Healthcare of the future

The advancement of digitization is the central prerequisite for the successful further development of our healthcare. Apps, for example, are already helping to record and evaluate health data. And a large part of the medical profession is currently already offering assistance via the Internet. These are just two examples that illustrate the opportunities that digitization offers for the German healthcare system. Read the following interview with Sebastian Hilke, head of the ZD.B Digital Health and Medicine theme platform at Bayern Innovativ, to discover even more exciting digital healthcare technologies.

I recently read about the electronic patient file (ePA). What is that for a file?

Sebastian Hilke: The electronic patient file is provided since 01.01.2021 to each legally insured person by the respective health insurance. The use of the electronic patient file is voluntary. Since July of this year, all contract physicians and psychotherapists should be able to write all treatment data and diagnoses in there, but also read them. However, this will probably not be fully functional until the beginning of 2021, as there are currently still a number of technical issues missing. The ePA is not offered at present for privately insured ones yet, because the private health insurances are not here yet with it.

Which data come into the electronic patient file purely - and above all, how?

Sebastian Hilke: The idea is that there all health data are stored, which result with a physician attendance, in the hospital, with the Physiotherapeuten or in similar mechanisms. This could be, for example, blood values from the last blood test, the result of an ultrasound examination or the current medication schedule. In addition, each person also has the option of independently storing information in his or her own file. For example, a doctor's letter can be scanned and saved to document it there. It is then also clearly marked that this document was not filed by the doctor. Another interesting and important point is the individual emergency record. This is information for the rescue service. If the injured person is no longer responsive in an accident, for example, the relevant data (such as incompatibilities, blood group, etc.) can be viewed here without requiring the person's cooperation.

Such data is very sensitive. Is it also secure?

Sebastian Hilke: Basically, all data is encrypted. Only the respective person himself or those to whom one releases the data himself can access this information. In this way, everyone always has control over their own data and can make it available to medical professionals or other service providers (e.g., physical or occupational therapists, psychotherapists, obstetricians). To check and actively manage this, there is a smartphone app offered by the respective health insurance company. When visiting the practice, the electronic health card is inserted into the card reader as usual. The only change is that you now still have to enter a personal identification number (PIN) to identify yourself as the right person. But the practice must also provide appropriate identification and prove that they are registered physicians. Their electronic health professional ID card also makes it possible to track who has retrieved which data and when, and entered it in the file. This is a well thought-out system with good logging of access. The electronic patient file will continue to be developed in terms of security in the coming years, so that it is always up to date.

Will the data be automatically transferred to the file at every visit to the doctor?

Sebastian Hilke: The idea behind this is that all the data that accumulates somewhere is collected there, resulting in a complete overview. This happens automatically as soon as you put the card in the terminal in the practice and confirm with the PIN. The use of the electronic patient file is also possible for people who are not familiar with a smartphone or tablet or do not have one - the respective health insurance company helps in these cases.

Do I have other advantages as a patient?

Sebastian Hilke: In addition to the already mentioned emergency data set, for appropriate security in emergency care, all health data are bundled in one place. Thus, the medical staff can get a better overview of which pre-existing conditions, examinations and diagnoses are available, which in turn avoids duplicate examinations, such as repeated X-rays.
The previously mentioned medication plan also represents an important function. This is because the medication and the instructions for taking it are noted there. This gives everyone involved in the treatment an overview of which medications have already been prescribed. It can therefore no longer happen that a drug is prescribed that has potential, perhaps even fatal, interactions or side effects in connection with other drugs.

Are practices in private practice prepared for this digital challenge at all?

Sebastian Hilke: On average, it takes 7.6 minutes per person. Basically, however, it is easier and faster to get an overview in the future through an electronic digital patient file, it is yes all relevant data stored, such as the vaccination card or maternity record. You know it from yourself: Sitting in the treatment room, feeling unwell, being asked about previous illnesses or examinations that you may not remember at that moment. But when all the information is stored in a central location, the quality of treatment increases due to better access to data, and thus there is a greater advantage over effort. Practices have also actually been well prepared for the electronic health record issue for a number of years because they are required to submit all of their billing digitally. The ePA is an issue that has been with us for over a decade. So I don't think this comes as a surprise. For the technical implementation, practices need a so-called connector in addition to the classic card terminals (which every practice has anyway). You can think of it as a highly secure router - the router at home that also connects us to the Internet. This is a very secure, encrypted connection. It's also all separated from each other and doesn't run over the normal Internet to make a hacker attack as unlikely as possible.

Is it foreseeable that there will be even more digital solutions in the future?

Sebastian Hilke: The vaccination and maternity passports are to be digitized, as are the dental bonus and the child examination booklet. So everything we know in analog paper form will then also be digitized and filed. In addition, other service providers, such as obstetricians or physiotherapists and occupational therapists, will also be connected to the system. In the future, nursing will also be able to work with the electronic file and read out and enter data there. What has already existed since the fall of 2021 is electronic work incapacity certificates. This means that the practices can transmit the diagnosed incapacity to work directly to the health insurance company. From mid-2022, companies will also be able to call up the incapacity to work from their employees' health insurers. This will save the sick person having to send the sick notes by post. Another digital alternative will also be available for prescriptions. The e-prescription will soon replace the previously known paper prescription. On 01.01.2022, it is to come nationwide, but one must wait and see whether the deadline can be met. Additionally, there are the digital health apps (DiGA) . These "health apps" are prescribed like medicines by prescription.

How can I imagine that with a prescribed app?

Sebastian Hilke: These are mostly apps for smartphones, but also applications for at home on the computer, which are intended to help you cope with, for example, knee pain, depression or cancer. The functions vary, e.g. it can be a therapy plan with exercises, possibly also with observation via the video function for correct execution. But it can also be psychotherapeutic exercises to help sufferers cope with depression. Or it could be a kind of diary in which diabetics write down their blood glucose levels and monitor them continuously. In parallel, there will also be digital care applications next year. We will then have both digital health and care apps.

Such apps have existed for some time. And there are, after all, fitness apps. Why are just these paid by the health insurance and the others not?

Sebastian Hilke: These apps have gone through an elaborate process: clinical studies have been made and they are safety tested. Thus, they complete a similar elaborate process as drugs. The apps have to show in the studies that they work, that there is a corresponding benefit and that they achieve a therapeutic effect. That means you really know that these apps add value to treatment. In the future, these digital health applications will also be connected to the electronic patient record, so that the data can also flow back and forth there.

But what about accessibility with all these electronic applications?

Sebastian Hilke: Well, with the electronic patient record, I can at least already say that the applications are basically created barrier-free. There is a connection with the smartphone operating systems and thus the functions are usable, which are there, such as the screen reading, but also the touch feedback. The latter means that the phone vibrates as soon as you press somewhere on it, and so it indicates which things are usable. It gets a bit more difficult with the documents that can be in the ePA. These are sometimes simply scanned PDFs and thus lack the necessary text information for the system to recognize. This means that accessibility is no longer a given. But everything that is in the file in terms of structured data and will also be in the future in terms of entries is accessible.

This all sounds very practical, convenient and flexible. Will you still see your doctor like this in the future?

Sebastian Hilke: In my opinion, we will continue to have personal contact with the doctor and the other service providers. Because they can't do everything digitally. In addition, it is important to understand that a digital application should be a support. It helps to have the relevant data available at all times, so that, for example, smaller consultations can be made virtually. Video consultations have been around for some time, but they too are only a digital supplement. Digital applications should not replace personal contact. Ideally, however, these will make treatment even better, more efficient and more pleasant for all of us.

The interview was conducted by Dr. Petra Blumenroth, Project Manager Technology I Frugal Innovation at Bayern Innovativ GmbH.