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“The level of digitization in German hospitals is worse than in the rest of Europe”

The Federal Minister of Health affectionately calls his colleagues at the health innovation hub “his truffle pigs” because they track down trends and innovations for the German healthcare system. Ecky Oesterhoff is responsible there specifically for clinics and hospitals and puts the KHZG into an overall context for once.

Mr. Oesterhoff, against the backdrop of the Corona pandemic, the numerous laws introduced by German Health Minister Jens Spahn are almost lost in the shuffle. Yet he has already initiated many, especially many purely digital laws. How does the KHZG fit in here?

I’ll have to backtrack a little here, because Jens Spahn has actually launched a great many laws during his time in office so far, and as you rightly say, numerous digital laws as well. However, the majority of these have dealt with outpatient care in the healthcare system in the past. The aim was to make the telematics infrastructure more widespread, i.e., above all, to network doctors in private practice with their practices. This is a basic prerequisite for patients to be able to make meaningful use of the electronic patient record, or ePA. This was sometimes a rather tough undertaking. But today, well over 80 percent of practices are connected to the telematics infrastructure. And now, with KIM, Communication in Medicine, comes another real game changer. This enables doctors to communicate patient data electronically from their primary system via a secure service that also ensures that a doctor is actually sitting on the other side. And all doctors in private practice in Germany are registered. In this respect, it is a real novelty: In the future, every doctor will not only be able to find a colleague in a comprehensive address directory, but will also be able to communicate with him or her directly and securely in digital form.

So does the KHZG herald the next logical expansion of digitization in healthcare?

Exactly. In Germany, we have a sector-based healthcare system unlike any other country I know. And these sectors can certainly be compared to clearly separated silos. However, the legislator always looks at things from the patient’s perspective and with a view to his or her patient journey, which can certainly move between different sectors – from outpatient to inpatient, for example. Always there: the patient’s ePA. It is therefore the constant that cuts across all silos and has the great potential to break them down. However, there is still a break here in the hospitals so far. They can’t work with ePA yet, are just now establishing it. But we also know that the level of digitalization in hospitals is currently worse across the board than in all other European countries, which of course does not look particularly good for us. And it was precisely to close these gaps – the overall poor level of digitization and the connection of hospitals to the ePA – that the KHZG was designed.

This overriding benefit of the KHZG sounds perfect in theory, of course. But is it also immediately tangible and perceptible in all clinics?

Not necessarily. In order to reap the benefits, many hospitals must first do things that are not immediately obvious to them. Today, for example, doctors and nurses do not have to identify each other permanently. Group identifiers on ward computers are standard, which are then used to document treatments and nursing services. Of course, this is no longer possible in a closed-loop medication process, for example, because it is important to know who carried out which process step and when. Or if a doctor in a clinic writes something in the ePA during treatment in the future, she must always authenticate herself. In the future, the entire medical profession will therefore have to carry an electronic health professional card with them, and the hospitals will have to provide the appropriate readers.

But the digitization of such processes offers an immense opportunity.

Absolutely, but first of all, all processes have to be rethought for the user. And they also have to behave differently. This is an important and major piece of communication work that needs to be done in the houses. The motto is: you’re doing something here now, it may cost you time and energy for the first three months, but then you’ll reap the rewards. Of course, this is especially hard for the staff because the documentation effort is already high and the IT is outdated. And now it’s going to get more complex in the first step – before it gets easier. Because in my opinion, the chances of this happening are better than ever.

You are in close contact with numerous hospitals and also with the Marburger Bund. Do the physicians believe that the KHZG can improve everyday work and care?

It must become the task of hospital management and IT to get the medical profession excited about digital topics. But we also notice from the conversations that physicians believe physicians. No one is simply digitized. You can’t just give the IT department the job of digitizing a hospital and hope that it will work. Digitization is always successful when those who know the processes well are involved, and not just on Tuesdays from 4 to 5 p.m. in a digitization committee or by picking out the new physician colleague. Digitization is always the responsibility of management and the most important multipliers.

Does this mean that the KHZG’s big opportunity is not just to get funding, but above all to set a strategic course?

A very important point. Many hospitals already know their potential funding level before they even submit an application. And then the reverse engineering begins: What projects can I implement with, say, 9.4 million – to give you a house number. I think that’s dangerous. Because such projects burden an organization even as they are being created. It’s better to have an overarching digital strategy and then see what fits the bill. Then you can tackle the three or four projects that make sense for the individual organization at this point in time and against the backdrop of the current level of digitization. If you’re only interested in getting funding or avoiding the penalty, you’re unlikely to be successful.

This raises the question of how many German hospitals have a digital strategy at all.

Certainly not all of them, and the KHZG is also designed for this purpose, because not all of the subsidy measures result in penalties if they are not implemented. The KHZG has set priorities that smaller institutions can use as a guide. The KHZG funding facts can become a digital strategy for them.

What about the digital healthcare market, can it handle the order volume at all?

The healthcare IT market in Germany currently turns over about 1.3 billion euros a year. And 4.3 billion is now flowing into this system on top of that, which will have to be “breathed” over the next three years. The market first has to manage this, and it is certainly overloading the overall system in some places. This means that further innovations beyond the KHZG will be hard to come by. Manufacturers are looking to establish KHZG-eligible solutions that can be easily rolled out and scaled. Smaller hospitals are therefore well advised to either find a partner, such as a larger hospital nearby, to dock with, or to rely on “off-the-shelf” software. However, there is a certain charm to this: Many hospitals receive functionally well-designed software from the KHZG subject areas. And this alone takes us to a new, but also comparable level in the nine purely digital funding areas of the KHZG.