How the COVID-19 pandemic reveals the digital immaturity of the German healthcare system

The current crisis is culminating in the lack of digitalization in the German healthcare system. This system is slowly reaching its capacity limits in view of the current situation. Exhausted and understaffed hospital staff are fighting COVID-19 in harsh conditions, while there is a lack of digital solutions that could really relieve our health sector and hospital staff by using efficient tools. Solutions such as those that map the capacity utilization of individual hospitals and provide intelligent suggestions for the distribution of sick patients. Or a digital listing of hospital equipment such as respirators, beds and medication supply. Only if these hospital supplies were connected digitally the unused potential could be identified and redistributed to where it is really needed. Therefore we stress the necessity to create digital solutions to relieve hospital staff to avoid situations like we are currently experiencing in possible further pandemics.

While other European countries such as Estonia are pioneers in digital healthcare, Germany is lagging behind. The German Health Minister Jens Spahn has passed significant legislation and emphasized the importance of digitizing the healthcare system within the last two years, but there is still a lack of effective and comprehensive implementation. The health sector is currently missing an effective strategy, political leadership and a special institution at the national level for a successful digital transformation in the healthcare system.

What do other countries have ahead of us?
In Israel, physicians are systematically using artificial intelligence, for example in cancer screening. Prescriptions are also transmitted digitally and important patient health data is stored in electronic files — doctors and hospitals can access them directly. In Estonia and Denmark, all citizens can view the results of their examinations, medication plans or vaccination data online. They can manage access options for doctors and other healthcare professionals themselves. In Israel and Canada, remote diagnosis and remote treatment via video are a natural part of health care.

In Germany Telemedicine, in particular, is experiencing a boom in the context of the current corona crisis. Companies such as Kry or Teleclinic offer their services free of charge in risk areas such as Heinsberg in North Rhine-Westphalia. Via video chat with doctors, patients can describe their symptoms and thus relieve the burden on doctors’ practices and hospitals. Unfortunately, however, this is currently the only noteworthy digital innovation.

The Estonian e-health system is amongst the world’s most ambitious and an extraordinary example of why this small EU country is popularly praised as one of the most advanced digital nations worldwide. Why is that? More than 95% of the data generated by hospitals and doctors have been digitized, and citizens have access to their own medical records, prescriptions, as well as health professionals. The system strives to improve cost-effectiveness, sustainability and the overall efficiency of the Estonian healthcare system. Estonia communicates clearly to transition from merely curative medicine to a preventive and value-based healthcare approach while at the same time also creating the necessary technological infrastructure to do so. Political decrees pave the way for the use of blockchain technologists to ensure that sensitive patient data is adequately protected for networked healthcare.

A direct outcome of this infrastructure and decision making is e.g. the connection of e-ambulance transport with the e-health system. Before paramedics set off on their way to the sick person, they can view all relevant health data online. This saves doctors valuable time that is better spent on effective treatment on the scene. Another example is the drug interaction and counter’s indication support software which is connected to the e-prescription database and aims to eliminate incorrect prescriptions based on a lack of doctors’ knowledge of the patient. In case a prescription interacts with other medicine the patient is currently taking, the system alarms doctors automatically.

With regard to the Corona pandemic, it is not surprising how Estonia is handling the COVID-19 crisis. Within a week, the number of corona cases in Estonia has risen to 135. The Minister of Trade, Kaimar Karu, has directly understood the dramatic situation with its impact on the economy and has launched a national appeal: “Use this crisis to emerge stronger.”

The next morning at 9:30 am, the Estonian startup community suggested the “Hack the Crisis” concept. A hackathon, where digital solutions will be developed to help in the fight against the virus. By 10:00 AM Minister Karu endorsed the concept and set everyone to action and launched the hackathon at 4:30 pm. Within 90 minutes, over 650 people had posted 80 ideas for consideration. By Sunday- two days later- there were 1,000 people participating and 30 teams working on solutions. The dynamic and determination to implement such concepts quickly are unprecedented.

Here are the top five ideas that evolved from the Estonian Hackathon:
1. Zelos — connecting people at risk with volunteers via call center
2. Ventit — breathing apparatus for people who develop acute respiratory distress syndrome
3. Vanemuine — a medical volunteer management database
4. Share Force One — a workforce sharing platform that connects B2B sides for temporary workforce exchange
5. Velmio — a corona-tracker to self-monitor one’s risk or recovery from home in real-time

Of course, Estonia’s digital transformation of all government services over the past five years puts the country in a more upright position to operate this crisis. But we need to change our mindset now and start creating an infrastructure where it is even possible to create compelling digital health tools and systems.

The Federal Government must understand that a networked and digital healthcare system is the only solution for a sustainable and efficient healthcare system.

This understanding needs to be communicated from policymakers to society while at the same time creating the necessary technological infrastructure to enable the deployment of digital health solutions.

Data protectionists need to create laws that ensure that sensitive patient data is appropriately protected with technological solutions such as Blockchain.

Laws such as the “Digitale Versorgungsgesetz” (Digital Supply Act) must be optimized to accommodate the development of digital solutions and not to discourage it.

Attractive incentives must be created for the development of digital solutions in the healthcare sector and access to doctors, hospitals and research facilities must be a matter of course.

Digital measures must be designed so that they are applicable to all age groups. So far, the introduction of new technologies is often viewed skeptically, especially for older patients.

Patients must have full access to their health data, be adequately informed and involved in the decision-making.

Similar pandemics such as COVID-19 could be predicted if there were a comprehensive digital network that could intelligently interpret and predict large amounts of data from the health system — the goal should be to be able to make such interpretations and predictions globally.

If we manage to implement these points successfully, we can reduce catastrophic conditions such as those we are experiencing now in hospitals in the event of future pandemics. We at medudoc are working ambitiously towards equipping doctors rather sooner than later with the necessary digital tools to help them concentrate completely on treating patients.

Sources:

https://www.siliconrepublic.com/start-ups/estonian-hackathon-covid19-coronavirus-solutions

https://www.forbes.com/sites/robertwolcott/2020/03/15/hack-the-crisis-6-lessons-from-estonias-coronavirus-crisis-response/

https://www.healtheuropa.eu/estonian-e-health-system/89750/

https://www.bertelsmann-stiftung.de/de/themen/aktuelle-meldungen/2018/november/digitale-gesundheit-deutschland-hinkt-hinterher/