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The comprehensive digitalization of the healthcare system has been under discussion for decades. The opportunities offered by AI-supported research and diagnostics are currently increasing the pressure to innovate. However, many questions remain unanswered. There are only a few tangible results.
In itself, the digitalization of the healthcare system sounds like a good idea all round. All examination results, diagnoses and treatments would be available at any time. This would allow doctors to better ensure, for example, that a newly prescribed medication for a patient is compatible with other treatments and illnesses. It would be easier to change doctors. Duplicate examinations due to lost documents could be avoided. And even those who have an accident or fall ill while on vacation would always have all their patient data with them - via a corresponding app on their smartphone.
Such perfect and seamless digitalization would not only make life easier for doctors and patients. It could also significantly accelerate medical research: Trends, effects and correlations can be identified from the data. This is especially true with regard to increasingly powerful AI tools: they are predestined to find patterns in enormous amounts of data. However, this data must first exist, be complete and be suitable for analysis.
The discussion about the digitalization of the healthcare system is far from new. It is now a good 20 years old. However, what has emerged from this discussion varies greatly from country to country.
Estonia, for example, is a great role model in Europe. The Baltic state took up the topic back in the 1990s and has been implementing it consistently ever since. Not only the healthcare system, but also administrative procedures and elections have been digitized. Denmark and Finland are also regarded as pioneers in e-health. This map provides an overview of the status quo in selected European countries.
Switzerland has proclaimed the "eHealth Switzerland 2.0 Strategy". The electronic patient dossier (EPD) is the main focus here. The website states: "For the Confederation and the cantons, digitalization is a key instrument for achieving important health policy goals, particularly in the areas of treatment quality, patient safety, efficiency, coordinated care, interprofessionalism and health literacy." The introduction of the EPR in Switzerland has been delayed, but is now underway.
In Germany, the counterpart is the electronic patient file (ePA). Although it has been introduced, it is hardly noticed by the population: Not even one percent of insured persons use it so far. One reason for this is the complicated application process. The German government now wants to switch from "opt-in" to "opt-out": in future, every citizen will have an ePA unless they actively object.
Not everyone agrees with this. Fears about the security of personal data and its use play a central role in the discussion.
These fears have not been plucked out of the air. There is a reason, for example, why the EU's General Data Protection Regulation (GDPR) scrutinizes information relating to personal health particularly strictly. At the same time, it stands in the way of plans for a "European Health Data Space" (EHDS) or at least makes its implementation more complicated. The idea behind EHDS: just as services and goods are exchanged within the EU as freely as possible, this should also be possible with health data.
But how do you ensure that this information does not fall into the wrong hands? Anonymizing or pseudonymizing it are ways of increasing the level of security. However, both variants come with specific advantages and disadvantages. With anonymization, for example, data can no longer be viewed for research purposes, as it is not clear which information belongs to which person. Although pseudonymization makes this possible, it is less secure.
Other questions revolve around who has access to what information and how much say patients should have.
Furthermore, a digitalized healthcare system is an enormous technical challenge. After all, e-health will only realize its potential if information is recorded and made available without gaps. This in turn only works if all relevant data routinely ends up in the system.
But even that is not enough: the information must also be available in a meaningful format, ideally standardized. If this is not the case, it is of limited or no use for research, for example. "Of course, you can draw valid findings from everyday clinical practice from routine data that we don't get from laboratory tests and controlled studies, but the database has to be clean for this," says medical informatics specialist Peter Haas in an interview with Heise.
Unstructured data would also make doctors' work more difficult: After all, if the worst comes to the worst, they cannot read through a large number of digitized documents first. They need to recognize important information and correlations as quickly as possible.
So there is still a lot to do in Switzerland, Germany and many other countries. Another driving force behind e-health is money. Digitization could save a lot of money. For Germany, for example, McKinsey estimates this at 42 billion euros per year. For Switzerland, the figure is CHF 8.2 billion. In addition, research based on health data could lead to new and better medicines, for example - another market worth billions.
