Digitization and the new opportunities it brings to the healthcare sector

Is it already too late for the digitization of healthcare? How does Germany compare to other countries in this setting? What opportunities and threats does big data involve? And why could uniform digital patient care lead to unimagined success, especially when it comes to the rehabilitation sector? These are questions that are not just interesting to German Health Minister Jens Spahn. REHACARE.com has examined the impact of digitization.

Has Germany missed out on digitization? Yes and no. At least when you consider medical innovations. Admittedly, Germany still lags behind in terms of digitization. However, when it comes to artificial intelligence (AI) in the operating room or the analysis of sensory data collected at the Smart Hospital, where systems are connected to facilitate shorter supply chains or preventive care with wearable devices and smart clothing – Medicine 4.0 has also made its way to Germany and healthcare technology advances are in full swing. That being said, nationwide infrastructure implementation has somewhat stalled – first and foremost when it comes to electronic health records.

Germany’s Federal Government has recognized the potential of digitization for the healthcare sector. In December 2015, Germany passed the eHealth Act, which is designed to create a secure infrastructure and introduce medical applications. The key aspects are:

• Establish a telematics infrastructure (TI), that is to say, a network of healthcare stakeholders and service providers such as physicians, hospitals, pharmacies, and health insurance companies, aimed at making access to essential medical information pertaining to patient care easier and faster;
  
  
• This includes the introduction and use of electronic health records, medication charts or other emergency information;
  
  
• and comprises interoperability, i.e., improving the communication between the different healthcare IT systems;
  
  
• The Act also aims to promote telemedicine services such as online video consultations with medical specialists or telecare – that being products and services that facilitate internet-based patient care. Telecare, in particular, ensures a high degree of autonomy in the patient’s daily life. This is made possible with the help of sensors or other devices like smartwatches that record vital health statistics over long periods of time and automatically request help in case of irregularities. Telemedicine or online doctor video consultations are considered great tools to combat physician and care shortages in rural areas.

Yet the practical implementation of the law is still stagnating.

Alongside the eHealth Act is the Initiative of the same name. It addresses mobile applications, big data and data security. The goal here is to identify obstacles that stand in the way of establishing digital applications and to develop strategies that remove these barriers. The idea is to make the transition from successful pilot projects to practical application in healthcare easier. Another emphasis was to improve health app transparency and to identify quality characteristics that make it easier for users to find the product that is best and safest for their needs.

The problem is that there are many successful pilot projects at the regional level – especially in Hesse and the Rhine-Main Metropolitan region – but not all patients can currently benefit from these solutions. This is also the conclusion of a recent study by the Bertelsmann Stiftung. Digital progress simply doesn’t benefit patients in Germany yet. Other countries like Canada, Denmark, Israel, and Estonia prove to be much further ahead. Germany only ranks 16 in a field of 17 countries.

Apart from the lack of flexibility in the healthcare system, which is unable to keep pace with digitization, data protection is yet another factor that demands attention. According to a PwC study, many German citizens worry that hospitals are ill-prepared for cyberattacks, thus making their data not secure. Even though trust increases with the size of the clinical facility, the fear of cybercrime is justified. After all, how secure is our data really?

Smart hospitals, electronic health records (EHR) – what actually happens during an attack? A sudden throwback to the analog age can be very risky for patients – especially at hospitals. The way general practitioners store data is also a major concern. More time and effort is needed to ensure increased IT security, requiring the involvement of additional companies – after all, the hospital or office staff is not able to manage data protection concerns of their systems on top of their regular tasks. That’s something that should be handled by experts. But even they are powerless when the staff who uses the systems has not been adequately trained or is too careless with the data.

On the other hand, we have apps that help us improve our sleep patterns, count our daily steps or keep tabs on our calorie intake, encourage us to exercise, or predict our fertility – our smartphone or tablet might actually know more about us than our doctors.

Especially in the rehabilitation sector, digitization could help cut costs and improve patient care. At last year‘s REHACARE Forum, digital innovation experts discussed how digital transformation can transform rehabilitation. Cost avoidance was another emphasis during the discussion. After all, prevention can avoid the need for rehabilitation measures. In the case of fall prevention, digital advances can offer support. In an interview, rehabilitation scientist Sophie Rabe explained, "there are presently a variety of sensor-based solutions that can reliably detect fall-related events and subsequently initiate the appropriate actions." And added, "time-saving solutions that can be easily integrated into daily health care routines and that optimize existing fall prevention processes will predominantly win out in the future."

It is estimated that hip fractures incur 2.77 billion euros of direct costs annually in Germany, not including long-term costs and non-medical expenses. This is why the Lindera GmbH offers a Mobility Test. A 30-second video creates a 3D image of the patient’s gait pattern. The approach uses AI to identify risk factors. This facilitates an objective and instant gait analysis. Based on the test results, physicians can subsequently recommend personalized fall prevention measures for patients.

Digital tools already help to increase the engagement of patients who are in the midst of a rehabilitation regimen. In last year’s Topic of the Month Modern Rehabilitation, REHACARE.com reported on the popularity of these solutions in practical application and reviewed the advantages of gamification approaches.

"Rehabilitative care presently only offers point solutions," explained Rabe. Meanwhile, this particular healthcare sector actually has what it takes to benefit from digitization. The goal of rehabilitation is to restore function and facilitate participation and not – as is the case in other areas – to merely treat a specific disease pattern. This opens the door for different digitization models. "Patient education and patient self-management are key components of rehabilitation. This is where digital applications can sustainably support desirable behavior changes through clear objectives, interactive learning content, feedback functions, and social reinforcement. As it pertains to ​​post-rehabilitation support, digital solutions can also encourage interaction with the patient and carry the learned health-promoting behaviors into everyday life."

Better and more comprehensive information during the transition from hospital to rehabilitation can allow a more customized treatment plan that is tailored to the needs of the patient.

At the end of the day, everyone benefits: the patients who successfully get back to their old life faster, and stakeholders such as therapists, caregivers, and doctors, as well as health insurance companies, which all could save money on healthcare expenses and treatment costs.

Medical cost pressures on insurers is another healthcare issue, especially as it relates to the rehabilitation sector. That’s one of the reasons why innovative startups are increasingly getting their chance to offer solutions. One of them is Mecuris GmbH, which manufactures custom and specially fitted 3D-printed prosthetics and orthotics. "Everyone is different and unique and should not be fitted with off-the-rack devices. This ensures that the 20 to 40 percent of wearers who don’t fit into the 'small', 'medium' or 'large' category (Editor’s Note: this refers to standard models supplied by German insurance providers) will also obtain optimal care services," said Manuel Opitz, CEO of Mecuris, at REHACARE in September of last year.

Digital tools or technical innovations won’t replace experts in their respective fields of expertise. This is something almost all experts or startup CEOs can agree on. Opitz also says, "I don’t think 3D printing will become the only way to create prosthetic or orthopedic devices." Instead, there will be "new tools and ways to offer more personalized and tailored care for each patient." David Ram, CEO of Tyromotion agrees with Opitz. In an interview with REHACARE.com, he explained that "progressive rehabilitation is not just based on state-of-the-art therapy equipment, it also requires 'human-machine interaction': the experience and expert knowledge of therapists supports robot and sensor-assisted therapy devices."

Regardless of what digitization may ultimately look like, the fact of the matter is that it offers many great ways to cut costs and save money. According to a McKinsey study in collaboration with the German Managed Care Association (Bundesverband Managed Care e.V., BMC), Germany could save up to 34 billion euros annually thanks to digitization measures. This is equivalent to nearly 12 percent of the actual total projected annual healthcare costs and expenditures.

On the one hand, this sum is the result of efficiency improvements and a decrease in unnecessary tests and treatments. An improved data flow thus eliminates the need for unnecessary duplicate exams and improves the quality of follow-up treatments. Mobile health apps and diagnostic tools for patients would simultaneously help reduce unnecessary hospital admissions and lower healthcare costs thanks to improved therapeutic outcomes and successes.

For now, we still have a long way to go before full implementation of the eHealth Act has been completed. Meanwhile, digitization continues its advance. If Germany wants to keep up with this trend, it must pick up the pace. That being said, patients and patient data sovereignty concerns must not fall by the wayside in this setting. Admittedly, you have to walk a fine line, but other countries have already shown the way. Now Germany has the chance to learn from them and follow their example.