The electronic health record is one of the key applications for digitisation in healthcare. Because it is more than a lifelong data storage device. For this to succeed, however, the applications must also focus on the right target group.
Smart diagnosis and therapy is essentially very easy to describe: to ensure the right diagnosis and, in turn, the right form of therapy, data gathered by both the patient and the doctor needs to be evaluated.
This includes not only the information that a patient and their doctor share or gather during a visit to the surgery, but also a whole host of additional details and data that allow this information to be evaluated effectively with digital tools.
These additional details and data are supplied by digital patient diaries, treatment documentation and all different kinds of devices designed to gather patient data.
The patient keeps the data sovereignty
So that data can be gathered and stored before and after a visit to the doctor, patients need their own patient record solution that their doctor can access. Only in this way can patients save the data that they will later want to share with their doctor.
And only when this data hub is owned by the patient can they gather and save as much data as they need and share this with one or more doctors. A record that actually belongs to the patient is, in accordance with the General Data Protection Regulation, the best solution because this means that the patient has full and exclusive sovereignty over their data. If this data hub were owned by the doctor, the doctor would be responsible for all activities relating to data storage, data protection, data security and authorisation. And this is responsibility that doctors are not willing to bear.
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Markus Bönig is one of the keynote speakers of eMEC 2019, which will take place on 14 November 2019 at the ICM Munich. More information about the program and registration can be found here.
Older patients benefit the most
In addition, only the patient is authorised to link a doctor with other players in the healthcare system (e.g. pharmacies or medical and health care supply stores). If a pharmacy and doctor were located within a single system, this could quickly lead to criminal liability for unauthorised referral. More than 80% of a pharmacy’s total sales depend exclusively on medical prescriptions, so the temptation to engage in prescription steering is correspondingly high.
One problem in this context is that tech-savvy people – in other words, those who are able to manage their medical records via an app or website – are usually not the ones suffering from chronic illnesses and so have little or no contact with their doctor.
The boss of the Siemens company health insurance fund recently summed the situation up in the Tagesspiegel newspaper: ‘Electronic patient records are beneficial mainly to older insured people, who have more frequent dealings with doctors and hospitals, are in poor health or chronically ill. The system currently being developed by the health insurance funds is far too complicated for these user groups.’
Old, sick and with an affinity for technology
So while patient/medical records are undoubtedly important for improving communication between doctors and their patients, gathering more data and sharing and evaluating this data more effectively, it is precisely those patients who would benefit most from this system who are often unable or unwilling to manage these records themselves. Thus the number of chronically ill patients who would benefit directly from smart diagnosis and therapy would be limited. The Online-Therapie.Plus solution from vitabook, for example, enables doctors to transmit all the relevant therapy documentation to their patients in digital form, create an online healthcare account for their patients as well as view and evaluate the data entered by patients.
This is where patient groups who are able to understand and use a website or app come in. These ‘sandwich patients’, who are old enough to be suffering from serious illness but young enough to handle modern technology, are the direct beneficiaries of digitalisation in healthcare.
The health record becomes a patient diary
These patients show a high level of willingness to have their own medical record, but little motivation to actively manage and maintain it. In surveys, more than 90% of respondents regularly state that they’d like to have a record – but maybe tomorrow. A record is not exactly a must-have item, so patients put off acquiring one until it is too late. Only if a medical record is recommended by a doctor during the course of treatment is one actually created.
But if a medical record is an essential element of medical diagnostics and therapy, however, this changes things completely. In this case, a record has to do more than just be a data repository – it has to be a personalised patient diary containing detailed information on the patient’s situation and highly specific instructions for action and documentation. The data contained in a medical record like this constitutes the raw material for smart diagnosis and therapy.