Mystery doctor’s letter

The report is two weeks old, it has what it takes to become a scandal and yet it goes unheard: a large number of general practitioners spend up to an hour a day reading medical letters, especially from clinics. And they don’t understand them. A study conducted by the University of Düsseldorf has shown this very clearly. The Ärztezeitung has reported on this. Nobody should be able to say that he did not know. And yet: Nothing.

Incomprehensible abbreviations, superfluous information, no structure, real gaps. The doctor’s letter in its current form is obviously not a suitable instrument for doctor-to-doctor communication. There are clear legal obligations for reliable discharge management. Author and reader of the letter also both studied, even the same subject. Nevertheless the quality of the communication is so miserable that the physician letter is more than a source of error: It is obviously a mistake warranty.

And yet I am again meeting players in the healthcare sector for whom the scan of a handwritten doctor’s letter is already a step in the direction of digitization. Most recently at a high-ranking conference in Berlin in April 2019. Spoiler alarm: It’s not. The study by the University of Düsseldorf clearly shows how low the fruits of the digitisation of the health system actually hang. 12,000 symptoms are classified. They must be recorded and documented, and one or more of the 10,000 diseases described must be deduced. What is an ongoing overload for the human brain mutates into a finger exercise in digital communication. Every computer science student in the first semester will program a communication logic that reliably processes and transports this information. Just as a warm up in the morning.

Did we ever think that a letter was the right medium to share complex medical data? We are not yet talking about the legitimate requirement of patients to receive their own medical data and its clinical interpretation first and foremost themselves – and in an understandable form. Anyone who has a serious interest in increasingly digitalised medicine for the benefit of people will start tomorrow.

Three questions – three answers: Dr. Stefan Knupfer, Board of Directors at AOK Plus

The 2b AHEAD expert network in dialogue. Health experts regularly raise relevant questions on the future of health. Other experts from our network comment on this – and in turn ask new questions that will go to new experts. In this way, an inspiring dialogue grows and we will continue to expand it.

Focus today: Dr. Stefan Knupfer from AOK Plus

The expert questions today go to Dr. Stefan Knupfer, Deputy Chairman of the Board of AOK Plus for Saxony and Thuringia, based in Dresden. In 2006, Dr. Knupfer was appointed as an authorised representative of the Management Board. With the merger to form AOK PLUS, he assumed the role of Managing Director of the Market Division. Since 2011, he has worked as Managing Director of the Finance/Controlling unit and authorized representative of the Executive Board.

The future of the principle of solidarity in an ageing society

Peter Ohnemus, DacadooPeter Ohnemus, founder and CEO of Dacadoo: How can the principle of solidarity be financed in a world where we live to be 85 years old on average and where 30% of the German population will soon be 65+? 

 

Dr. Stefan Knupfer, AOK Plus

Dr. Stefan Knupfer, Deputy Chairman of AOK Plus: The logic underlying the solidarity principle to this day is based on the assumption that an ageing society must also be a sicker society. I think this approach is obsolete.

Isn’t it rather the case that older people stay healthy longer and age healthier? Isn’t it also the case that ageing people today have better and cheaper therapies available than a few years ago?

The main burden of health expenditure in a person’s life lies in the last three years of life and is significantly higher for chronically ill people than for those who are not chronically ill. So is it not much more sensible to focus on the prevention of chronic diseases at this point? I think that the digital transformation offers numerous opportunities here, the potential of which is currently far from being sufficiently exploited.

The fact is that both medical progress and, in particular, digitalization are progressing at a rapid pace. This is accompanied by numerous opportunities that have not yet been exploited, or only insufficiently exploited, to make health care more efficient and different, without losing sight of the well-being of the individual in an ageing society.

In addition, the social and economic system in Germany is currently essentially based on private property, whereby a redistribution principle or the approach of a Sharing Economy has so far had little effect. As a result of demographic change and increasing tendencies towards individualisation, the solidarity principle of statutory health insurance schemes is getting into difficulties. In the future, this will pave the political way for a citizens’ insurance to provide basic services or a new financing of the solidarity principle through tax subsidies, e.g. from a financial transaction tax.

In the future, distributive justice will have to play a greater role. Health will become a public good. Particular challenges lie in the equitable distribution of health resources and in equitable access to health prevention and care for all people, regardless of their origin or income. Rationalisation through digitisation alone will not be enough to compensate for cost pressures from medical progress and demographic change, making the question of alternative system logic unavoidable.

In a sharing economy based on distributive justice, everyone has equal access to medical-technical innovations. Trends such as increasing “medical tourism” in the sense of cross-border use of medical services and the increasing willingness to share data also necessitate a fundamental rethink. In my view, Big Data can be a new “currency” and replace obsolete causality arguments. In times of digital transformation, an idea of solidarity extended by the data division dimension will continue to express the will of people to stand up for each other in the future.

Experimental medicine for terminally ill patients

Liz Parrish, BiovivaLiz Parrish, Gründerin und CEO von Bioviva: Do you believe that terminally ill patients should have access to experimental medicine? Please explain.

 

 

Dr. Stefan Knupfer, AOK PlusDr. Stefan Knupfer, stellvertrender Vorsitzender der AOK Plus: In my opinion, experimental medicine represents the basis of all therapeutic interventions, as it lays the foundation for further clinical trials with proof-of-principles experiments.

Experimental medicine makes it possible to understand human diseases, so as their origin, their pathogenesis and their effects on the organism in general and to develop new effictive therapies of various kinds from this understanding. Experimental medicine usually means basic research – of course with the aim to improve practical therapeutic action at the bedside.

However, until the findings of experimental medicine are actually available at the bedside, often a lot of time passes – time that a terminally ill person may no longer have. Such a terminally ill human being, fully aware of and fully aware of his situation, and freely to choosing to do so should, in my view, have access to experimental medicine – that is, to medical interventions that are not yet fully ecidence-based for health care.

The key point, however, is that terminally ill people are often no longer able to make such a decision of full consciousness and full willpower themselves. Here I see an ethical fundamental question of our society that urgently needs an open discourse: how do we deal with the advanced medical options we now have to artificially keep people alive? May trusted people speak for terminally ill relatives, ie act in their (presumed) will when it comes to choosing experimental medicine as a last resort or even providing a terminally ill relative for further basic research?

So far, there is no social consensus, no “modus operandi”, which is carried by all people. In this respect, a generalized answer to the question of access to experimental medicine for terminally ill people, which can only be answered individually, is currently not possible.

The doctor as “health pastor”

Frieder Hänisch, Limbach GruppeFrieder Hänisch, Business Development, Limbach Gruppe: Is the essential role of the physician in the future still the “health pastor”, who brings about the therapy decision and has a competence advantage over technical services (e.g. ADA-App), or is he only needed as a legal entity for liability issues in the health care system?

Dr. Stefan Knupfer, AOK PlusDr. Stefan Knupfer, stellvertrender Vorsitzender der AOK Plus: To start with, a counter question: Is the doctor really a “health pastor” today? Is he not rather a quite rational “health status surveyor” and a therapist of often only symptoms, but not of systemic and dynamic states – because illness and health are not static entities?

The so-called “talking medicine”, which places high demands on the social skills of the physician, has in recent decades actually stepped more and more into the background of medical activity. However, I believe that this trend will again develop in the direction of a return to what we call “pastoral” competences. Social competences, a high degree of empathy and the ability to advise and perhaps even coach other people will play a decisive role in the role of the physician in the future.

Similarly, physicians will be required to have a much greater understanding of digital applications in the future, because they will support the work of physicians on patients to a much greater extent in the future. The role of the physician will be between the physician as “Life Scientist” and the physician as “Mental Scientist”.

The information asymmetry between doctor and patient is decreasing more and more, which means that mature and well-informed patients will expect the best possible offers from a doctor for their respective health situation in the future.

SITiG and bitkom call for a federal agency for digital medicine

There are good reasons to think that the development towards a digitalised health economy in Germany is too slow. Unfortunately, there are even many good reasons for this. Anyone who can once again watch how medical specialists manually transfer patient data into the hospital database, including depreciation errors, has no more questions here. The device is out of order, again. This happened to me ten days ago. Bitkom and SITiG have now proposed setting up a federal agency for digital medicine to speed things up.

A motor for health communication?

This federal agency for digital medicine  is to develop standards, so the publications of the initiators in short and long, in order to make safe health communication possible. In the language of bitkom: “A Federal Agency for Digitised Medicine can create framework conditions for technical and semantic interoperability and for the implementation of data protection and data security requirements”. That´s Achim Berg, bitkom President. This agency shall have a catalytic effect, unites all players and will make Germany the “number one technology and research location” for medicine in Europe. The only thing still missing is the German government’s eHealth strategy, on which all of this could be built. A rogue who thinks of the Federal Government’s AI strategy and its almost comically formulated goal of establishing artificial intelligence as an “export hit”.

The Ärztezeitung sums up the initiative of SITiG and bitkom (involuntarily?): At its core both associations are concerned with control. With this federal agency for digital medicine they want to create a new instance of central supervision.

More Power to the Patient

The initiative fits in with the picture of future healthcare that has long been demanded by the associations. The result of these demands is known. The initiative also fits in with the tenor of the “Digital Health” conference organised by bitkom last week in Berlin: “More Power to the Patient”, the title of the conference, summarized here very succinctly.  Core results of the keynotes and contributions: It needs the electronic patient file. And again: lots of solutions for the object “patient”. But only little power for the user of the system, only little decision-making authority for the customer of the health economy. People are always turned into patients. And a “patient” obviously always needs others who know what is good for him. Others who decide for him and others who improve his care. Others who turn him into an object and others who set up federal agencies for this purpose.

The future of healthcare

Once again to take notes: Those who equip their field staff with iPads have not yet digitized their sales. Anyone who supplies a school class with laptops has not yet made a contribution to digital education. And anyone who demands an agency that will develop standards for the interoperability of data in the course of the introduction of the electronic health card in a long process and at great expense has neither digitized the health industry nor made a significant contribution to the future of healthcare.

The healthcare of the future will enable people to measure, change and raise their state of health and well-being – ideally beyond a 100% natural or God-given threshold. People will use technology to do this: Data of the most diverse kind and quality, algorithms for their evaluation, databases, genetic engineering, 3D printing and the like more. This is the scope of the digitalisation of health. Anyone wishing to support this through a federal agency should set up an agency that – analogous to the newly established digital agency of the German federal government – promotes leap innovations financially and structurally. There is plenty of room for this – see above. A federal agency for digital medicine, which ultimately springs from the spirit of controlling a complex system, will achieve exactly the opposite.