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Conclusions from the Round-table Discussion on Digital Care in Germany and Sweden –Accelerating and Safeguarding the Ongoing Transformation

Last Thursday a Swedish-German round-table discussion was held on the topic of digital transformation in the two countries. The event was organized by Swecare and the German-Swedish Chamber of Commerce in cooperation with the Swedish eHealth Agency. The purpose of the discussion was to strengthen cooperation in digital solutions for healthcare, and included speakers from the Swedish Association of Local Governments and Regions (SKR), Region Jönköping, the Federal Association of Managed Care, the German Association of Healthcare IT Vendors, the Charité Universitätsmedizin Berlin and University Medical Center Schleswig Holstein. In addition to this, the companies Cambio Healthcare Systems, Sobi and Visiba Care joined the discussion with their experiences of developing digital solutions for healthcare.

Digital solutions in healthcare, such online consultation, increased exponentially in Sweden during the first weeks of the pandemic. Germany has also seen a steady increase in this respect, though to a less extent than Sweden. Both Germany and Sweden have also put forth strategies and plans to boost the digital transformation. Presentations and questions discussed in the two sessions centered around the prerequisites for the digital transformation from policy and practical perspectives.

Some conclusions from the discussions

The Leadership

The leadership also play a crucial role – political as well as at implementation level. In Germany the Federal Minister of Health Jens Spahn has been conducive by initiating some 20 laws promoting digital use in healthcare. The Hospital Future Act support hospitals in their digital transformation, e.g. through funding, but also the possibility of penalties for hospitals failing to offer relevant digital services. Sweden’s Vision 2025 for eHealth states has been translated into action plans with prioritized initiatives or projects, national initiatives with a high degree of urgency and that contribute to more than one of the target areas.

At implementation level, skilled staff, familiar with using digital solutions is needed, and a lack thereof thus constitutes a considerable obstacle to the use of digital tools in Sweden as well as Germany. When developing such tools, the user experience has to be considered in order to facilitate the adoption, but also new ways of working, something that Ulf Österstad, Region Jönköping was very clear about. He mentioned that a small group of champions (doctors and nurses) that can lead the way, combined with support to raise the rest of the staff to improved understanding.

Attitudes

Attitudes - among patients, staff and decision-makers - can be important drivers and obstacles for the digital transformation. The German survey indicates that those that can benefit the most, family doctors and hospitals, are not necessarily the ones driving the transformation. According to the discussion, healthcare providers in Germany need good examples of the benefits and the how digital solutions can best be implemented. The Swedish survey showed that more than 50% of the staff surveyed believed that online consultations improved their working day during the pandemic, with advantages of a reduced risk of infection, increased flexibility and improved time effectiveness. There is thus a potential in showing German providers positive examples from Sweden.

Digital care at the emergency departments of University Hospital Kiel and University Hospital Lübeck

Example of Best practice - Region Kronoberg, Sweden

Digital infrastructure and supportive tools

Sufficiently developed digital infrastructure with supportive digital tools are of course part of the necessary foundation. The digital tools should be developed in collaboration between healthcare providers or patients and digital service providers. Standards can play an important role for the legitimacy and functionality of digital solutions. This will also help patients understand which tools can effectively help them in caring for their own health, communicate better with their providers and to share relevant data. While standardized, the healthcare side also wants flexible solutions, with a clear additional clinical benefit of, in terms of better outcomes/higher quality, savings in time, money or other resources).

Several other aspects were mentioned but time wasn’t enough to dig deeper: legislative obstacles, some of them linked to data protection and security, and financial aspects, such as funding, monetary incentives and reimbursement models.

The discussions were concluded by Prof. Dr Friedrich Köhler, Head of the Center for Cardiovascular Telemedicine, Senior Physician, who gave us his vision for digital healthcare at his Department of Cardiology and Angiology at Charité Universitätsmedizin Berlin. He has seen who digital patient contact combined with tools for monitoring and the use of AI both improves the skills and knowledge of the patient and translates into better outcomes. A decision to reimburse digital tools for patients with heart failure has recently been made, and Prof. Dr. Köhler sees the clinical benefits of this, and at the same time a large market open also for innovative Swedish companies. This way, the digital tools and decision-support systems can function as they should – supporting better decisions, while the physician is still the one making those decisions.

Swecare, the German-Swedish Chamber of Commerce and the eHealth Agency would like to thank all presenters, panellists and the participants who were very active in the chat, for joining us in these interesting discussions.