Future Health Day: From paths to the cloud, data and AI

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"In most clinics and doctors' surgeries, things still look like they did 20 years ago. Paper, phone calls, bedside bells and even faxes are still part of everyday life. Considering demographic change, we can no longer afford this. We have to digitize; otherwise the system will blow up in our faces," said Gottfried Ludewig, Head of T-Systems' healthcare division at the recent Future Health Day at Deutsche Telekom. Financing also plays an important role in the digitalization of the healthcare system, as was discussed at the event. With the transformation fund and the special fund, the industry in particular is looking forward to new opportunities.

"If we find that the topic of sensor technology enables us to collect 24-7 data and actually feed it back into the system, then it is certainly not due to a lack of technology," said Ludewig. We need to get the infrastructure out of the cellars and into the cloud and invest in networked systems. According to Ludewig, other countries such as Denmark show that it is possible. Greece has the most advanced telemedicine platform to date.

In Switzerland and Austria, digitalization in the healthcare sector is progressing just as unevenly as in Germany. Only 100,000 people have the electronic patient dossier (EPD), the Swiss equivalent of the electronic patient file (ePA). In Switzerland and the Netherlands, you have to actively consent to state patient files. All other European countries now create these automatically, at least in part, unless you object.

According to Martin Fiedler, Medical Director of Bern University Hospital, attempts have been made to install the EPR for 15 years. The Inselspital Bern is regarded as a pioneer among clinics in Switzerland.

Epic "best decision"

Fiedler explained that 30,000 patients are already using Epic's software at the hospital in Bern. Epic, whose stand at this year's DMEA has at least doubled in size, is one of the largest US companies for healthcare software. Among other things, it can be used to call up X-ray images and medical values, check in at the hospital and more. The system is also networked with aftercare facilities. Fiedler described Epic as the "best decision" that has been made.

According to Dietmar Schulz, CIO at Robert Bosch Hospital, it was not possible to move everything to the cloud from the outset. A gradual transition is required, "and we need an integration platform that enables us to securely connect on-premise with the cloud". The biggest challenge, however, is to make all data identities machine-readable. The Robert Bosch Hospital is aiming for a 5-year plan to rebuild the infrastructure layer by layer and replace the old one. A 5G campus network will probably be set up at the same time. The plan is to build an agile hospital, with doctors responsible for optimizing medical processes.

Digital identities

"We don't need new laws, we have to start now," said Simone Schwering, Deputy Chairwoman of Barmer Krankenkasse, in a panel on whether digital identities, ePA, TI Messenger and co. are enough for the digital health transition. According to Schwering, we have to use what is available. Many possibilities are still unknown, even though they work. The introduction of digital identities, particularly in the healthcare sector, is an important step towards efficient and secure processes. Barmer Krankenkasse has already equipped 2.8 million policyholders with digital identities. "Our policyholders want digital products and are enthusiastic about them," explained Schwering. "Without a digital identity, there will be no completely digital processes afterwards," said Gottfried Ludewig. Secure but accessible solutions are needed.

According to Gematik Managing Director Florian Fuhrmann, digital identities will become more widespread as soon as the Cardlink process, which was launched in 2024 at the insistence of online pharmacies, expires. "We are right in the middle of digitalization." The vision of integrated, patient-centered data management is a paradigm shift that requires time and commitment. "We definitely need to develop into a TI 2.0 and reduce complexity," explained Fuhrmann. The complexity of the telematics infrastructure has been criticized for years.

" TIM, KIM and ePA are just the beginning," said Fuhrmann. Numerous positive things are happening in the model regions, in which around 300 service providers are participating, but the software manufacturers are not yet as advanced as they would like. However, they are making good progress. The electronic medication list has already been able to prevent a life-threatening interaction.

More data use thanks to § 25b

Dr. Irmgard Stippler, Chairwoman of the Board of AOK Bayern, explained the advantages of the possibilities offered by Section 25b of the Health Data Usage Act to pool data for predictive models. Analytical tools have been available to health insurance companies for some time, but now there are more possibilities for "vaccination prevention in care, drug therapy safety and so on". In the past, Section 25b has been sharply criticized by data protectionists, as it could allow health insurance companies to exert a lot of pressure on insured individuals.

At AOK Bayern, one of the use cases was in the care sector to make insured people aware of care situations at an early stage. Another use case is to help people who work in construction to receive medical rehabilitation at an early stage in cooperation with the pension insurance fund. The fund is making slow progress as it is classified as a high-risk company in this area under the AI regulation. Overall, it is necessary to clarify once again what AI is and what it is not. When establishing AI compliance, whether "everything we use is high-risk AI" or not also needs to be clarified.

Fully automate processing

Internally, work is also underway to fully automate processing, with the human being at the end of the process. With a bonus program where you can collect points by going to the gym, donating blood and other things, it takes nine days for a clerk to check this. With AI, this would be possible in real time, with the AI chatting with the insured person and then pointing out incorrect information, for example. As soon as the documents are uploaded, approval can be granted. These are the first steps.

According to Thomas Renner, who is the sub-department head for "Digitalization and Innovation" at the Federal Ministry of Health, the ministry is well on the way to creating the conditions for AI to be used in all policies. "And of course this applies to electronic patient records [...]. But it also affects the hospital sector". What is needed is a "stable, basic digitalization of the infrastructure in the healthcare sector. And I think a lot has happened in this respect," says Renner. Data availability is important for AI and, thanks to the Health Data Use Act, we are also well on the way to bringing AI into use.

The use cases for AI are still being examined internally at the BMG. Many departments are starting with "encapsulated language models". The first use cases are in answering parliamentary questions, where AI provides support. Data from real-world laboratories is also necessary. The quality of the AI systems correlates with the quality of the data. There also needs to be an honest debate about how much efficiency and quality AI solutions bring to a system and whether this can be financed.

(mack)