The crisis as an opportunity for our health system?

• Digitization can make our healthcare system more effective.

• We see the greatest leverage for digital solutions at the base of the healthcare system.

• A short-term and inexpensive solution is the doctor's consultation via video. 

• Health applications based on artificial intelligence help to close gaps in knowledge or experience.

The coronavirus (more precisely SARS-CoV-2) has changed our lives in a very short time. The long-term effects on our economy and our coexistence cannot yet be fully assessed.

But it is already possible to see how our health care system has overcome the crisis and where there are weaknesses. We thought about how and where digitisation can help here - in the short term, but also in the long term.

Doctors assume that SARS-CoV-2, similar to the flu, will become endemic in Germany. It will thus change from an occasional visitor to a permanent guest who will appear again and again at regular intervals. We must therefore currently assume that pathogens such as SARS-CoV-2 will continue to have a major impact on our everyday lives in the future and should be prepared for this.

In the event of a viral pandemic, all eyes will be on the healthcare system. The current crisis confirms what the Federal Ministry of Economics and Energy has already stated in Germany in 2018: this sector is one of the worst performers in terms of digitalisation. There are many reasons for this - the high level of regulation is probably one of the more important.

Digitalisation could make our health care system much more effective - in current but especially in future crisis situations. We have examined some areas of the health care system under the influence of the current crisis and outline possible paths to a more digital and better future. In this first part we deal with family doctor's practices or outpatient care as well as hospitals or inpatient care. In the second part, we deal with medical technology manufacturers, laboratories or diagnostics and the pharmaceutical industry.

General practitioners' practices or outpatient care

In times of a pandemic, patients who have "normal" illnesses cannot be cared for locally in their family doctor's practice. Although some emergencies can be clarified by telephone, important diagnostic tools are missing. It is to be feared that this will delay many therapies and thus cause higher costs for the health system. This is why we see the greatest leverage for digital solutions at the grassroots level of the healthcare system.

In the short term: Better data protection for doctor's consultations via video

A short-term and inexpensive solution is the doctor's consultation via video. Many doctors have already switched to video portals in the meantime in order to get at least a visual impression of their patients. However, vital signs such as blood pressure, pulse and lung sounds cannot be reliably recorded in this way. After all, the attending physician at least gets a first impression of the patient and may already be able to initiate first therapy steps. The Associations of Statutory Health Insurance Physicians in Switzerland have already reacted in this regard and have lifted the restrictions on video consultations. Unfortunately, many medical practices are not yet equipped with the necessary technology. There is often a lack of cameras for the work computers and the corresponding video chat software.

In a patient-doctor conversation, confidential information is usually exchanged. For this reason, the usual video portals (Skype, Zoom, etc.) can only be considered if the patient has been informed in writing that the data protection law may not be complied with and he/she gives his/her consent. Certified and free video services such as those from Health Info Net AG (HIN) are an alternative. For training via video, however, the usual portals can be used.

In the medium term: integration into the accounting systems

Video consultation coupled with automated documentation using speech recognition and solid security with modern encryption will replace many visits to the doctor in the medium term. The automated linking of the documentation generated in this way with the accounting systems will bring a further gain in productivity, and not only in crisis situations. This gives doctors more time overall for the important issues during treatment.

In addition, many modern diagnostic devices are already equipped with technologies that allow data to be transmitted to a smartphone or directly to the Internet. However, despite the available connection technology, the integration of the devices into the existing IT infrastructure has not yet progressed very far. From our point of view, this is a very interesting starting point. With an additional integration of the device data into an electronic patient file, the effort for documentation would also be significantly reduced here.

Long-term: Relief through AI-based solutions

Many specialists also had to close their practices during Corona due to lack of demand. For this reason, many GP practices have been and still are confronted with cases that they would normally have referred to clinics or specialists. Here, health applications based on artificial intelligence could help to close gaps in knowledge or experience. The apps are designed to support doctors in their work and not to replace it - AI as "Augmented Intelligence". Another exciting idea is to take the first steps in anamnesis via a chat bot. There are already first promising approaches that show that such AI-based solutions can significantly improve the efficiency of the health care system "at the front line". It is unclear, however, whether the necessary acceptance of such solutions among office-based physicians and the general public already exists today.

Hospitals / stationary care

Hospitals are the neuralgic points during a pandemic. If the hospitalisation rate rises above the intensive care capacity of a country, the system collapses. Many measures during the Corona crisis had only one goal: to prevent hospital overload. If it were possible to use the capacities of hospitals more efficiently and to control them more flexibly, the measures to contain a virus could be made much less drastic.

Short-term: living will by tablet

Educating and informing patients and relatives takes a lot of time, especially when language becomes a barrier. The most important questions could be answered on an app. A simple, automatic translation as well as the possibility for hospitals to add certain contents themselves would be helpful. Furthermore, many patients do not have a living will or it is lying at home.

Since no relatives are admitted to hospital during a pandemic, older people in particular are often overwhelmed. An app on a tablet, which helps to answer the most important questions with age-appropriate info blocks and videos, could create great added value here. The app could send the resulting text via email to the relatives for checking. The hospital then receives an electronic statement with the most important instructions for filing in the hospital information system. With modern low-code approaches, such as Mendix from Siemens, such apps can be created at short notice and with little effort.

Medium-term: Digital checklists and communication systems

Entering and leaving quarantine stations, which are often implemented as vacuum systems, is very time-consuming for the staff. The required material must be introduced and cleaned. If something is forgotten, the entire process must be repeated. Often notes are handwritten inside the quarantine stations and cannot be passed on outside. Here, digital checklists and a digitalised communication solution would help to efficiently overcome the physical limitations of the quarantine stations.

When the hospitalisations during the Corona crisis were at their peak, it soon became clear that the personnel disposition in the hospitals was reaching its limits. Digital resource planning tools that take into account paradigms from the agile world, such as Kanban and Scrum, could offer a solution here. For short-term implementation, standard tools already used for ticket management in software maintenance could be reconfigured for use in hospitals.

Long-term: onboarding apps and robotic systems

Hospital admission is a critical step in the process in the event of a pandemic. The triage of patients requires a large number of personnel who must have a certain basic medical training. This staff is then not available for medical care within the hospital. We already know onboarding apps from other industries that could significantly increase the efficiency of triage. Here the responsible personnel is guided through the processes by a software system and the recorded data is automatically forwarded to the hospital system. But beware: since this software solution interferes with the treatment pathway and thus potentially endangers the lives of patients, it must be developed in compliance with applicable medical standards. The development of such support systems will therefore take some time.

Patients hospitalised in intensive care with COVID-19 had to cope with above-average hospitalisation periods. This is also a great challenge for the nursing staff, as patients have to be cared for around the clock and have to be turned several times. Sometimes 4-5 persons are necessary for this. Ventilation in the prone position is a particular challenge here. Technical aids and assistance systems could support the nursing staff in this respect. Cooperative and secure robotic systems are already widely used in other industries. In our experience, the needs of the caregivers - i.e. the users - are particularly decisive in the development of such aids, in addition to the regulatory requirements.