Digitalisation in the health sector: Opportunities and stumbling blocks28-06-2023 Author: Jan Tissler
Comprehensive digitalisation of the healthcare system has been discussed for decades. The opportunities for AI-assisted research and diagnosis are currently increasing the pressure to innovate. However, many questions remain unanswered. Tangible results are only sporadic.
The digitalisation of health care in itself sounds like a good idea. It would make all examination results, diagnoses and treatments available at any time. It would allow doctors to better ensure that a newly prescribed medication for a patient is compatible with other treatments and illnesses. Changing doctors would become easier. Duplicate examinations due to lost documents could be avoided. And even those who have an accident or fall ill while on holiday would always have all their patient data with them – via a corresponding app on their smartphone.
Such perfect and seamless digitalisation would not only make life easier for doctors and patients but could also significantly accelerate medical research: Trends, effects and correlations could be identified from the data. This is especially true with regard to increasingly powerful AI tools: they are predestined to find patterns in enormous amounts of data. However, this data must first exist and be complete and suitable for analysis.
The discussion about the digitalisation of the health care system is far from new. It is now a good 20 years old. What has emerged from this discussion, however, differs greatly with regard to different countries.
Role models Estonia, Denmark and Finland
Estonia, for example, is considered a great role model in Europe. The Baltic state took up the topic as early as the 1990s and has consistently implemented it ever since. Not only health care but also administrative procedures and elections have been digitalised. Denmark and Finland are also considered pioneers in e-health. This map provides an overview of the state of affairs in selected European countries.
Switzerland has proclaimed the "Strategy eHealth Switzerland 2.0". The electronic patient dossier (EPD) is the main focus here. The website states: "For the Confederation and the cantons, digitalisation is a central instrument for achieving important health policy goals, namely in the areas of treatment quality, patient safety, efficiency, coordinated care and interprofessionalism as well as health literacy." The introduction of the EPD in Switzerland has been delayed but is now underway.
In Germany, the counterpart is the electronic patient record (ePA). Although it has been introduced, it is hardly noticed by the population: Not even one percent of the insured have used it so far. One reason is the complicated application process. The German government now wants to change from "opt-in" to "opt-out": in future, every citizen should have an ePA provided they do not actively object.
Not everyone agrees with this by a long shot. Fears about the security of one's own data and its use play a key role in the discussion.
Fears around data protection
These fears are not made up out of thin air. There is a reason why the EU's General Data Protection Regulation (GDPR) is particularly strict in its scrutiny of health-related information. At the same time, it stands in the way of plans for a "European Health Data Space" (EHDS) or at least makes its implementation more complicated. The idea behind EHDS is that just as services and goods can be exchanged as freely as possible within the EU, this should also be possible with health data.
But how can make sure this information doesn't fall into the wrong hands? Anonymising or pseudonymising the data are ways to increase the level of security. However, both options come with specific advantages and disadvantages. In the case of anonymisation, for example, data can no longer be viewed in the course of research, since it is not clear which information belongs to which person. Pseudonymisation makes this possible but is less secure.
Other questions revolve around who has access to which information and how much say patients should have.
E-health as a technological challenge
A digitalised health system is also an enormous technical challenge. After all, e-health only reveals its potential when information is seamlessly recorded and made available. This in turn only works if all relevant data routinely ends up in the system.
But even that isn't enough: the information must also be available in a meaningful format, ideally standardised. Were this not the case, it could only be used for research to a limited extent or not at all. "Of course, you can draw valid findings from everyday clinical practices from routine data that we don't get from laboratory experiments and controlled studies, but to do so, the database has to be clean," explains medical computer scientist Peter Haas in an interview with Heise.
Unstructured data would also make doctors' work more difficult since if worst comes to worst, they can't first read through several digitalised documents. They have to be able to recognise important information and contexts as quickly as possible.
So, there is still a lot to do in Switzerland, Germany and many other countries. Another driver of e-health in all of this is money. Digitalisation could save a lot of it. For Germany, for example, McKinsey estimates this figure at 42 billion euros per year. For Switzerland, the figure is 8.2 billion Swiss francs. In addition, research based on health data could lead to new and better medicines -–another market worth billions.