Digitization should never be an IT project, but always a hospital project – this is the central advice that the head of the Digital Transformation Unit at Berlin’s Charité, Peter Gocke, MD, gives to others responsible for implementing the KHZG.
Dr. Gocke, your position alone makes it clear that Charité is one of the pioneers when it comes to digitization. The necessary resources are available and the digital transformation is being addressed, which is definitely not the case at all hospitals. What further potential do you see for your hospital in the KHZG?
The KHZG is not about digitizing individual houses. The aim is to pave the way for a better healthcare system in Germany overall. And to achieve this, all hospitals and doctors’ practices, as well as patients, must be able to move within a roughly comparable framework of digitization. With this realization, I actually also began my career development from physician to digitization at the time. At that time, it was possible to completely digitize the radiology department of my then employer, the University Medical Center Essen, with a relatively manageable amount of time. However, the fact that the rest of the hospital was not yet so digital significantly limited many of the advantages. It was then that I realized that you can’t just digitize one department, but always have to take a holistic approach. Otherwise, employees and patients will not benefit to the extent that is necessary to justify the effort and costs or as patient safety actually requires.
So when you apply this to the German healthcare system, you are saying that it is not enough to digitize just a few clinics?
Exactly. And this is also the focus of the KHZG: the processes relevant to patients in all facilities are to be digitized. I think the selected mix of mandatory and optional criteria makes a lot of sense. This is also reflected in the fact that, although we are currently hearing a lot about the KHZG, we are hearing very little criticism of its content.
Can the KHZG achieve this comprehensive digitization – especially in view of the total amount of funding available?
Digitization is not something you start now and finish in a few months. We are always talking about a continuous process. In this respect, the funding from the KHZG can only be a first step. But it is much more important than just the amount of money that a defined direction and clear criteria have been established here as to what is to be done in the first place. What benefits the patients and the structures in the hospitals? I don’t yet know whether this will finally settle the issue of financial requirements. But in the past, we always complained that we had no money for digitization. Now we’re getting money, and some people are already complaining that it’s not enough and that there won’t be enough resources and that the implementation time is too short. That may even all have its justification, but it doesn’t help us.
So you’re appealing for people to take advantage of the opportunities that the KHZG now offers?
Absolutely – especially because the KHZG is not the only project that pays into the digitization of healthcare. The next is the telematics infrastructure, which is developing in parallel and whose roadmap goes even further than that of the KHZG. In any case, here, too, you have concrete specifications to think about today if you are now setting yourself up digitally for the coming years with the KHZG. The KHZG is intended to promote the digitization of processes, and these will be increasingly interwoven with the telematics infrastructure in the future. And the two together are a guarantee that Germany is now actually taking the digitization of the healthcare system seriously – and will arrive at a national, networked, digital platform.
Is it also the deductions anchored in the KHZG, which will take effect from 2025, that encourage people to tackle projects now?
The approach in the KHZG reminds me somewhat of that of the USA in the “Meaningful Use” program. First, digitization was funded, then a little less each year, and after a year’s break in funding, increasing penalties became due each year if services were not offered digitally. First promote, then demand is also the premise of the KHZG. However, the defined criteria are much more important than the announced penalties. Because if you take a closer look at these, you can’t avoid taking a closer look at structures and processes, so that after this analysis they can be implemented digitally in hopefully better quality. So the funding guideline itself is already a document from which I can derive my need for action very well and, above all, concretely.
Is there a fundamental insight that you would now like to pass on to less digitized hospitals from your experience?
During my time at UK Eppendorf, we achieved very extensive digitization there in just a few years, which led us to be the first hospital in Europe to achieve the highest level 7 of the HIMSS EMRAM. There was a fixed rule for digitization: “IT follows Process”. This means that the target process is defined and optimized first, and only then do we look at what the best digital support looks like. In the past, systems were unfortunately purchased far too often in many houses because, for example, a manufacturer was convincing in its presentation. It is then extremely difficult to adapt these systems to reality. What is also important is that digitization with the KHZG is definitely not an IT project, but a hospital project and therefore a task for hospital management. In this sense, the KHZG implementation cannot be mapped alone within an IT or digitization strategy, but must always be embedded in a hospital strategy from which these and other requirements for IT and digitization arise. And, of course, we must not get bogged down in the minutiae of individual technical solutions.