Digital Health in the Covid-19 crisis (3) – what should now be improved
During the lockdown, many countries had positive experiences with digital health (Atique et al., 2020). We should definitely continue the development that has been initiated. This means concretely: 1. Integration of telemedical services into conventional health care: Wherever the renunciation of physical face-to-face appointments only marginally reduces the quality of health care, but eliminates its disadvantages (risk of infection in the waiting room, travel costs for patients or vice versa for health professionals, etc.), face-to-face appointments should be replaced by telemedical service provision. Where physical face-to-face appointments are necessary, these can be made up for or telemedical consultations can be carried out alternately with physical consultations. 2.Better time management in the waiting room: In some medical practices, it is common for patients to have to wait 1 to 3 hours despite having an appointment. This problem can – and must – be alleviated through adequate planning. 3.Outsource measurements to pharmacies and patients: Many measurements, for example blood pressure, blood sugar or urine values, do not have to and should not be taken in medical care facilities. The further development of measuring devices allows for a shift of measurements closer to the patients. 4.Comprehensive digital communication along all those involved in the treatment chain: The fact that information has to be physically passed on by patients is no longer appropriate. A first step towards dismantling these 19th century practices is e-medication. 5.Involving patients/clients in the collection of data on their health status and progress: Health professionals should offer appropriate (web-based) applications so that patients/clients can enter data on their health, symptoms or measured values themselves before a telemedical service or a physical face-to-face appointment or during follow-up. This not only saves the health professional’s time, but also enables him/her to immediately assess the health situation. 6.Remote involvement of experts in the treatment practice: Digital tools allow experts to be called in from outside for difficult diagnoses or therapy decisions. Among other things, this makes it possible to provide medical care close to home without quality risks for patients and can significantly speed up the diagnosis. However, the lockdown has also reminded us that much of the homework for the digitalisation of the healthcare system has not yet been satisfactorily completed. What is needed in particular is: 7.Establishing efficient and accurate information processing in the event of a pandemic: Information processing is currently based in part on organisational structures that have grown historically. It does not use the potential of information technologies for system-wide processing of distributed information, although corresponding solutions have been in use in other areas for two decades. Adapting these adequately would save costs, improve the quality of information and enable targeted reactions to the spread of infection. 8.Eliminate media discontinuities and ensure widespread interoperability in the health sector: Media disruptions reduce efficiency to such an extent that in practice this leads to a reduction in services at the expense of patients. Possible cooperation between service providers is blocked because the information processing systems used are not interoperable. These problems can only be eliminated if all disciplines and all roles pull together for the benefit of patients and support the digital integration of information flows. 9.Replace textual deserts with consistently generated semi-structured data: The documentation of treatments is very suboptimal in several health professions and for different reasons – from the long text reports of nursing to the non-documentation of diagnoses in practical medicine and the incomprehensible doctor’s letters and invoices to the pdf graveyards in patient dossiers This causes useless time expenditure and blocks the use of information in parts entirely. Here, both digital translation tools and changed information generation practices can bring significant improvements. 10.Widespread use of smart digital tools: Digital tools can support the work of health professionals in many ways and enable them to treat patients more effectively – from ambulance services and general medicine to cutting-edge medicine for very serious diseases and other health care services. What is needed is for institutions and professionals to stay on the ball, educate themselves and develop their practice. 11.Building, promoting and updating digital competences: Both health professionals and patients/clients/residents must have adequate digital competences. Health professionals need to build, develop and continuously update these through appropriate (online) training opportunities so that they in turn can empower their patients/clients/residents in a goal-oriented and value-added use of digital tools. 12.Accelerated expansion of disease registries: Digital disease registries are valuable sources of information for research and the further development of personalised precision medicine. They form an important foundation of evidence-based medicine and are also of great importance for health resource planning. Therefore, their expansion should be driven forward with commitment and supported financially. The lockdown has also reminded us that practicable solutions are lacking in some areas – especially for how existing data can be used sensibly. Sometimes these are blocked by group interests with false pretexts, sometimes there is either no consensus or no technical solutions. These problems need to be addressed. 13.Clarification of the fears of doctors and other health professionals of too much transparency: Often data protection for the health professionals is meant when data protection for the patients is called for. Or it is about financial compensation when talking about the quality of treatment methods. It is therefore urgent to talk about the real reasons why digitalisation for the benefit of patients is often blocked by the very people who dedicate their entire professional lives to this benefit. 14.Develop practicable governance concepts for the handling of personal health data: Information is one of the most valuable assets for research, practice and quality control in health care. Nevertheless, we are hardly making any progress in the use of information. Clear rules are needed for the handling of personal health data that exploit opportunities and minimise risks. These rules must be based on the state of the art and the benefits for patients, not on the security needs of those responsible or on ideologically formulated red lines. 15.Further development of technical solutions to protect privacy: We need technical solutions that make the misuse of data as difficult as possible and thus pave the way for an effective use of the potential of personal health data. In addition, there are issues that have been in our consciousness for a long time and will remain for a long time. We should continue to pursue them even in the current health crisis: 16.Promoting interdisciplinary collaboration processes: Information flows need direct exchange in addition to data flows. Often, physical exchange is even a prerequisite for the effective use of digital communication tools. This physical exchange needs suitable organisational structures and processes. Primary care units with as many health professionals present on site as possible are an example of how to take big steps forward. 17.Joint training of the health professions: The blockages in the flow of information in the health system can only be overcome through the commitment of all those involved. They have to perceive each other as useful and valuable so that they actually work for blockage-free information flows. Joint training is very effective in promoting the necessary mutual appreciation.
- Atique, S., Bautista, J.R., Block, L.J., Lee, J.J., Lozada-Perezmitre, E., Nibber, R., O’Connor, S., Peltonen, L.-M., Ronquillo, C., Tayaben, J., Thilo, F.J.S. and Topaz, M. (2020), A nursing informatics response to COVID-19: Perspectives from five regions of the world. J Adv Nurs. doi:10.1111/jan.14417