake-
holders to be involved in the
digital health services innovation
value network, generate business
cases, calculate costs and potential
returns on investment, and devise
go-to-market strategies.
While the complexity of healthcare
ultimately means there may be
multiple potential business models
for citizen health empowerment,
essential to them all will be partner-
ship and collaboration among the
various players who have a role in
the innovation value networks that
deliver solutions to market.
THE WAY FORWARD
iMinds is committed to working
with all relevant stakeholders to
develop, test and commercialize
solutions that will realize the vision
of citizen health empowerment —
specifically, by providing research
and business support, user-driven
co-creation opportunities through
its Living Labs, and insights into the
legal and ethical questions that still
need to be answered.
In the end, citizen health empow-
erment is not about technology —
although technology is certainly a
driving force. It’s about enabling
a new way of fostering health in a
person-centered, health-focused
system that allows citizens to be
active, self-empowered participants
in their personal health manage-
ment processes.
SPOTLIGHT ON IMINDS LIVING LABS
iMinds Living Labs is a leading organization in the European Network of
Living Labs (ENoLL), which utilizes state-of-the-art tools and scientifically
validated R&D methods to advance digital technology research. Involving
users at every step of the innovation process, iMinds Living Labs include an:
• Exploration lab for early stage innovation processes
• Experimental lab for exploring solution boundaries and creating and
testing first prototypes
• Evaluation lab for validating user interest in an innovation and/or the
business model behind it

CITIZEN
HEALTH
EMPOWERMENT
GEERT HOUBEN, CEO Aristoco (Cubigo)

THE ONE-CLICK
GATEWAY TO A
WORLD OF HEALTH
EMPOWERMENT
As they age, more and more baby
boomers are making the decision to
avoid retirement facilities and spend
their golden years at home. To
support this and give older people
more control over their health
and wellbeing, software company
Aristoco developed Cubigo, a
platform that integrates diverse
healthcare apps and programs into
a single, simple interface. We spoke
to Aristoco CEO GEERT HOUBEN to
learn more about how the company
is using its technology to create
“caring communities” for aging
populations.
Q: Do older people today
approach healthcare differently
than previous generations?
Geert Houben: Sure. They have a
different view of their golden years
than their parents did. We’re seeing
a lot of baby boomers decide they
want to avoid going to rest homes
or assisted living facilities for as long
as possible. As a software company,
we’re looking at this trend from a
technology perspective, trying to
create tools that will help these
older people take their care into
their own hands. Not only is this
what many older people want, but
it also helps reduce government
spending for elder care, which in
Belgium and the rest of the world is
going through the roof. We need to
find other ways of providing health-
care than shipping people off to big
buildings full of services, many of
which they might not use. We’re
trying to make it easier for people
to stay at home.
Q: How does the idea of the
“caring community” fit into this?
Geert Houben: When you decen-
tralize care, move it away from rest
homes and hospitals to homes,
the neighborhood and the local
environment become very import-
ant. That’s the caring community—a
community that helps take care of
you, and there are different players
in different roles. You have yourself, >>

of course, then your family, then the
neighborhood. The neighborhood
is critically important, because,
for example, you might not have
family living near you—your kids
might be 50 kilometers away, so
the people next door might be a
huge help. That concept, the caring
community, is something we want
to empower. We want to give the
entire community the tools they
need to care for each other.
Q: How does Cubigo work?
Geert Houben: Cubigo is a
dashboard that brings together a
number of healthcare and social
applications through a single,
simplified user interface. Each
app is represented graphically
by a cube. So, if you order meals
online, or instant message with
your neighbors, or video chat
with your nurse, you can do all
that through an easy-to-use inter-
face. You sign in once with a single
password, whether on your laptop,
iPad, smartphone, digital television,
whatever, and you’re ready to go.
Q: Where did the concept come
from?
Geert Houben: We were noticing
more and more healthcare-re-
lated organizations, compa-
nies and stakeholders making
their own online programs and
apps. The problem is, they’re all
distinct pieces of technology, like
a website to book online medical
appointments, or pharmaceuti-
cal refill reminders sent to your
email. That can be difficult for an
older demographic. If they use
tech, they want it to be reliable,
accessible, and above all, easy to
use. So the Cubigo concept is to
simplify all of that. Kind of like a
TV remote control. If you buy a
TV from one manufacturer, a DVR
from another, a Blu-ray player from
a third, you’ve got three different
remotes with a lot of the same
buttons but in a different order.
We make the universal remote, and
we make it especially easy to use.
We’re empowering people to do as
much as they can to control their
own healthcare, at home.
Q: What kind of applications are
supported and enabled by Cubigo?
Geert Houben: We did a large study
to find out what sorts of tools
WE MAKE THE
UNIVERSAL REMOTE,
AND WE MAKE IT
ESPECIALLY EASY
TO USE.
“
“
THE ONE-CLICK GATEWAY
EMPOWERMENT

people needed to stay at home
as long as possible. We found
that the results could be grouped
into three categories: social tools,
comfort services, and security and
care. The social aspect is about
fighting loneliness. People need
to stay in contact with friends and
family. In Cubigo, we have a way
to send messages through the
dashboard that go directly to your
kids’ Facebook, so they don’t have
to have Cubigo to stay in contact.
We also have a tool that lets you
list activities and interests, and it’ll
match you up with other people
in your immediate neighborhood
who have similar interests. So, I
like to play chess, and I can easily
find other people nearby to play
with. There’s a big social aspect to
Cubigo.
Q: And you mentioned comfort
services and security as well?
Geert Houben: Comfort services
are about finding help to do things
that may become more difficult
as you age. So, gardening, for
example, or groceries, or prepar-
ing meals and cleaning house.
We want to make it easy for local
businesses to offer services that
can be ordered online. The third
pillar is security and care. If I fall
down and injure myself, I want to
be able to alert someone easily—
not necessarily emergency services
or the kids, but maybe a neighbor
who can lend a hand. Cubigo can
enable that kind of contact. We’re
also looking at connecting weight
scales, blood pressure monitors,
those kinds of devices. The results
from that monitoring would be
sent to the nurse or doctor, who
can set an appointment if there’s
something concerning, rather than
having patients in once a week if
there’s no need.
Q: Are app creators on board
with having their applications
aggregated in this way?
Geert Houben: Absolutely. Because
in the end, we’re using their
services, bringing them business.
Yes, they have to let go of their
user interface, but they don’t have
to do any extra work. They still
build and distribute their app just
as they normally would, they just
have a new service channel.
Q: What has been the response
so far?
Geert Houben: Very good. We’re
active in Belgium, the Nether-
lands, Spain and the USA. They’re
very different markets because the
healthcare systems are so differ-
ent. In Belgium, for instance, the
federal government is in charge
of healthcare budgets, but in the
Netherlands it’s the municipalities,
so care is more localized. The latter
works really well for our model,
because we can sell the platform
to the municipalities, and they can
ask all the different local provid-
ers to offer their services through
Cubigo. We also work directly with
organizations like assisted living
facilities. So, a facility with, say, 50
apartments can give the platform to
everyone in the building, and they
have a button that calls a nurse,
or they can order their meals, and
things like that.
Q: What has iMinds’ role been?
Geert Houben: They are the
program office for the Flemish Care
Living Labs, which we’re actively
involved in. In the Living Labs we >>

use cohorts and communities of
our users—with their permission, of
course, and following the rules of
the labs—to research new products,
services, new ways of doing care.
Instead of testing these things in a
closed laboratory, in isolation, we
can test them in the real world. The
Flemish Care Living Labs provide a
method for testing whether a good
idea or concept can, in a natural
environment, be converted into a
successful product or service. A lot
of organizations are missing that
step today. Looking ahead, we see
opportunities for iMinds to connect
us with universities and other
academic institutions for further
research. They can match-make
and bring us together with groups
that share our view of the future of
healthcare.
Q: Finally, congratulations on
being accepted into the Google
Blackbox program. How did that
come about?
Geert Houben: We went through
iMinds’ Go Global program in 2013
for help accessing the U.S. market.
That led to our involvement with
Aging2.0, an organization focused
on innovation related to aging. They
invited us to participate in their
global summit as an international
best practice example. They put
forward a shortlist of startups from
their network as candidates for the
Blackbox program, and we were
chosen as the startup from our
sector to participate. We’re proud
of that, and the fact that we’re the
first Flemish company to be invited
into the Blackbox program.
ARISTOCO
Aristoco’s Cubigo software
is an online ‘app’-plat-
form with services that
provide people the tools to
let them live in their own
environment as long and
as comfortably as possible.
Cubes are developed in the
three main pillars: social
contacts (Cubigo Social),
self-care (Cubigo Care) and
comfort (Cubigo Services).
Cubigo lets users choose
which care and services
they need, keeping control
over their own lives as long
as possible.
THE ONE-CLICK GATEWAY
EMPOWERMENT

THE FLEMISH CARE
LIVING LABS PROVIDE
A METHOD FOR TESTING
WHETHER A GOOD IDEA
OR CONCEPT CAN BE
CONVERTED INTO A
SUCCESSFUL PRODUCT
OR SERVICE. A LOT OF
ORGANIZATIONS ARE
MISSING THAT STEP
TODAY.
“
“
GEERT HOUBEN, CEO Aristoco (Cubigo)

VIRTUAL COACHING,
REAL-LIFE RESULTS
With obesity a growing problem in Europe and North America, healthcare professionals
are on the hunt for ways to help people make better choices about food and physical
activity. Under the banner of the iMinds b-SLIM project, a diverse group of partners
are creating a “Super Coach” digital app to help people lose weight — and keep it off.
We spoke to BrandNewHealth researcher DR. STEVEN DE PEUTER and FOUNDER
DR. CLAUDIA PUT about the app and its potential.
CITIZEN
HEALTH
EMPOWER-
MENT
CITIZEN
HEALTH
EMPOWERMENT

Q: Why is weight loss so difficult
for many people?
Steven De Peuter: It’s not so much
losing the weight as it is keeping
it off. You can do a crash diet in a
short period of time and shed some
weight, but it’s very unlikely you’ll
be able to maintain that weight.
Sustainable, healthy weight loss
takes time and continuous effort,
especially for the obese, who
need more time to reach a healthy
weight.
Claudia Put: In the end, success
comes from changing behavior.
That can be tough. Unhealthy habits
can be hard to break, especially
related to diet. For many of us, food
is essential to who we are, what we
do, how we feel. People may use
food for comfort. When you feel
bad, it’s easy to grab a sweet or
salty snack. So breaking that habit
can negatively impact your mood
in the short term.
Q: What will the Super Coach app
offer that other programs don’t?
Steven De Peuter: What sets our
approach apart is that our app
won’t tell the user what to do, it
will give suggestions and advice
on how to change behavior and
self-manage their weight, physical
activity and diet. It’s about creating
unique, personalized plans specific
to the new behaviors the user is
trying to learn.
Claudia Put: We’re essentially
breaking down complex behavior
patterns into smaller, more achiev-
able steps with intermediary goals.
We’re also looking at helping users
plan in advance for what to do
when they encounter a barrier or a
setback. The app provides encour-
agement every step of the way, for
every small change.
Q: How will the application
collect the data used to make the
personalized plans?
Steven De Peuter: A lot of it will be
self-reported. We’re creating both
web-based and mobile versions
for accessibility. When users regis-
ter, they’ll fill out questionnaires for
their most important behaviors,
what they like to eat, how often
they exercise, things like that. We
may also have them identify with >>
“
“
WE’RE LOOKING AT HELPING USERS
PLAN IN ADVANCE FOR WHAT TO DO WHEN
THEY ENCOUNTER A BARRIER OR A SETBACK.
THE APP PROVIDES ENCOURAGEMENT
EVERY STEP OF THE WAY.

a list of barriers: maybe they don’t
like the taste of fruits and vegeta-
bles, for example. And we’ll help
determine what motivates them,
distinguishing between intrinsic
and extrinsic motivators. Intrin-
sic motivators—doing something
because you want to feel better, or
because it’s fun—are much more
effective than extrinsic motivators,
such as doing something because
you have to or to obtain some sort
of reward.
Q: Will the app depend
exclusively on user-based
reporting?
Steven De Peuter: No, we will also
gather objective data. For example,
we’re incorporating an accelerom-
eter that will keep track of physical
activity, and there will be an element
that baselines shopping habits and
tracks changes over the course of
time. One of the interesting things
about the project is that we’ll be
able to compare the self-reported
data with the objective data to see
how accurately people report on
their own behavior. Furthermore,
we’ll be able to investigate whether
objective tracking of physical activ-
ity is necessary for behavior change,
or just nice-to-have. We’ll be doing
this partially through a clinical trial.
Q: What else do you hope to
investigate through the clinical
trial?
Steven De Peuter: We want to better
understand the effectiveness of
digital coaching. We’ll be compar-
ing groups who use only the appli-
cation—without direct contact from
doctors and researchers—and those
who follow more traditional weight
loss approaches, such as meeting
with a dietician or physical activity
coach. We will also do extensive 3D
modeling of the people in the trial
to help them visualize their weight
loss, how their body is changing.
We’re hoping we can develop a
comprehensive model for weight
loss in the obese. It’s not something
that’s really out there. There’s some
literature on different body types,
such as “pear-shaped” or “apple-
shaped,” but we want to add to that
a model specific to the obese.
Q: The project has a number of
partners. What do they each
bring to the table?
WE WANT
TO BETTER
UNDERSTAND THE
EFFECTIVENESS
OF DIGITAL
COACHING.
“
“
VIRTUAL COACHING,
REAL-LIFE RESULTS

Claudia Put: iMinds was essen-
tial to bringing all the partners
together and is providing a lot of
the research. Under the iMinds
umbrella, the iMinds Vision Lab at
the University of Antwerp will work
with the iMinds Medical Imaging
Research Center at the University
of Leuven to help create 3D scans
of users’ faces and bodies. Through
a series of interviews, the iMinds
Center for Usability Research
at the University of Leuven will
research the barriers and difficul-
ties users might face, and will probe
user expectations of a weight loss
application. iMinds-STADIUS at KU
Leuven is working on data analy-
sis, data mining, and predictive and
visual analytics. The University of
Leuven’s Departments of Kinesiol-
ogy and Clinical and Experimental
Endocrinology are taking the lead
on the clinical trial and providing
advice on diet and physical activity.
Q: Outside of research
organizations you also have
industry partners, correct?
Claudia Put: Yes, well, there’s us at
BrandNewHealth, and also YorBody
Belgium, which is providing the
activity tracker and the necessary
algorithms to interpret the data,
and building the project’s database.
The Delhaize Group, which owns a
chain of supermarkets, will help us
create suggested shopping lists
and track users’ shopping habits to
see if the app’s suggestions influ-
ence buying patterns.
Q: How soon do you expect to
launch the app?
Steven De Peuter: We began the
project in April of 2014; the clini-
cal trial begins in October 2015. We
hope to have the application fully
designed by September 2015 at the
latest to have it ready for use by
approximately 100 obese persons
in the clinical trial. iMinds has
assembled such a diverse team with
expertise in different areas, we’re
confident we’ll be able to create
something to address obesity and
support people in confidently,
health-consciously and sustainably
losing weight.
ABOUT B-SLIM
iMinds’ b-SLIM project is
looking to develop a digital
application to monitor diet,
physical activity and motiva-
tion for users hoping to
sustainably lose weight. The
application will integrate
a variety of data streams
and provide tailored advice,
support and sugges-
tions. Read more online:
http://www.iminds.be/en/
projects/2014/03/20/b-slim.
ABOUT BRAND-
NEWHEALTH
BrandNewHealth is a pioneer
in cost-effective digital health
coaching that combines
psychology, health sciences,
ICT and communications to
deliver effective, individual-
ized support to large groups
of people.

CITIZEN
HEALTH
EMPOWERMENT
EVA GEURTS en KARIN CONINX, iMinds - EDM - UHasselt28 | iMinds insights

Q: There are a number of health
and wellness apps that focus on
encouraging and tracking ex-
ercise. What makes this particular
application so potentially useful
to cardiac patients?
Eva Geurts: The technology is
basically familiar to users: a smart-
phone and smartwatch to monitor
heart rate. The difference between
our app and cycling apps for healthy
people is that ours is designed to
put heart patients at ease with the
level of exercise they can safely
perform. People who have suffered
heart attacks need to prioritize
fitness, and many of them do. But
once they leave the rehab facil-
ity—typically after three months of
closely supervised exercise—many
are hesitant to do the work on their
own. They worry they’ll push too
hard or too far and put themselves
at risk. So we end up seeing a lot of
patients undertrain.
Karin Coninx: This is especially true
when it comes to cycling, which is
an excellent exercise for cardiac
patients. In the Limburg area, there
is an extensive network of popular
bike paths that allows people to
define bike tours flexibly. But start-
ing a bike tour can be intimidating
for a patient who’s unsure of his or
her ability complete the full route,
especially when some slopes will
increase the effort required. Our
app can tell a person to slow down,
A HEALTH APP
WITH TRUE HEART
For patients recovering from heart attacks, regular exercise is a critical
part of the rehabilitation process. But once out of the hospital, it can be
hard for patients to stay motivated. That’s why Hasselt University—working
with Jessa Hospital—developed an app that not only encourages exercise
but also gives heart patients the tools to do it safely and effectively. EVA
GEURTS helped create the app as part of her Master’s thesis in informatics.
She and professor DR. KARIN CONINX from iMinds’ Expertise center for
Digital Media (EDM) at UHasselt explained to us how the app could help
save lives.
>>

pick up the pace, and even suggests
adapted support for people riding
e-bikes. It’s all about building confi-
dence for users. Part of that confi-
dence comes, I think too, from the
fact that this app has been devel-
oped collaboratively by a hospital—
it’s not just coming out of the app
development space. There’s solid
healthcare expertise behind it.
Q: Why bicycling?
Karin Coninx: A lot of exercise
apps focus on walking, often using
pedometers or accelerometers to
register steps and activity. But many
people prefer biking, especially
elderly patients. We want to make
it easier for patients to engage in
a wide variety of exercises so they
can suit their mood on any given
day.
Q: What challenges did you face
in developing the app?
Eva Geurts: Most fitness apps are
designed for healthy people only.
Ours is designed for those who
have been ill—who have heart
disease and are rehabilitating—
and for healthy persons who want
to consciously prevent health
risk factors and engage in physi-
PART OF
THE CONFIDENCE
COMES FROM THE
FACT THAT THIS APP
HAS BEEN DEVELOPED
COLLABORATIVELY
BY A HOSPITAL.
“
“
A HEALTH APP
WITH TRUE HEART

cal exercise. So we needed to be
able to offer specific, personal-
ized suggestions to guide people’s
physical efforts that wouldn’t exist
with a typical fitness app.
Q: That raises an interesting
question. How does the app de-
termine a safe heart rate?
Eva Geurts: It’s completely person-
alized. Every patient goes through
a physical exam guided by the
medical team at the rehabilita-
tion center, and that data is used
to create the parameters for their
exercise. The patient knows their
data is specific to their needs, their
program and their bodies, which
gives an added level of confidence.
Q: What other challenges did you
face?
Karin Coninx: I would say a second
challenge had to do with the general
user experience. That relates to the
research interests of EDM. Making
sure anyone in the general public
could use this tool introduces some
very practical considerations. For
example, because the app is used
while cycling, we put a lot of thought
into readability and clear presenta-
tion of information. The screen has
to be readable in a glance to avoid
distracting the cyclist from the
environment. We also focused on
unobtrusive data collection. That’s
why we use a smartwatch rather
than a chest strap to measure
heart rate. Furthermore, the user
should not be bothered with techni-
cal details, and the watch and the
smartphone connect automatically
through the app to exchange data.
Besides heart rate, other data such
as burned calories and distance are
collected or calculated. Then you
have to show the relevant informa-
tion to the patient in a really clear
way.
Q: Outside of monitoring health
and exertion, what else does the
app do?
Eva Geurts: It actually comes
pre-loaded with local bicycle routes,
paths and tours. We’ve included
recommended stops and places to
recharge electric bikes. Users can
create their own paths by linking
stops together, or we can suggest
new routes based on their level of
fitness and how they’re progressing
in the rehabilitation program. We’re
also able to vary routes based on
how long the user wants to bike or
how far. We want to make the train-
ing effort as pleasant as possible.
Karin Coninx: We’re currently
working with a graphic designer in
our human-computer interaction
group to ensure the user interface is
not only easy to use but also graph-
ically appealing and fun. It’s not
gamification we’re looking for, but
it needs to be playful, a pleasure to
use—again, it’s all about encourag-
ing people to exercise safely.
Q: The app clearly has a lot of
benefits for patients. What about
caregivers and health workers?
Karin Coninx: That’s the next
step. We’re currently working on
the caregiver side: a caregiver
dashboard that will allow us to feed
the app with the patient’s individ-
ual training parameters, analyze
data collected by the app, and use
the resulting insights to design
future exercises. For caregivers, it
is very important to have a concise
overview of data from several
patients at the same time, and to
be able to integrate this into daily
practice at the rehab center.
Q: Where does the app stand
now?
Eva Geurts: We’ve done a number
of trials with healthy users and >>

some patients, and the response
has been great. When testing with
more patients, the challenge is
to generate credible evidence of
value from using the app that will
prove the nature and magnitude of
behavioral changes among people
using the app.
Q: Will the app have a market
beyond heart patients?
Karin Coninx: We’re really inter-
ested in broadening the user
base. Currently, we’re focused on
rehabilitation. But when it comes
to cardiac patients, rehabilitation
is very close to prevention. You’re
trying to avoid a second heart
attack, which is very close to using
the app in a preventive way for
either patients or healthy persons.
So this kind of application would
be useful for heart patients, people
with diabetes, the obese, or people
simply trying to lose weight and
stay healthy. Since the basic infra-
structure and interface is already
designed, it’s really flexible, and we
can see that it can be used by a lot
of different people. Not only is that
good for the user but it’s also good
for us, since a broad user base can
help secure financing for further
development and possibly to move
into the commercial marketplace.
ABOUT IMINDS -
EDM - UHASSELT
The Expertise center for
Digital Media (EDM) is
the ICT research institute
of Hasselt University and
part of the iMinds research
community. EDM performs
research in computer science
since 1987. Research focuses
on two core competences:
‘Visual Computing’ and
‘Human-Computer Interac-
tion’. EDM is active in the full
range of the research contin-
uum: from fundamental to
basic and applied research
as well as contract R&D.
EDM’s key objective is to be
a leading research institute in
human-computer interaction,
computer graphics, multime-
dia networking, computer
vision and virtual environ-
ments..
A HEALTH APP
WITH TRUE HEART

CURRENTLY,
WE’RE FOCUSED ON
REHABILITATION. BUT
WHEN IT COMES TO
CARDIAC PATIENTS,
REHABILITATION
IS VERY CLOSE TO
PREVENTION.
“
“
KARIN CONINX, iMinds - EDM - UHasselt

Remote monitoring streamlines healthcare
by allowing practitioners to collect data from
patients without requiring visits to the office or
the hospital. The ubiquity of smartphones and
other connected consumer technologies like
pedometers and accelerometers means practi-
tioners have more potential data sources to draw
from than ever before, helping bring context to
more traditional data from pacemakers, glucose
meters and the like.
Dr. Pieter Vandervoort,
cardiologist at Ziekenhuis Oost-Limburg
CITIZEN
HEALTH
EMPOWERMENT

Q: What, in a nutshell, is NEMO?
Dr. Pieter Vandervoort: NEMO
pulls together remote monitoring
data from different vendors and
devices, analyzes it, and presents
it through a single dashboard for
clinical use.
Q: What’s driving the need for
this kind of solution?
Dr. Pieter Vandervoort: Just
imagine: I do remote monitoring
with more than 600 patients, a
majority of whom have advanced
heart failure. All of them have
implanted devices like resynchro-
nization-pacemakers or defibrilla-
tors, made by four or five differ-
ent vendors. That means different
data standards, databases, proto-
cols and algorithms. Many of
these patients are also using other
devices such as blood pressure
monitors, weight scales and
activity trackers, whose informa-
tion is processed using different
visualization tools and presented
on different websites. If I have a
single patient with four devices,
I have to open up four different
websites and sift through informa-
tion that’s all displayed differently.
It’s complex, cumbersome, and
time-consuming. Instead of going
to four different websites, why not
just have all your clinical data come
to one place?
Q: What kinds of data will NEMO
aggregate?
Dr. Pieter Vandervoort: We’re
looking at integrating data not only
from clinical devices but also from
consumer products, such as smart-
phones, smartwatches or activity
trackers like Withings, FitBit or the
Nike FuelBand. The ultimate goal
SMART DEVICES FOR
SMARTER MONITORING
iMinds’ neutral mobile health platform (NEMO) project in Limburg is looking
at creating a platform to collect, analyze and display remote monitoring
information from a wide variety of technologies and products. We spoke to
the project’s initiator, DR. PIETER VANDERVOORT—cardiologist at Zieken-
huis Oost Limburg, Genk and co-chairman Mobile Health Unit at UHasselt—
about how NEMO may help reinvent remote monitoring.
>>

is to combine data from clinical
and consumer devices and make
them both clinically relevant. It’s
all about context, about getting a
fuller picture of the patient.
Q: Can you give an example of
how that might work?
Dr. Pieter Vandervoort: Consider
a patient with a pacemaker. That
pacemaker can give you informa-
tion about the patient’s heartbeat,
but it can’t tell you what they’re
doing at any given time. An activ-
ity meter like an accelerometer
can do that, and can put the heart
rate into context. If the heart rate
is rising, it makes a difference
whether the person is biking or
sitting on a couch watching televi-
sion. People’s glucose measure-
ments also might take on different
meanings if we could relate them
to their activities during the day.
Bringing in a wealth of data from
a variety of sensors and looking at
it together—you’re going to see a
lot of relations that you might not
otherwise notice. One plus one is
going to be more than two, in this
case. That’s the kind of thing that’s
going to be possible with this type
of platform.
Q: What other benefits do you
envision?
Dr. Pieter Vandervoort: NEMO will
facilitate remote monitoring in
clinical practice, for sure, making
it easier for healthcare providers,
family physicians, nurses, home
care providers, all these people
to find and interpret data that’s
collected outside of the doctor’s
office or the hospital. It’s also
better for the patient. People take
an interest in their own health,
right? That’s why they buy the
types of consumer devices we’re
talking about. So NEMO will make
it easier for patients to look at a
single picture with all of their data
in context and make decisions and
adjustments about their activity or
behavior in real time.
There could also be benefits for
primary prevention. If we can
track a large number of patients
with different activity sensors—
and have all the data in the same
place—we could really show the
impact of certain activities on a
simple parameter, such as weight.
We know that if we decrease the
weight of a population in an area
by one kilogram, for example,
then we’ll have fewer patients
with diabetes, hypertension, heart
disease, strokes, et cetera. It will
help us really show benefits at the
population level.
Q: How far along are you in the
NEMO project—and what is
iMinds’ role?
Dr. Pieter Vandervoort: We’re still in
the conceptual stages. We’ve done
a lot of preliminary research into
visualizing different data sources,
and have worked on the analyzing
software, combining glucose meter
data with blood pressure and
accelerometer data. These are all
different parts of what will eventu-
ally be NEMO, but NEMO itself is
just at the beginning. iMinds Health
has just started, and what they’re
doing is really bringing all this
research and clinical experience
together into one place, facilitating
the collaboration between hospi-
tals and Hasselt University. As well
as helping us find the funding to
take NEMO to the next level.
Q: What are the key research
challenges you face at the
moment?
Dr. Pieter Vandervoort: There are
technical challenges, certainly, with
different transfer protocols and data
collection methods. But these will
be solved. Improvements in wi-fi, in
3G and 4G availability, in data trans-
SMART DEVICES FOR
SMARTER MONITORING

fer protocols will deal with those
issues. In the four or five years in
which we’ve been actively monitor-
ing patients remotely, we’ve seen
enormous progress on the technical
front for devices like pacemakers, for
example. So I’m not too concerned
about that. We do have challenges
when it comes to data identification
and privacy, however.
Q: What would those be?
Dr. Pieter Vandervoort: With
something like a pacemaker, there’s
no question about which patient
a set of remote monitoring data
pertains to. But say we’re collect-
ing information from a smart-
phone, or a wireless scale. We
technically don’t know who’s using
the device—someone could have
lent their spouse their phone, let’s
say. Then there’s the issue of data
privacy, which is a big concern. We
want to make sure the data can
only be accessed by people with
a therapeutic relationship with the
patient. That’s also a concern for
the device manufacturers. There’s
no way a pacemaker manufacturer
is going to allow their data to be
collected on a platform that’s run
by a competitor, for example. That’s
why our platform is going to be
vendor independent, “neutral,” as
we call it. We sign a generic agree-
ment with manufacturers spelling
out the rules of exchange — for the
project specifically.
Q: What sort of response do you
anticipate once NEMO is ready to
roll out?
Dr. Pieter Vandervoort: I think
the benefits of the project will
be clear. Uptake might be diffi-
cult at first because of reimburse-
ment issues. Currently in Belgium
and most of Europe—even in the
U.S.—doctors are paid through
insurance only if there’s a physical
encounter with a patient. There’s
no real reimbursement option for
remote monitoring and follow up.
That might limit clinical use in the
immediate future. But as technol-
ogy changes, it invariably pushes
policy forward, and governments
and insurance companies will have
to follow. I hope NEMO can be part
of that evolution, that we can start
with a small group of believers and
champions and prove the concept
works for patients and practi-
tioners, then move on to convince
insurance companies and govern-
ments to change the system.
ABOUT NEMO
iMinds’ neutral mobile health
platform (NEMO) provides
a single view of remote
monitoring data originating
from both ‘traditional’ medical
devices (such as pacemakers
and glucose meters) as well
as consumer devices (such
as smartphones equipped
with pedometers and accel-
erometers). The concept is
being tested, validated and
integrated in the workflow of
partner hospitals, with initial
experiments expected for the
third quarter of 2015.

BIRGIT MORLION
Program Director
iMinds Health
LIST OF CONTRIBUTORS
TO THIS PAPER:
ANN ACKAERT
Post-Doctoral Researcher
iMinds - IBCN - UGent
JAN AERTS
Assistant Professor
iMinds - STADIUS - KU Leuven
LAURA BELENGUER QUEROL
Director Strategy & Innovation
iMinds Medical Information Technolo-
gies Department
KARIN CONINX
Professor iMinds - EDM - UHasselt
STEVEN DE PEUTER
Researcher BrandNewHealth
EVA GEURTS
Researcher iMinds - EDM - UHasselt
GEERT HOUBEN
CEO Aristoco (Cubigo)
AN JACOBS
Professor iMinds - SMIT - VUB
LIEVEN MAESSCHALCK
Founder, Physical Therapist
Move to Cure
BIRGIT MORLION
Program Director iMinds Health
CLAUDIA PUT
CEO BrandNewHealth
KARIN SLEGERS
Assistant Professor
iMinds - CUO - KU Leuven
ERIC VAN DER HULST
Program Manager iMinds Health
PIETER VANDERVOORT
Cardiologist Ziekenhuis Oost Limburg
FREDERIC VANNIEUWENBORG
Doctoral Researcher
iMinds - IBCN - UGent
JAN VAN OOTEGHEM
Researcher iMinds - IBCN - UGent
ANTON VEDDER
Professor iMinds - ICRI - KU Leuven
GRIET VERHENNEMAN
Researcher iMinds - ICRI - KU Leuven
iMinds Insights editorial team: Sven De Cleyn, Koen De Vos, Thomas Kallstenius, Els Van
Bruystegem, Wim Van Daele, Stefan Vermeulen
Copy: Ascribe Communications
Design: Coming-Soon.be
Photography: Lieven Dirckx, Nils Blanckaert
©2015 iMinds vzw - CC-BY 4.0. You are free to share and adapt the content in this
publication with reference to iMinds.
Additional content will be published on www.iminds.be/insights
FOR MORE INFORMATION
about iMinds’ collaboration with the health sector,
please contact Birgit Morlion,
birgit.morlion@iminds.be, +32 9 331 48 08

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