At the Praevenire Health Days at the Seitenstetten Monastery, more than 40 experts spent a day engaged in discussions about the digitalisation of health care. The first half of the symposium was about blended care and ELGA as an operating system for digital health.
Based on the results of the two previous PRAEVENIRE Digital Health Workshops 2019 and 2020, four upcoming transformations of the healthcare system were jointly analysed:
- The transformation from conventional healthcare to blended care
- The transformation from the use of the ELGA software available today to the comprehensive use of ELGA as an operating system for digital healthcare
- The transformation from human data analysis to augmented intelligence
- The transformation from an erratic discussion of the digitisation of health care to a factual discussion of the opportunities and risks
The detailed expertises of the participants of the symposium will be incorporated into the next version of the PRAEVENIRE White Paper “Future of Healthcare” (version 2021/22). The results are briefly presented and explained below.
Blended care is the integration of conventional care with telemedicine, apps and digital measuring devices that are operated by patients themselves or worn on their bodies. The diverse contributions to the discussion in the symposium showed that the potential of blended care is much more extensive than previously assumed. Due to this complexity, considerable hurdles (technical, legal) have to be overcome for practical applicability and implementation in the health care chain. The integration of telemedical elements, digital data measurements and apps offers numerous options for significant improvements in all areas of healthcare.
A distinction must be made between three forms:
- The conventional forms of blended care are already being practised experimentally or researched scientifically.
- The necessary technical solutions are currently being developed for the forms of blended care that have so far only been conceptualised.
- The unconventional, creative forms of blended care have only idea status so far. The conventional forms include (but are not limited to):
- Inclusion of online services at the GP and in the hospital
- Professionally guided self-measurement
- Use of apps, for example in psychiatry and oncology
- Use of devices on the body, for example for fall detection or fall prognosis
They reduce the time spent by service providers without great additional costs and thus make medical care more patient-friendly. They support communication and improve the information situation for diagnosis and therapy decisions, thus improving the quality and effectiveness of care. And they offer spontaneous help in situations that are subjectively perceived as stressful and promote active engagement with one’s own health or illness, which in some cases leads to measurably better therapeutic success. However, the challenge here is to institutionalise these care concepts so that as many patients as possible can benefit from them.
How do wearables help?
In the field of digital research and development, much revolves around measuring devices on the body, interpretation aids and autonomous control of devices. There is still a long way to go here and it is unclear for the time being what will become established in practice – especially where there is only an indirect benefit. The challenge here is to establish broad knowledge sharing between medical research, health professionals from practice and technology innovators that goes beyond interdisciplinary collaboration in individual projects. The field of unconventional, creative forms of blended care is particularly rich. At the symposium, various ideas came up for which there is little or no research and development for the time being. Some of them could nevertheless be put into practice in a few years, because they bring direct benefits to the patients or correspond to the innovative wishes of the health professionals.
All in all, blended care can bring healthcare closer to the patients and address the growing diversity of life courses. It thus represents a significant further development of the concept of care close to home. In addition, there is initial evidence that blended care provides better outcomes at lower costs in some situations. The symposium showed that this potential is probably greatly underestimated because there are still many concrete areas of application that have not yet been studied. Most importantly, blended care empowers patients to play a more active role in their recovery and to proactively manage their own health as a precaution. However, the implementation of blended care is not a foregone conclusion.
The effort for doctors and health professionals to introduce it varies – sometimes very little, sometimes quite a lot. Guidelines, basic concepts for quality management, support for pilot projects, further training and advice for interested professionals are needed in order to use the potential of blended care. Furthermore, there are open questions around the emergence of a functioning innovation ecosystem and around legal liability. Moreover, it is foreseeable that the complex mix of interests will lead to substantial resistance when institutionalisation is imminent. The great challenge is therefore, on the one hand, to enthuse health professionals for these new forms of care for the benefit of patients and, on the other hand, to regulate the financial remuneration of the services to be provided in such a way that there are no economic reasons for health professionals to reject this transformation. In the symposium it became clear that blended care will significantly improve health care if – and only if – institutionalisation is approached holistically.
ELGA as an operating system
ELGA is the data flow infrastructure for the Austrian health care system, which enables not only cross-organisational intra-Austrian data exchange but also international data exchange. As many anecdotal experiences and imperative demands there are around ELGA and as solid opinions on ELGA are, the actual knowledge about ELGA is low. It is largely unknown – what ELGA actually is (and what it is NOT) – what it can do and what it can be used for – what is technically missing for its potential benefits to be realised – which practices fundamentally block the flow of information in the health system
Medicine and informatics
The current situation shows that, on the one hand, evidence-based medicine is aspired to by many, but information-based medicine is often rejected. The awareness that evidence-based medicine presupposes the existence of usable information is certainly present, but it only materialises where the non-knowledge is very concrete, for example in the case of rare diseases. Otherwise, awareness of the need for an information-oriented health system is often overlaid by interest politics, which creates “cardboard dummies” that obscure the view of what is urgent.
- Firstly, the development of situationally designed user interfaces that use ELGA as an operating system for digital services in the healthcare sector is urgently needed. Such user interfaces are lacking, especially for doctors in typical treatment situations. But other health professionals would also benefit from access to patient data thanks to such user interfaces and – this was a central topic at the workshop – patients could actively use ELGA themselves.
- Secondly, it would be urgent to show objectively where information needed in the health care system is not produced and why it is not produced, in order to then clarify in a broad discourse to what extent we really want to accept the absence or inaccessibility of important information in the health care system.
Are we willing to forego personalised precision medicine because data use bothers us or the documentation of disease progression and therapies is too burdensome? While the development of user interfaces is a technical task that must be financed, the discourse on an information-oriented health care system is a professional discourse that a priori has nothing to do with technology. Without this technical discourse, the development of technical solutions will not adequately address the actual needs and the digital transformation of the health system will remain in its infancy for years to come.
The symposium showed that without a massive broad dissemination of knowledge about the requirements of information-oriented health care and the functional characteristics of ELGA, no progress around ELGA can be expected in the next few years. As long as the WOZU of ELGA is not clarified and widely accepted, there is little hope for further development. Since some participants at the symposium considered this clarification unlikely due to existing sensitivities, the question was even raised as to whether it would not be better to make a new start under a new name in order to build the infrastructure for digital health.