This article is the product of a POLITICO Working Group.
Germany may be known for its efficiency, but that’s not true when it comes to the digitalization of its health system.
Since 2019, Germany has introduced three major new digital health laws covering everything from electronic patient records to the digitalization of its hospitals. But in hospitals and GP rooms, significant progress is something of an enigma.
While the pandemic helped crystalize the importance of digital tools such as virtual consultations, in many areas, Germany is years behind others in the bloc. Around 95 percent of communication between outpatient doctors and hospitals is still paper-based; patients aren’t even using their electronic health records; and only around two dozen digital health apps have been approved, according to a report from McKinsey.
Health Minister Karl Lauterbach knows change has been glacial — he was one of the initiators of a proposal to create an electronic patient file at a meeting at a Berlin hotel. That was 20 years ago.
Speaking at the country’s annual digital health fair in April, Lauterbach said he would “never have imagined” that 20 years on, he would be standing before an audience with the electronic patient file still not fully introduced. “That thought would have blown my mind,” he said.
What Lauterbach believes is missing is a new strategy.
The country has a lot of “tactics, a lot of technology and a lot of innovation, but we have no overarching strategy,” he said.
A key problem is that Germany is fragmented with different software and standards being used across the country, said Matthias Mieves, member of the Bundestag and Social Democrat. “You don’t have to compare us to Israel. We are years behind Denmark and Sweden too.”
It’s meant that the rollout of e-prescriptions has been delayed again and electronic patient records are still being implemented in some facilities. Germany has some catching up to do as the European Health Data Space lands, setting a 2025 deadline for the country to be able to share this data with the rest of the EU.
In Bertelsmann Stiftung’s digital health ranking, Germany comes in 16th place, second to last out of the countries compared. It shouldn’t be this way.
Eye on the prize
“Germany is sitting on one of the biggest treasure troves of health care data,” said Stefan Biesdorf, partner and member of McKinsey Digital and McKinsey Analytics, at a POLITICO working group on Germany’s digitalization in April. “The public health system has comprehensive and longitudinal data for 88 percent of the German population.”
Different software interfaces and administrative procedures across the country mean that data from millions of patients can’t easily be used.
Markus Leyck Dieken, CEO of gematik, the agency running the platform for digital applications in the health care system, is determined to change things and tackle the fragmentation in Germany’s health care system, which is unique among European nations.
While there are great projects being carried out in Germany, they’re being done by individual regions, companies or health insurers, he said. Even the systems that hospitals use to collect data varies.
“Who has the guts and the courage to say although we are torn apart by particular interests, we have to overcome those because otherwise, nobody will have anything?” he said.
Henning Schneider, CIO of private hospital group Asklepios, describes the issue: They have data archived from millions of patients in local information systems but in the end, they cannot extract much information out of the data, because each hospital has collected the data with different processes, with different focuses and under guidelines of the regional data privacy regulations.
What’s left is a “graveyard with a lot of data there which you cannot use to improve patient treatment.”
Bring in the new blood
The new coalition government led by Chancellor Olaf Scholz promised to reduce bureaucracy, speed up the introduction of the electronic patient file and e-prescriptions and draft a new health data law.
But the reality has been a little different.
“We haven’t seen too much action from [the federal government] in the last six or seven months,” said Georg Muenzenrieder, who heads up digitalization in health care at the Bavarian State Ministry for Health and Care and is also chair of gematik’s board.
“We have lost some time — and not only a few weeks, but more than half a year now.”
The new government’s task has been made more difficult by the sheer complexity of the health system, said Muenzenrieder. “[Germany has] these different layers of legal framework and decision making, and they make the system very slow,” he said.
While patients are in favor of digitalization, less than 1 percent of those surveyed are actually using it.
“We need a communication campaign,” said Anne Sophie Geier, managing director of the German Digital Healthcare Association. The aftermath of a pandemic is the right time to convince people, she said.
Lauterbach seems to understand that as well, describing himself as not just the “health minister” but also the “digitalization minister.” The aim is for the new strategy process to be rolled out after the summer break and for a plan to land this year.
If any extra impetus were needed, it’s coming from Brussels. The European Commission proposed a European Health Data Space on May 3 to promote digitalization in the sector.
“We have a window of opportunity now, we can learn from the past,” said Muenzenrieder.
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