She was Chief Medical Information Officer for the Dutch Ministry of Health, Welfare and Sports and was recently appointed a board member on ZonMw, the Dutch national organisation for health research and healthcare innovation.
When Amsterdam UMC announced her latest appointment to ZonMw, it said she fulfilled “the profile of a leading clinical scientific researcher who is active in a broader field than her own and a figurehead with insight into knowledge and research agendas in the broad field of healthcare”. This assessment is unsurprising when you consider her academic background spans medicine and design.
During a brief gap between back-to-back meetings, the highly sought after Professor explained: “I’m a hybrid surgeon. When I finished high school, I went to the Design Academy in Eindhoven for a year. Although I did well, I wasn’t the most brilliant kid there so I decided to make a change and went on to take degrees in Health Science and Medicine. They may seem different but really all my studies centred on solving problems in society.
As the lead on E-health at her hospital, Marlies’ expertise was in huge demand when Covid-19 hit and Amsterdam UMC’s 10,000-plus employees had to transition to carrying out consultations with patients via video in just two weeks.
“We had to think about how to achieve that. Challenges like this are where technology, design and healthcare meet and because I’m able to think across boundaries it helps me to identify how hospitals can successfully use new technologies,” Marlies said.
Increasingly, over the past 10 years Marlies has found more and more of her colleagues have become enthusiastic about embracing the opportunities that new technologies are offering surgeons and medical students.
She said: “The old adage used to be big surgeon, big cut. Now if you’re a proficient abdominal surgeon you use little cuts. You use laparoscopy or robotic technology.
“A lot of technology has entered the operating room – indeed there’s so much technology in the OR that it can be hard for a surgeon to master it all. However, technology presents us with so many opportunities inside and outside the operating room.
“For example, when it comes to training, we have limited access to operating rooms and a shortage of people because of post-pandemic issues but also increased demands related to patient safety. We cannot train our residents to the standards we need to in the actual workplace so it makes sense to use simulation or serious gaming to address that problem.”
Currently, Marlies is working on another exciting research project to discover if technology can be used to help patients manage pain. The Digital Pain project was launched to help hospital patients who need wounds dressing as the painful process often makes patients fearful of their wound care, which increases their pain further. To tackle the problem, Marlies and her colleagues are studying whether virtual reality environments can be used to help patients while their wounds are dressed, and how to do that best.
She said: “We’ve started immersing patients in virtual reality environments so they’re distracted and the time it takes to take care of their wounds becomes shorter in their memory. As a result, they may need less pain medication.
“We’re studying which virtual reality situations relax patients the most because we want to discover whether it’s better for us or the patients to select which virtual reality situation is used. For example, I like pop music much more than classical music but my brain becomes more tranquil when I listen to Bach than when I listen to Madonna. It doesn’t necessarily follow that someone’s preference provides the best solution so research in this area is really exciting.”
Marlies says one of the biggest challenges with introducing new technologies to hospitals and operating rooms are the questions that arise in relation to privacy, ethics and logistics.
Proponents of new technologies need to ensure they are CE marked, may be properly sanitised and are robust enough for nurses and doctors to use regularly. They also need to address who will be held responsible if a piece of expensive technology is damaged or stolen and if a piece of technology might breach patient privacy.
“We now use ‘Black Boxes’ in operating rooms to generate comprehensive output files of surgical procedures, so we can do a team de-brief but that raises questions about privacy,” said Marlies. “We scramble faces and alter voices, but we have to consider whether we need patient consent or just an opt-out option for them, when the objective is to improve processes in the OR instead of direct patient care.
“Another huge area for hospitals at the moment is how we use technology to provide care at a distance through teleconsultations and remote monitoring. We need to consider whether patients are using monitoring technology correctly at home, how we get that information into patient health records and how it is used. Realistically, it is too costly and most likely, also non-informative, to add all outpatient data recorded at home into hospital files, so you need to start looking at subsets and how the information that is entered into patient files is used."
“For instance, if a patient is having their health monitored remotely and they have a stroke at night that information will go into their files if there is a patent coupling of data. But data landing in an electronic health record is not automatically going to set off an alarm in the hospital. We need to think about these scenarios because as far as the patient is concerned, they’re being monitored and they feel protected.”
Marlies also feels it is time that we have a societal debate about the use of technology in hospital and patients’ rights to privacy to give the public a better understanding of the difficulties that hospitals face when it comes to implementing new technologies.
She said: “In terms of technology lots of things are possible. The question is how do we fit technology into the existing infrastructure of our hospitals?"
“People think about all the things they can do online in their daily lives and they don’t understand why hospitals can’t do the same thing. They’re not wrong in their wish but it can be difficult for us to explain that we are bound by old rules and regulations about privacy and safety."
“People may want to sacrifice their privacy also to make processes run smoother in the hospital. But we are governing that by default, their privacy concerning health data is protected. That is in essence a good thing of course, but why do we not inform the public in more detail about the possible risks, so they can make a calculated decision themselves about what personal health data they want to share, and for what purpose? And, between health care providers and institutions, should we not enable a default ‘share all’ behind a good security layer if the patient wants this?"
“Personally, I don’t really care if someone knows what my blood type is any more than if they know that I like a particular type of granola – it doesn’t represent a threat to me. However, it can be a tricky balance because the moment you want to buy a house and an insurance company discovers you’re on a list of 10 medications you can’t get your mortgage cheap because of your risk factor."
“This type of information can be misused if purpose-binding of sharing and with whom it is shared is not clear; whereas the type of granola you eat, to my latest knowledge, can’t be used against you.”
