How do we have to redesign health care so that people have more healthy years of life? Together with several hundred experts, the Austrian association Praevenire is working on the White Paper Health 2030, which is intended to provide an answer to the initial question. One important aspect is digital health, or the digital transformation of health care. Digital health promises a significant further development of healthcare for the benefit of patients. For this reason, the White Paper will devote an entire chapter to the topic of digital health. In order to develop this chapter, an initial interpretative order on digital health was drawn up at the 2019 Praevenire Health Forum as part of a digital health workshop organised by the BFH, which revealed many exciting perspectives for the future. Concrete opportunities and concrete obstacles were identified, as well as open, unresolved questions. Many of these results already seem very familiar to us after a year of intensive discussion, although we are only at the beginning with their understanding. For example, that blended care can save costs and improve the quality of care in very different medical disciplines at the same time. Or that artificial intelligence supports the automation of simple decisions just as much as it helps to recognise risks in general medicine as augmented intelligence and can be used in cutting-edge medicine to organise the wealth of information. However, there are still clear limits to machine learning and the feasibility and quality of the results must be carefully examined in each individual case. Or – to give a third example – that there are numerous possibilities to optimise the system of systems within healthcare by means of Big Data, while at the same time it is difficult to prove the economic benefit of many obvious medical advances. Through numerous individual interviews, several online roundtables and two feedback loops, the original framework was expanded and ultimately led to the identification of ten design principles that are useful and must necessarily be followed for digital health projects and programmes to be successful in practice. These ten design principles are:
- Orientation towards health professionals
- Focus on information flows
- Increased use of augmented intelligence
- Guidance through good practices
- Inclusion of all without blockages
- Security and solidarity
- Interoperability and high IT maturity as the norm
- Good training, continuous education and crystallisation points for new knowledge
- Autonomy and international cooperation
Each of these design principles was concretised by describing forms of implementation, goals and preconditions for success. In total, this resulted in provisionally about 170 different aspects of Digital Health. Only some of these individual aspects are relevant for a specific project. But for many projects, all ten design principles are important. This complexity is surprising. Can’t it be much simpler? Is such an approach even strategically suitable? The answer is that it is both more difficult and much simpler than it seems at first glance. “Inclusion without blockages”, for example, does not mean practising multi-stakeholder management in multi-rational contexts. Rather, it means involving everyone at eye level at the programme level, while concrete projects are carried out in such a focused way that only a few stakeholders are involved and, if possible, there is only one rational perspective. It therefore depends on the correct application of the design principle. The example is also typical in that the digital transformation brings both with it: the confirmation of old truths (e.g. “Usability is important!” becomes “UX is important!”) and the turning away from old principles (e.g. “Everyone must be heard!” becomes “We make sure that few need to be heard by carrying out focused projects!”) In the concrete case, this is almost always quite simple if you know your stuff, and often hyper-complex if you have no idea. A small tragedy lies in the fact that you don’t get praise for getting it right (that would be trivial!), nor for understanding it correctly (that is far too complex!). But praise is not the point. Because the first two design principles define the game: patient-centredness and orientation towards health professionals!
Praevenire Health Forum 2020
The results summarised here will be presented in detail at the Praevenire Health Forum 2020. The BFH Centre Digital Society will once again organise the Digital Health Workshop.