Konvergenz digitaler Gesundheitsanwendungen

Thomas Thiessen; Alexander Schachinger

Convergence of digital health applications with medical care supply structures: results of an empirical structured observation in German-speaking countries.

Summary

Within the framework of a quantitative structured observation, new forms of web-based health applications in German-speaking countries were analyzed in the period of 2017/2018. The subject area covered all web-based applications that users could use in the context of medical treatment or prevention. In light of the two-world dilemma, namely the world of websites and apps on the one hand and the traditional medical care structures not linked to the first world on the other hand, the following observation results are relevant: web-based applications interweave with outpatient and inpatient care facilities such as doctors, pharmacies or clinics in terms of their specific application scenarios. Users and patients are starting to receive their apps from the doctor or pharmacist first, even though no uniform, regulatory guidelines have yet been implemented at the political level. This finding underpins the digilog approach, which combines a wide variety of analogue and digital forms of patient-centered care supply formats, in order to provide complete care coverage for an ageing rural population using the example of the federal state of Brandenburg. With or without regulation, it is clear that digital health must connect with analog health care on site in a manner of increased efficiency and is already doing so as one can see with first steps being taken.

Background and Situation

Over the past three to five years, the majority of startups have developed web-based applications for consumers that increasingly demonstrate functions and effects relevant to medical diagnosis and therapy. The authors define this field of innovation as the digital healthcare market: all web-based applications that can be used by healthy people and patients on their Internet-enabled devices with or without medical prescription or monitoring. With this development, the so-called two-world dilemma arose for the patient: the world of traditional medicine and care supply by physicians, pharmacists and hospitals on the one hand and the world of thousands of health websites and apps on the other1. Since the very beginning, both worlds have generally not been connected with each other and thus leave the majority of patients disoriented and alone in regard to their demand for information and therapy in an increasingly digital society.

The Challenge

Even though start-ups with their digital healthcare solutions are noticeably becoming more closely linked to local medical care, the strict regulation and self-administration of the healthcare system and the internal IT infrastructures still do not permit a holistic basis for connecting digital data and services. Although politics and regulatory bodies are currently working increasingly on possible regulatory integration of adequate solutions, these have so far failed to emerge as a holistic solution. This dilemma, as well as the additional challenge of ensuring complete medical care in rural regions, was the original idea behind the digilog approach, which emerged from the idea of the "boundaryless hospital".

Methodology and Data Collection

This situation, which is constantly increasing the pressure to adapt for both subsystems, was the reason to carry out a segment analysis at exactly this system intersection in the form of a quantitative observation with the subject area of all digital supply solutions in the German-speaking area. Two core variables were decisive for the execution of the observation: a) the time factor in the form of the calendar years 2012-2018 and b) an index, formed from several disjoint observation categories, which codes a digital supply solution on the market. The observation categories used for index formation were presented in simplified form:

  1. specific application/linking of the digital application with an ambulatory/stationary provider,
  2. reaching a number of users of at least 50,000 (measured in the form of downloads in relevant app stores or regular visits/month to the website with the analysis tool similarweb),
  3.  proof of a publication on the proof of medical/health benefit,
  4. new possibility of reimbursement by an insurance or other cost-covering organisation,
  5. partners in a care supply consortium, as partners in the innovation fund or financing of at least 2 million euros.

The data collection took place in the form of a three-stage data collection process: a) research of all digital solutions available in the D,A,CH area, b) consolidation of the specific benefits and the digital supply scenario of the application through positioning on the provider's website and through reporting in the trade press, and c) direct contact with the management to clarify open functional questions.

Conclusions

Over the past four to five years, the number of digital healthcare solutions that have a direct or indirect application in traditional local medical care has increased approximately tenfold. This statement may not be a novelty for industry experts, but it shows for the first time quantitative evidence that the pressure for politics and regulatory bodies is growing exponentially and that digital health care applications are increasingly finding a niche place in healthcare, even without a regulatory-political solution. In simplified terms, the latest solutions in particular can be characterized in the following way:

  1. The business model is divided into three parts: sales revenues come from three customer segments: a) private consumers/patients who pay themselves, b) ambulant and on-site car providers, c) reimbursement by health insurers,
  2. the digital application allows data exchange up to messenger services with the qualified staff in the doctor's practice and the pharmacy
  3. The international state of research shows a better utilization and impact ratio when digital applications are connected with local supply structures.
Artikelgrafik1

Figure 1: Number of digital care applications connected to medical care structures or cost units 2012-2018 (basis: n=98 index cases, 95% accuracy).

Implications

One of several derivations of this observation is the conclusion that digital care applications create a place for the patient in the system, even without a necessary federal, political/ regulatory solutions for the entire health care system (examples: Electronic health record, uniform solution for the "app on prescription" and comparable scenarios). For example, a cluster of start-ups that enable direct patient chats with doctors and pharmacists already found thousands of doctors' practices and pharmacies as users (example cases: Egopulse, medzapp, AppZumArzt). Online rehabilitation and coaching solutions such as Caspar Health are already being used and billed as digital aftercare in over 80 clinics. And online coaching solutions are used in scope and depth as a health insurance benefit or also as preparation for follow-ups to ambulatory or clinical treatment (example cases: Kinderheldin, Deprexis24, Neolexon). The question of whether and to what extent these individual solutions will digitize medical care nationwide in the near future, even without a regulatory solution in place, cannot be answered despite the results. What is certain, however, is that the pressure on politics and regulatory bodies will continue to increase exponentially in the short term and that the providers will continue to implement their own or third party digital applications strategically. In addition, the challenge lies in the acceptance of digital care solutions by specialists and patients alike, in the integration and provision of heterogeneous patient data for diagnostics and therapy, and in the application of the right digital medical tools for the right patient at the right time in the treatment path.


Context digilog

The challenges mentioned were the basis of the digilog approach and its eHealth Center, which implements the mentioned aspects in a care-centered manner.

The digilog project, which consists of analog and digital treatment solutions with more than 25 consortium partners from the medical technology, clinic, medical profession, cost unit, research and other segments for future-oriented care in the state of Brandenburg, is on the one hand part of the innovation trend on the basis of the current results. On the other hand, the coordination architecture of digilog is not fixed to one or more individual solutions. Since it can be assumed that digital diagnostics, therapy software and standards for data platforms will also change in the future, a digital care scenario should, as implemented in the case of digilog, be able to apply the basic dynamics of digital health innovations and at the same time not tie its core architecture critically to a single standard or a solution provider.

Literatur

Agarwal R, Anderson C, Zarate J, Ward C: If We Offer it, Will They Accept? Factors Affecting Patient Use Intentions of Personal Health Records and Secure Messaging J Med Internet Res 2013;15(2):e43
Kruse CS, Mileski M, Vijaykumar AG, Viswanathan SV, Suskandla U, Chidambaram Y: Impact of Electronic Health Records on Long-Term Care Facilities: Systematic Review JMIR Med Inform 2017;5(3):e35
Talboom-Kamp EP, Verdijk NA, Kasteleyn MJ, Harmans LM, Talboom IJ, Numans ME, Chavannes NH:
High Level of Integration in Integrated Disease Management Leads to Higher Usage in the e-Vita Study: Self-Management of Chronic Obstructive Pulmonary Disease With Web-Based Platforms in a Parallel Cohort Design
J Med Internet Res 2017;19(5):e185
Witry, M. J., Doucette, W. R., Daly, J. M., Levy, B. T., & Chrischilles, E. A. (2010). Family physician perceptions of personal health records. Perspectives in health information management, 7(Winter), 1d.

Vydra, T. P., Cuaresma, E., Kretovics, M., & Bose-Brill, S. (2015). Diffusion and Use of Tethered Personal Health Records in Primary Care. Perspectives in health information management, 12(Spring), 1c.
Kittler, A., Pizziferri, L., Volk, L., Jagannath, Y., Wald, J., & Bates, D. (2004). Primary care physician attitudes towards using a secure web-based portal designed to facilitate electronic communication with patients. Journal of Innovation in Health Informatics, 12(3), 129-138.
Schachinger, A. (2017). Der blinde Fleck von Entscheidern im Gesundheitswesen: Über Wirksamkeitsnachweise für digitale Versorgungsanwendungen. EHEALTHCOM. 2/3 2018, 42-45.
Schachinger, A: EPatient Survey 2017: Die App ersetzt nicht den Arzt. Stuttgart: Thieme Verlag: KMA 22(06):12 DOI: 10.1055/s-0036-1594619
Schmailzl KJG, Sendler HTH. Networked Care: IT- assisted tools (wearable sensors) for patients at risk. In: Boundaryless Hospital – Rethink and Redefine Health Care Management. Albach H, Meffert H, Pinkwart A, Reichwald R, v. Eiff W (Hrsg.). Springer-Verlag Berlin Heidelberg 2016: 111.
McGrail KM, Ahuja MA, Leaver CA: Virtual Visits and Patient-Centered Care: Results of a Patient Survey and Observational Study. J Med Internet Res 2017;19(5):e177
Melmed A: Chat with a Doctor: Using Asynchronous Virtual Care Access for On-Demand Physician Advice. JMIR: Vol.3, No 1, 2017, iproc 2017;3(1):e18

thomas
en_GBEnglish
de_DEGerman en_GBEnglish