Telemedicine in Germany: still in the developmental stage
Before discussing telemedicine in Germany, it is vital to understand the true definition and intention of the word. Telemedicine provides a beneficial and coherent service to those patients who wish to or rely on speaking to their doctors and healthcare professionals over the phone or via online chat.
Telemedicine is not a new phenomenon and throughout time has indicated many changes and new age solutions. These are now coming to fruition with patients being able to communicate their heart rate, blood pressure and other vital health statistics to their healthcare professionals with the use of new devices and with this are able to monitor and manage chronic conditions from the comfort of their homes.
While the focus of this article is on the development of Telemedicine in Germany, the development in the USA has been significant and therefore is presented as a comparative measure. In the US, telehealth is expected to grow at a cumulative annual rate of 27.5%, thereby reaching $9.35 billion by 2021.
According to IHS Technology, telemedicine services are predicted to increase exponentially with a forecasted 7 million patients globally by 2018, from 350,000 patients only in 2013.
This then poses the question, if Germany has the potential to develop in the same trend as the US and the rest of the world.
Advantages of telehealth
The predominant reasons as to why patients would consider making use of telemedicine are cutting waiting times and reducing costs. This is furthered by the following statistics:
The UK Department of Health has also released its own study regarding the advantages of telemedicine and has shown a 20% reduction in A & E admissions and a 15% reduction in room visits. Additionally, the Department of Health was overall able to observe a 14% reduction in elective admissions to hospital.
Two major obstacles for the development of telemedicine in Germany
While in the Scandinavian countries Norway and Sweden it has been possible to integrate online diagnosis and treatments for the past 5 years and in Switzerland patients can consult a healthcare professional 24/7 via telephone or the so-called Medgate services, the same advancements cannot be seen in Germany, even though the latter is considered a “developing country” in terms of telemedicine.
It can even be said that Germany is not taking advantage of telemedicine and can be considered to be falling behind in comparison to the global leaders of telemedicine. A few small impacts can be seen over the last few years, but overall two large obstacles are threatening the development of telemedicine on a substantial scale.
The first obstacle is the so-called “prohibition of long-distance treatment” (das Fernbehandlungsverbot) in Germany. This law states that Doctors are forbidden from consulting or advising patients through the use of telemedicine, therefore ensuring patients are directly and personally seen by their healthcare professional.
The law further states that follow-up checks or consultations can then be carried out via video media. During this video consultation, it is furthermore strictly prohibited for doctors to carry out any further diagnosis or issue a prescription. The CEO of the German Union for Telemedicine (Deutsche Gesellschaft für Telemedizin), Wolfgang Loos, has been quoted saying the ‘Fernbehandlungsverbot’ is outdated and has long been overtaken by technology and should, therefore, be modified to suit the current evolution of telemedicine.
The second large obstacle is the lack of payment laws for telemedical services, while also having high expenditure for telemedical applications and offers comparatively to the usefulness. Martin Grieger, a representative from the AOK Federal Board has emphasised the urgent need to measure and clarify quality improvements that can be made to telemedicine while concurrently saving costs within the selection of telemedical services.
”German patients have a desire for online prescriptions”: A Bertelsmann Foundation Survey
In 2016 the Bertelsmann Foundation, an independent foundation, conducted a nation-wide survey, in which they could find that the majority of participants stated online consultations and the subsequent online prescriptions should be possible via telephone or other media. Furthermore, it was stated that if the patient has any doubts, they should be able to autonomously decide if they would like a personal face-to-face appointment with their healthcare professional. Overall, a 54% majority agreed fully that this service should be available in Germany, while only 44% did not fully or completely disagreed.
Prescription of medication: Patients want to consult their doctor also by phone or online
For the prescription of a medication I would also like to consult a doctor online or by telephone. The doctor will then decide whether a face-to-face consultation is necessary in practice.
22% totally agree, 32% rather agree, 21% rather disagree, 13% totally disagree, 12% do not know
The survey also showed that the survey participants have a preference to distinguish between repeat and first prescriptions. While 50% of participants favoured repeat-prescriptions being issued via telemedicine for contraception, diabetes treatments, and hypertension treatments, only 42% of participants would feel comfortable being issued with the first prescription for cortisone creams and only 30% would favour receiving a prescription for antibiotics via telemedicine.
Prescriptions via Telemedicine: Patients differentiate between prescription drug refills and the first prescription
If a prescription of pharmaceuticals is required, could you think of a doctor’s consultation only by phone, video or online chat?
53%: Refills of birth-control pills
50%: Refills of hypotension treatment
42%: Prescription cortisone-containing ointment for a skin condition
30%: Antibiotic for bronchitis
The future of telemedicine in Germany
The survey by the Bertelsmann Foundation indicates a clear shift within Germany and a loosened view on telemedicine within the country. This is furthered by another study by Bitkom in which it was stated that 45% of all smartphone users in Germany use a health app and therefore presents huge potential.
Furthermore, Ulrich Fölsch from the German Society of Internal Medicine has stated that the telemedical service has “great potential, especially in the care of chronically ill patients”. Additionally, a joint study by Bitkom and Hartmannbund, a medical association, stated that a staggering 7 out of 10 doctors in Germany view digitalisation as a fantastic opportunity for healthcare.
Most importantly, according to the Bertelsmann Foundation, a sweeping injunction on all e-prescriptions via phone or online consultations is neither in the patients’ interest nor is it useful in the advancement of telemedical innovations.
Dr. Bernhard Rohleder, the general manager of Bitkom, was quoted saying: “Digitisation is the second major development step in medicine after the introduction of antibiotics a hundred years ago“. It is therefore clear that the global availability to telemedicine must be introduced rapidly and that the digitisation of healthcare must be made obtainable to patients.
Future advancements: Big data in the healthcare sector
Big data is predicted to have a much larger impact in the future of healthcare in comparison to the present time. Doctors and healthcare professionals are expected to use big data, such as algorithms and artificial intelligence to rapidly select the most appropriate treatment method.
The pharmaceutical sector is expecting to produce individualised medications for patients within the next 8 years, using research and big data analysis. This will not only allow healthcare professionals to tailor medications to specific patients but will also be able to increase efficiency and time spent with patients, their diagnosis and treatments.
It has been stated that one in three doctors envisage artificial intelligence being used daily to support doctors with diagnoses by 2030, while one in five hold the opinion that medication intake can be automated and performed by microchips implanted under the skin, which could also improve organ function. This shows the huge potential of growth of the digitisation of healthcare and the need for Germany to take advantage of this growing market as to not be left behind in the advancements.