Digitization: "A common vision is missing."

Digitization is a perennial topic in the healthcare sector. Much has been written about the opportunities and dangers. But why is progress so slow in Germany and where do other EU countries stand?

empirica – Communication and Technology Research – has an eye on the market. Dr. Rainer Thiel knows the pitfalls and the current state of development on the way to a nationwide digital healthcare system.

The EU project Digital Health Uptake (DHU), which is managed by empirica, relies on knowledge transfer to break down existing transfer barriers. Dr. Veli Stroetmann explained to us exactly what this looks like.

Dr Thiel, what is the status quo in terms of digitization of healthcare in the EU?

Dr Rainer Thiel: There are many positive developments at EU and Member State levels. However, in the studies we conduct at empirica, such as the Study on "Interoperability of Electronic Health Records" (2021) and a recent study on citizens’ access to electronic health data, we see that the situation still resembles a "hotchpotch" in which countries progress at different speeds.

For instance, cross-border exchange of ePrescription information is already possible for a few advanced countries, while others are still only piloting their ePrescription systems. With the proposed European Health Data Space (EHDS) Regulation, an urgently needed joint vision is underway with immense potential to trigger further collaborations and improvements.

In Germany, the most controversial issue is the proper handling of data, first and foremost its use and security. What hurdles still exist?

Dr Thiel: Germany lacked a strategic direction for digital health until this year which was a major barrier. A vision about why to use data and to what impact is still missing. Different activities have taken place in siloes through top-down approaches, which resulted in solutions that did not meet the reality of the users.

The planned opt-out approach for the ePA (electronic medical record) is positive, but low-threshold access and user centricity is key. Legislative provisions are there, although finding (financial) incentives for nationwide implementation of solutions remains a major task. Also, the self-governance of the German healthcare system comprising various bodies with vested interests and veto power can lead to easily allowed logjams.

It will be interesting to see whether the gematik as the envisaged national digital agency can drive a vision and coordinate a national, centralized approach with all relevant stakeholders. At empirica, we are closely observing these developments.

Generally speaking, how can a better balance be struck between innovation regulation?

Dr Thiel: With the speed at which innovations are advancing, it is imperative to ensure safety and effectiveness through appropriate regulation that enables innovation. It is a question of "better" rather than "how much" regulation. Decision-makers need to listen to the needs of users and industry stakeholders, and also look abroad and learn. Aligning the enabler (policy) side, demand and supply side is a major challenge. Facilitating such alignment is a focus of the EU-funded Digital Health Uptake (DHU) project, coordinated by us at empirica.

Dr. Stroetmann, where does a project like DHU come in to break down barriers and facilitate cross-border digitization?

Dr Veli Stroetmann: We have experienced across projects that a major barrier for accelerating the uptake of digital health solutions and services is that different stakeholders do not speak the same language. The industry is not sufficiently aware of the needs of the public sector, and the public sector, or other buyers, do not know what is out there that could address their needs. This is something that also the European Commission has identified as needing further effort and investigation.

There are plenty of good digital health solutions out there, but they are not necessarily upscaled or shared widely with others, be it at local, regional, national or EU level. Our experience shows that regular knowledge exchange between health stakeholders, activities for mutual learning and transfer of solutions or services between regions or countries is essential for cross-border digitalisation. This is where DHU comes in.

So what specific role(s) does the project play in the process?

Dr Stroetmann: DHU offers distinct services to the digital health and care community in Europe. We regard the project as a knowledge community to align the needs of the demand, supply and policy side. We identify and make visible common challenges (e.g., standards, data privacy, user needs) and good practices (e.g., new care models, innovative procurement), and provide technical support, resources and training for increasing the uptake of digital health solutions and services.