Telemedicine specialists call for robust infrastructure for information exchange
In times of a growing shortage of doctors, especially in rural areas, telemedicine is a helpful addition for patients – despite the difficult conditions.
From left to right: Rainer Beckers, Managing Director of ZTG GmbH; Dr. Jan Hensmann, Head of Gematik, Telematics Infrastructure and eHealth at the BMG; Thomas Ballast, Deputy Head of TK; virtual: Dr. Eimo Martens from the telemedicine center at the Klinikum rechts der Isar of the TU Munich and Frank Hennemann, Head of Patient Relations at NELA, and himself affected.
(Image: ZTG GmbH)
In the coming years, there will be an increasing shortage of doctors to provide care. Telemedicine, whose beginnings date back 20 years, should help, especially in rural areas. Progress has already been made, said Gernot Marx, Chairman of the Society for Telemedicine at the 14th Telemedicine Congress, where an audience award was also presented. At national level, for example, teleintensive care has received a boost, and the ban on remote treatment has been lifted over many years, making video consultations possible.
The Society for Telemedicine agrees that hospital reform can only succeed with telemedicine. Telemonitoring can be used to detect at an early stage if a patient's condition deteriorates. Telemedicine options are already available for heart failure in particular, some of which are also covered by health insurance companies. However, the regulations for transferring projects to standard care are usually very complex, Marx criticized. Telemedicine can provide a great deal of security, especially for chronically ill patients or people who have had an operation. Telemedicine specialists or hybrid doctors, as Health Minister Karl Lauterbach calls them, should not replace GPs.
"Efficient telemedicine centers (TMZ) that can collect and evaluate data on a relevant scale are crucial for the successful integration of telemonitoring," says another DGTelmed demand. As part of the hospital reform, not every clinic will have to be able to offer all services in future, but experts should be available via digital media – teleconsultations and televisits –. This requires a "functioning technical infrastructure". With the start of widespread use of the e-prescription, there was repeated criticism – for example due to disruptions to the services of the telematics infrastructure, which is intended for secure data exchange.
Communication channels and platform for data exchange important
"Well-structured" and secure communication channels are important to enable communication between other specialists and GPs, but also with patients. The DGTelmed is therefore calling for "the establishment of professional structures to bring telemonitoring to a more economical and quality-oriented scale". Equally important are "jointly managed" electronic case files to avoid the need for faxing. The electronic patient file for everyone will not be ready by January. Nevertheless, the telemedicine specialists present at the congress in particular hope that it will soon be possible to exchange patient data.
According to the DGTelmed, "qualified and manufacturer-independent advice, supported by a transparent criteria framework and a professionally sound evaluation portfolio" would be helpful. In addition, the systems must be interoperable and enable data to be exchanged between doctors from hospitals and GPs, for example. Both the KIM service for communication in the medical sector and the TI messenger TIM are currently not equipped for this. In addition, many users believe that the KIM service has hurdles and is not yet where it should be.
Building trust and motivation
DGTelmed sees "great potential for improving care" in the digitalization of the healthcare system and wants to help improve the digital structure. However, the "different roles of the digital health agency as a supervisory authority and at the same time as a market participant [...] contradict good governance", which has already been criticized by other parties. Instead, the company advocates confidence-building and motivation. Eimo Martens, who heads a telemedicine center at the Klinikum rechts der Isar of the Technical University of Munich, also emphasizes that GPs are still important for patients, as is the exchange between hybrid and GPs.
The deputy head of Techniker Krankenkasse, Thomas Ballast, expressed his satisfaction with the progress made so far in the digitalization of the healthcare system. After a long period of "at least perceived stabilization, we are now faced with truly available and ever-improving technical solutions", the telematics infrastructure intended for the exchange of health data. This is particularly important for the provision of care in rural areas. Techniker and other health insurance companies are currently running various pilot projects for telemedical care. Accordingly, TK has now also launched a project in which nursing staff visit patients in rural areas with a telemedicine backpack – a doctor is called in if necessary. This allows wound care to be monitored, for example.
KIM and TIM before the win
Some of the systems, such as those with connectors for connecting to the telematics infrastructure, are still outdated, said Thomas Ballast, deputy head of the technicians. However, this should change soon – the KIM service (communication in the medical sector) and the TI messenger TIM are already available as uniform communication standards. According to Ballast, the potential game changer is the "electronic patient file for everyone", which all those with statutory health insurance are to receive automatically on January 16. TK is expecting 20 to 30 percent of objections, and most people will probably not opt in, says Ballast. He hopes that TK will quickly succeed in filling the ePA with billing data, as it is largely an empty file folder. Anyone who currently goes to the practice with the ePA is currently a special case.
Ballast also spoke about the "Semcon" innovation fund project currently underway at TK, with which TK wants to find out how the routine data of health insurance companies can be used to determine patient needs. The private health insurance companies would like to get involved as soon as they see added value for healthcare. According to Ballast, the expansion of Gematik into the "Digital Agency for Health" is also helpful for digitization projects. It has also been known since yesterday that Florian Fuhrmann is to become the new head of Gematik – he is the head of kv.digital, a subsidiary of the National Association of Statutory Health Insurance Physicians.
Special love for data protection
Ballast also complained that data protection was preventing user-friendliness. "In Germany, we [have] this special love of data protection and data security, which means, for example, that we [...] have a higher level of security than other countries." He pleaded for "a better relationship with data protection and data security". "There will never be 100% security," said Ballast.
The e-prescription has already arrived in the population, reminded Jan Hensmann, Head of Policy Issues at Gematik, Telematics Infrastructure and eHealth at the Federal Ministry of Health. A cultural change is already taking place. According to Hensmann, those involved in the digital transformation need to embrace something new. Interoperability also plays an important role in the digitalization of the healthcare system. The "technical feasibility" of this is a regular topic, emphasized Hensmann. "Digital care" should therefore also become part of medical training.
(mack)
