Smart(phone) Medicine

Despite a flourishing economy and well-organised health sector, Germany lags behind in the digitalisation of healthcare. It is about to change now with the support of the hih – health innovation hub established by the Federal Ministry of Health. An interview with Dr Henrik Matthies, managing director of the hih.

Why did the Federal Ministry of Health decide to set up the health innovation hub?

The Federal Ministry of Health aims to transform the complex healthcare system towards a digital one. Already for 15 years, there are efforts to do that. Now the Federal Minister of Health Jens Spahn is very eager to make that a success, realising, there is no way to keep the status quo. It’s about time to take a step forward, and Jens Spahn is not running away from making the right decisions to push things forward. We were established to be a sparring partner for the Ministry of Health and several other institutions that help to manage the health ecosystem. We are also in the role of a connector between different stakeholders.

On the one hand, we try to translate the digital health ecosystem, what the regulations are all about, and how to be adequately prepared to make the best use of them. We also bring this “digital sphere” to the doctors, pharmacists, and anyone who is engaged in this complex healthcare system. We can do this because we come from all different parts of the ecosystem. hih is a team of twelve people, including for example a GP who is still practising medicine. Having such authorities in our team, we want to make sure that whatever we wish to moonshot is at a certain degree possible to implement. We also have experts of interoperability, data formats, who help us navigate through data exchange issues. I’m personally coming from the digital health startup scene. Thus, a bunch of experienced experts from different parts of the market, which together can form this vision and translate regulatory into concrete action.

Due to a hih statement, “healthcare 2025 combines solidarity and empathy with the utmost in organisational and technological innovation.” What steps have been planned on the way to this future vision of healthcare in Germany?

We were quite lucky. A few weeks after our launch, the DVG regulations have been passed (DVG – Digitale Versorgung Gesetz, eng.: Digital Supply Law), an initiative to accelerate the digitalisation of the healthcare market. The DVG is crucial as it’s a brave step towards bringing healthcare system in 2019. According to the Digital Health Index 2019, published by Bertelsmann Foundation, Germany take the second to last place when it comes to the progress of the healthcare market digitalisation. That’s why there are considerable demand and necessity to get going. DVG makes it easier. If a digital health company has a product or service that is fulfilling a certain number of criteria, can apply for a fast-track. The fast-track means that as soon as you are allowed to participate, you are directly in the regular health market – for the first twelve months without scientifically proven studies. Any doctor can prescribe a digital service to any given patient, as long as they are in the public healthcare system. Within the first year, you have to generate data to prove your evidence. So you don’t even need a preliminary certification to apply for this fast-track. However, you have 12 months to deliver evidence. If you fail, you get kicked out of the market and are not allowed to enter it with the same product again. It’s a clear decision-making procedure that is happening within a few months. Before the new law was implemented, it was impossible to enter the german healthcare market with a new digital tool. Now the door has been opened.

“Hih-2025” suggests a time perspective of 2025. Why?

We want to look beyond. The most necessary step right now is to make sure that digitalisation works. And this is what mostly consumed us. But we also want to give a vision, which is especially crucial for the focused on the status quo German market. We don’t do it because we want to have digitalisation. We want to have a better healthcare system. To make this challenge, we need to look beyond and draw a vision: How can we protect our health in a few years? There are so many fantastic opportunities which are never discussed in Germany because we are only concentrating on data security or potential adverse effects. Nobody is talking about all the benefits that are coming with the digital revolution. This is what we want to stand for and develop in an upcoming couple of months.

What exactly can hih deliver what before wasn’t impossible to achieve? Do you believe that after years of stagnancy, the digitalisation will finally start?

Yes, indeed, I am very optimistic. This time we won’t screw it up. It took us 15 years, and almost no progress, to realise that the initial setup is not working. You can’t leave all the decision to market players themselves. There has to be a central authority that develops basic principles. We are here because one thing is to develop a roadmap, but equally important topic is to translate it into action.

You said that excellent health system lacks incentives for innovation; but digital solutions support everyday practice, giving practitioners time to work with patients. Does a good-working healthcare system, like in Germany, reduce motivation to change?

Definitely! Small market like Estonia lagged 10-15 years ago behind. Then the country opted to enter the digital era, with tremendous benefits we see today. Back then, the decision was motivated by limited funding, lack of infrastructure. Estonia could have tried a conventional way but decided to look beyond, seeing, that digitalisation can disrupt the entire system. In Germany, all the market players are in a very comfortable situation because of the traditional model, so no one has any incentives to change. That’s why the DVG is so helpful because it’s bringing new players. Since a couple of years, we have in Germany digital health ecosystem, hundreds of potential applications for this market that are not coming through.

Are you not afraid that the hub – following some critics – will remain an excuse for the Federal Ministry of Health that “something has been done”, “something is happening in this field”, “we are embracing the change”?

There is always a critic, and it’s helpful – you are never 100% perfect. I have some difficulty to understand the line of argumentation that “nothing really happens.”  We have had about 16 legal initiatives within 16 months – it has never happened before. So many things are changing. The Ministry of Health itself, with very experienced legal health experts, may need support from those who come directly from the German healthcare system, to turn legislation into actions.

The goal of the hub is to identify innovation early to evaluate their benefits and promote their implementation in care. How do you want to convince different stakeholders, with different interests, to join?

Before I joined the hub, I had a similar understanding of the market. To my positive surprise, some many individuals are progressive and want to drive change. It’s a real joy to work with them, once they understand what we can bring together to the table. I give you an example. We’ve been on the roadshow recently translating the DVG to different stakeholders. We met over 400 individuals from startups, university clinics, industry, pharma companies, GPs, practitioners. The vast majority was absolutely in favour of what is going to happen. I don’t believe that we will not succeed because of too many resistant forces. I do think that we can succeed because there are enough progressive people who want a change. It’s not just our job to unite them, but we can support this growing momentum and movement towards innovation.

Are the startups the main power to move forward the digital change in Germany?

Startups are a vital force, but it’s about all the players, including insurers, clinics, doctors, media etc. Without them, you will not succeed. There is a lot of buzz around digital health now, and it helps. But in the end, you need working solutions, doctors who try them out and join the pilot projects. And you need payers. Luckily, for 2-3 years, a few German healthcare insurers have identified digital health as one of the critical topics. Already before the DVG, they had invested substantial amounts into the pilot projects to promote digital health.

What does the hub have to achieve so in a few years, let’s say in 2025, you will be fully satisfied with the results?

The one surprising news is that we will dissolve ourselves in two and a half year. The time frame is not so vast. I’m convinced that we have three main topics where we aim to succeed. First, to make the fast-track experienceable so that many German citizens, in a few months from now, realise that something is happening. So, for example, a doctor can prescribe a digital application which is supporting me in a way I didn’t expect before. The second goal is an electronic patient record, which is necessary underlying infrastructure. If we are not able to exchange information securely, if we don’t have a given data format to do that, if we don’t have all the necessary principles in place, the fast-track magic won’t last. This is a job of gematik (Gesellschaft für Telematikanwendungen der Gesundheitskarte, eng.: Society For Telematics Applications Of The Health Card). What we can support is developing use cases, user journeys that convince, from the very early days on, doctors and patients – or citizens – to use this technology. The third part is digital care. We have a lot of focus on prevention and keeping people healthy with some emphasis on chronic diseases. There is a minimal focus on using technology to improve care, especially elderly care. This is where we want to build a supportive ecosystem and bring forward several projects that show technology can also help in this field.

Thank you for your time!