The patient as the focal point in ICT: the Madonna Project.

The Madonna Program, "A Web-based, patient-centred, protocol-driven, interhospital collaboration project for Woman's Health using an interactive intelligent web portal" is a new care initiative that recently, in the context of the interdepartmental action program 'Social sectors and ICT', received financial support from the Dutch Ministry of Health, Welfare and Sport.
The aim of the Madonna Program is to develop and realize a more efficient and cost-saving system of health care with the aid of ICT applications and -services for both the citizen and the patient in the field of obstetrics and gynaecology (in the Amsterdam-West region).
The project originated on the work floor, mainly from the dissatisfaction of gynaecologists and their patients with the current diagnostics and therapeutic state of affairs in the health care chain. Madonna is symbolic for "mother and child", but also for the "emancipated woman of today". The most important characteristics of Madonna are:

- The patient is the focal point (demand-based health care, the care chain is reversed)
- Optimal care takes place within a regional network of cooperating hospitals (transmural Diagnosis Treatment Protocol (DTP) and Electronic Patient Dossier (EPD) are then necessary elements).
- The designed care paths are based on existing treatment protocols ('evidence-based health care').

Demand-based health care with the use of ICT applications and services is still rarely used. Madonna is based on an intelligent, interactive front office (the Madonna portal), linked to various back offices. The initiative was taken by gynaecologists from the VU Medical Centre and the St Lucas Andreas Hospital in Amsterdam-West, with the strong support of the boards of directors of both hospitals.
Other partners within the collaborative venture are:

- the Dutch Patients Consumers Federation [Nederlandse Patiënten Consumenten Federatie (NPCF)],
- the National ICT Institute for Health Care [Nationaal ICT instituut voor Zorg (NICTIZ)],
- the Electronic Health Care Dossier Amsterdam Foundation [Stichting Elektronisch Zorgdossier Amsterdam (EZDA)],
- Agis Health Insurance [Agis Zorgverzekeringen], and
- Microsoft.

On the basis of a number of preliminary studies, a concept for integrated regional health care was developed, a number of elements of which have already been partly implemented. The ICT services concept will be further developed within the Madonna Program, whereby the patient logistics within the region will be further streamlined. By making use in an innovative manner of ICT work is on-going on the creation of a single virtual front counter, in the form of an interactive intelligent web portal that provides access to health care in Amsterdam West. Via this web portal the client (citizen or patient) and professionals (such as the family doctor and midwife) can find answers to questions, triage and referral can take place in the domain of gynaecology and obstetrics. The portal allows information to be obtained via digital interaction and an appointment can be made with the right specialised outpatients clinic. Moreover the patient in this way also contributes herself to creating her own electronic dossier. The data only have to be recorded unambiguously once, and the data can be accessed at all times by all medical staff concerned and by the patient independently of the time and the location of the patient.

Hereby attention will be paid specifically to the highest national standards for security, identification and authorization. The Madonna Program is expected to lead, among other things, to shorter waiting times, short treatment trajectories, a reduction in the costs of health care and a more rapid return to work for those people involved in employment. This was confirmed by means of a simulation study conducted by TU Delft. Simplified collaboration between regional hospitals must lead to a better division of tasks on the basis of available expertise and health care capacity.
The program should lead to the development of new standards (for ICT and logistics) and to a new, healthy financing model for health care chains using ICT. The ultimate goal of Madonna is to optimize patient logistics and knowledge management, with the aim of achieving affordable, but high quality patient care, education, training and research.  

Amsterdam, november 2006
Prof. Dr.Peter Kenemans, Professor of Obstetrics and Gynaecology, VU Medical Centre, Amsterdam.