Digital health is associated with many challenges that are not easy to overcome. We have to learn how to deal with them. A good example of the challenges of digital health are digital communication tools. Video conferencing shows us the small, subtle difference between verbal information exchange and non-verbal interaction. There is something missing. Another example: Home office is possible for parents if they also digitalise childcare in parallel using tablets. Here, too, something is missing. And something would also be missing if we tried to transfer large parts of patient care, as we have known it since time immemorial, into the digital world. We live in an enormously method-centred, subject-concentrated medicine that produces an unmanageable amount of information. Sorting this data and information is no problem for various digital health solutions. However, the evaluation of their relevance for an individual patient in her socio-economic environment, the derivation of necessary measures and not least the assumption of responsibility for these measures will – from my point of view as an ophthalmologist – always require a human being or a member of the many health professions.

Digital health solutions require a paradigm shift

Even though this fact was known – with digital solutions showing little of this understanding – people shied away from the resulting questions until the beginning of the Corona crisis. Because if digital health solutions are to support people in health professions, then the framework of our actions and paradigms must also be reconsidered. The patient himself becomes the health-competent manager of his health. He decides for himself when he shares which information with whom. His personal health data will be managed decentrally, namely by himself. The compatibility of individual technical solutions with all systems or medical technology products is essential. At the same time, just because a doctor has access to all data, she cannot collect all data and therefore in some cases no legal consequences can be derived. All these framework conditions do not really fit with the world of patient care in which we lived until shortly before the Corona crisis, but they are essential for a meaningful, enriching use of digital health. And it is precisely this still missing commitment to paradigm shifts that makes it enormously difficult for decision-makers to decide for or against a new digital health system in view of its complexity and scope. They are noticeably overtaxed and left alone. The Corona crisis suddenly freed up the necessary financial resources. However, financial resources do not promote openness and understanding of the need for the complete restructuring of processes.

The focus remains on the human being, the patient, but also the doctor

Therefore, in my view, technology is not the problem at all in this time of Corona crisis – as long as one is allowed to ignore budgetary constraints. The challenge is to find the right technical solutions in this situation to really (!) support patients and doctors in their regional environment, and to get the appropriate backing for the use of these solutions. We will urgently need these technical tools because we are already heading for what I see as an enormously challenging situation this autumn. Many people with a declining understanding of social distancing in closed spaces can bring us into a situation that we were still able to ward off in the first wave. For my professional tasks, I have adopted the symbol of the 4/4 cycle for my strategic personnel planning for autumn and winter 2020:

• The first quarter of my team will probably be sick or possibly feeling sick during the flu season – in any case, too rattled to go to work.
• The second quarter will be quarantined for a certain period of time according to official guidelines. You never know.
• The third quarter will be completely overwhelmed with the constantly changing conditions and will have a high need to talk, maybe even a touch of burnout. Enough, in any case, to be unable to work efficiently. And that is legitimate. We will have to pay particular attention to this quarter, because it will tip the scales in many situations in terms of the efficiency of the entire team.
• And the last quarter will be the one that actually delivers the core performance of the company.

In my view, it will be significant that we will all find ourselves in a different one of these quarters day by day or week by week, whether we like it or not. In other words: We have to expect reductions in performance, no matter how motivated a team is. A frustrating thought, but in terms of planning probably closer to real feasibility than the usual Vogel Strauss tactic of waiting and reacting. And it is, in my opinion, the visions of the leaders that give a team support and orientation in uncertain times at work and even in private life. I see this more as an opportunity in terms of the team and the company. Encrusted “it’s always been like this” thinking suddenly has no place any more. Openness to change is clearly noticeable because forced but planned changes are less unpleasant than unplanned ones. One of these changes will be the new era ushered in by Digital Health, which can partly compensate for many processes that suffer massively and are restricted by the pandemic. Targeted patient flows, avoidance of multiple examinations, prevention of excess mortality through comprehensive communication. There is a high probability that managers will back the wrong horse in the various solutions – this is called evolution. Health systems are too heterogeneous for there to be global “one-size-fits-all” solutions: A certain learning curve will be unavoidable at the regional level. Not taking bold steps in this direction, however, means letting opportunities to maintain or improve a health system in a pandemic pass by. It is not only the time for political chump change, but also for pioneers. As always, it is up to us what we make and want to make of this crisis. Social Closeness despite Physical Distancing, as far as technical aids and protective equipment make it possible, will shape my future professional world. I don’t know much about the term social distancing. I am convinced that we will very quickly find ways to adapt and get used to the new circumstances. As always, life goes on. Different. But similarly colourful.

The series

Part 1: There is no going back to the pre-crisis era was published on 24 July.

Note

For ease of reading, either the masculine or feminine form of speech has been used. However, in all statements both genders and all others are included.