Here to stay: Digital health in times of COVID-19 – a German deep dive
How Germany’s vibrant digital health ecosystem supports the nation’s coping with COVID-19, and what impact the last few days in crisis mode already have onto the digitalization of Germany’s healthcare system.
If the COVID-19 pandemic would have hit Germany only 1,5 years ago, the situation would have been worse. Since 2018, the German Minister of Health, Jens Spahn, has pushed forward an unprecedented amount of legislative actions to digitalize the – for very long purely analog – German healthcare system. The comparatively reduced threat to the German healthcare system but also to the overall health of the population can also be explained by looking at the various digital health solutions already in place today. Let’s take a closer look.Social distancing in healthcare = telemedicine
Social distancing in healthcare = telemedicine
In the current crisis, social distancing is key in order to reduce the otherwise exponential infection rate. As late as December 2019, the German parliament passed the DVG (digital care act). Enacted ‘just-in-time’ for Corona, the DVG expands video consultations to all physicians/medical disciplines. Facing COVID-19, the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, KBV) was quick to lift limitations and barriers: much less limitations in terms of the amount of video consultation for physicians, more possibilities for video consultations for psychotherapists, the possibility to issue a certificate for sick leave without personal contact etc.. An up-to-date list of these services incl. costs, reimbursement policy, functionality and prices can be found here. And the effect?
We see a surge in the demand for video consultations: one provider alone recorded 100.000 minutes of telemedicine service per day in comparison to 30.000 minutes per day prior to Corona. Across all providers demand is increasing while some physicians make their very first experience with video consultations. Many providers, such as Deutsche Arzt AG, quickly opened up their solutions to other healthcare professionals like physiotherapists. Kry, market leader in Scandinavia and now also active on the German market, offers its entire service for free for especially hard hit areas such as Heinsberg, Germany’s epicenter of the pandemic, as early as February 2020. In the past week alone, Kry reported a 200% increase in demand for its video consultation service. Germany’s telemedicine pioneer Teleclinic reports a weekly 50% increase in demand since the outbreak of Corona. Today, almost all telemedicine providers offer free consultation for every German citizen regarding COVID-19.
- So far, the crisis has been a catalyst for telemedicine services in Germany. In addition to pure telemedicine providers, physicians, psychotherapists and other healthcare professionals adopted the technology, patients are increasingly looking for virtual support by their physician.
Bots & Co – the power of automated triage
Before 2018, it would have been impossible to envision a German healthcare system were chatbots and apps guide the population or in which healthcare authorities discuss digital health product strategies. In the early days of COVID-19 in Germany, thousands of physicians were overrun by anxious patients who followed known routine and physically went to a doctor whenever facing a medical challenge.
Leipzig-based DocYet launched their Corona chatbot early on in March as a CE-certified medical device, relying on guidelines by the Robert-Koch-Institute (RKI), Germany’s central scientific institution for public health. The German healthcare stakeholders needed the intense discussions of the past years in order to trust digital solutions: requirements, reliability, medical-product certification, how to apply evidence-based medicine to digital health and how to deal with limitations of digital health. Germany’s digital health champion Ada will launch their Corona triage solution shortly. During this crisis, we see exciting debuts in the digital health sphere: Charité, Germanys leading university clinic, has launched their online self-assessment system, CovApp., the RKI is working on several digital Corona solutions and is said to publish the first within the next days.
- COVID-19 is encouraging established healthcare authorities to develop – within days and very often for the first time – digital health products and an according strategy. This is possible because both decision makers and the market are ready for this new paradigm.
Prescribing digital health applications – the DVG fast track vs the pandemia
In terms of digitalization, Germany has been lagging behind for the last two decades. This changed with dthe DVG, an internationally unprecedented law passed by the German parliament in December 2019, that revolutionizes the use of digital health applications (Digitale Gesundheitsanwendungen, DiGAs): Starting this summer, any physician in Germany may prescribe digital health solutions to publicly insured patients, while the DiGA-providers will be reimbursed for their services by the national statutory health insurance funds.
In the light of this law, a vibrant digital health ecosystem has emerged in Germany that, despite lacking market access so far, has diversified into all healthcare related areas: from screening, prevention, diagnosis, treatment and rehabilitation to elderly care. While the majority of the ecosystem consists of small to medium-sized startups, most of their products and solutions are already CE-certified as medical products, often come with scientific evidence and follow international standards.
This ecosystem reacted almost instantly, adapted their existing scalable solutions for Corona specific requirements and thus significantly relieves the healthcare system today.
Take Caspar Health, a provider of digital rehabilitation solutions: Before Corona, they were already active in 100 rehabilitation clinics and provided tens of thousands therapies to patients so far. Since Corona, they onboarded another 70 rehabilitation clinics in a few weeks and in the past week alone as many therapies were started as in the past three years combined. In one week.
An impressive number of companies have switched to free service during Corona. Among them are the mental health market leaders HelloBetter (former Get.On) and Selfapy. Both now offer specific Corona support including hotlines, guided programs, coaching and other services at large for free and are confronted with a significant peak in B2C-demand but also requests from companies, universities and other institutions to provide their employees, students etc. with a structured mental health program.
From today on, market leader Kaia will offer free 3-months vouchers for their motion-coached backpain product, after a 40% increase in daily in-app activity rate since Corona hit Europe.
Many healthcare jobs so far required physical interaction. Corona forced them to rethink their entire modus operandi. Pregnant German women and their partners were used to attend physical prenatal classes. Companies like Keleya offer now various online courses in collaboration with the German midwife association and already see a 10x increase in demand, compared to pre-Corona. Kinderheldin, another pregnancy solution provider, has quickly added a live-course platform to its offering alongside digital coaching and had an almost instant demand spike of 70% within a week.
And in case you simply want to keep track who you met recently in order to react when you or your peers get infected, the Coronika app supports you with a digital interactive diary and provides you with all information you need when in doubt.
- Healthcare players from all sectors quickly integrated digital health solutions to combat losses from the analog lock down of the country. Millions of Germans are now experiencing digital health in the ease of their homes, often for the first time. In the future, many will expect to choose between analog and digital care, aware of the pros and cons of both channels.
Germany will continue its long-needed leapfrog towards a digital-backed healthcare system. The legislative pipeline is packed and on track: this Summer the DiGA FastTrack starts. From January 1st 2021 onward, every statutory health insured German (>85% of the population) is entitled to the German version of a personal electronic health record (EHR), a record that is provider-agnostic, thus works across the entire healthcare system. Physicians as well as hospitals will be incentivized to use the EHRs. E-prescription will follow later in 2021. After years of discussions, Germany has finally paved way for Snomed CT membership and is now pushing all healthcare sectors to move towards international data formats and interoperability, including the for very long rigid proprietary IT-systems of physicians and clinics.
It is too early to call Germany a digital health nation. The country lost a lot of time and it will remain a challenge to catch up. But the past days and weeks of the Corona pandemic spurred a large-scale demand and supply of digital health solutions that otherwise would have needed months if not years to be accepted and used by patients alike physicians and other healthcare professionals. The digitalization agenda of the Ministry of Health is further sustaining this development, alongside a vibrant digital health ecosystem.
Dr. Henrik Matthies is the hih’s Managing Director.