Technology assessors: Major need for reform for a breakthrough in telemedicine

Telemedicine only received a brief boost during the coronavirus pandemic. Medical care for patients from a distance using information and communication technologies has been seen as having considerable potential for years. It should help to reduce travel and waiting times, detect deterioration in a patient's condition earlier, avoid hospital stays, provide specialist expertise more comprehensively and provide services more efficiently. The increased use of telemedicine applications (TMA) is also necessary in view of demographic change and the shortage of specialists, explains the Bundestag's Office of Technology Assessment (TAB). Nevertheless, the approach still faces numerous hurdles in Germany.

Telemedicine is "only slowly finding its way into regular medical care", according to the recently published study. This indicates "that normative, organizational, technical, personnel or social barriers" are limiting the spread of the technology. It is also possible that "the hopes and expectations of the healthcare system are too high and the potential of telemedicine" is overestimated. One thing is certain: "A variety of telemedicine pilot projects have been carried out in Germany for a number of years." There is also a special innovation fund for this. However, the transfer of pilot projects to standard care is proving difficult.

The researchers are calling for reforms to enable the regular use and billing of teleconsultations, telemonitoring and video consultations. Laws, guidelines, contracts, remuneration catalogs and certification procedures for technical components would have to be developed, adapted and updated. There are currently no standardized paths to regular care structures, "also because the outpatient and inpatient sectors, emergency rescue, rehabilitation and care are regulated, organized and financed independently". Only in outpatient care could individual new telemedical services be remunerated due to the high level of disaggregation.

Sticking points: IT equipment and networks

The authors also believe that the inclusion of telemedicine service items in the billing basis is no guarantee of a breakthrough. All parties involved would have to break down barriers to application in order to promote acceptance of the technology in medical treatments. However, TMA requires "reliable and high-performance internet availability". The scientists complain that rural regions in particular, where hopes for an improvement in care are the highest, often suffer from poor network coverage.

According to the study, doctors and patients need "at least a certain level of basic IT equipment" as well as corresponding application skills. Security requirements that comply with the General Data Protection Regulation ( GDPR) have been defined in the Federal Mantelvertrag, certification procedures have been established and lists of tested services are available. Nevertheless, "considerable efforts will still be needed in the future to digitize a wide range of processes and improve the interoperability of different IT components".

Switzerland as a pioneering country

According to the experts, this also applies to processes in which medically relevant data is collected, transmitted and analyzed in order to record the situation more precisely from a distance, create findings and initiate the necessary treatment steps. Devices and software used for this purpose must be certified as medical devices within the framework of statutory health insurance. To this end, manufacturers would have to prove their safety and performance and also test them during use. Some medical devices, such as CT/MRI devices, may only be used in medical facilities by trained specialists.

According to the report, Switzerland, for example, is already further ahead with teleconsultations: At the company Medgate, 320 employees look after around one million patients per year in video consultations.

In this country, virtual consultations only seem to have become widespread among psychotherapists. Otherwise, the established structures would be retained and at best supplemented with digital components. It is therefore also important to anchor TMA in education and training, create specific support services for service providers and set up joint platforms with reliable services. With the law on the digital modernization of care and nursing, the Bundestag actually wanted to give telemedicine a boost in 2021.

(olb)