Digital health solutions can provide support where existing therapeutic approaches and structures reach their limits:

• They offer all patients low-threshold care options for both prevalent and rare diseases and democratize access to medical knowledge.
• They support professionals in their daily work, who can integrate relevant health data at the patients' request.
• They strengthen efficient and location-independent collaboration between service providers.
• They can support treatment management for various illnesses or even take over it completely.

E-health companies are also strengthening Germany as a high-tech location. They create jobs, bring highly qualified workers and international venture and growth capital to Germany, export generated technologies abroad and thus also make an important contribution to the digital transformation of the German economy.

In order to exploit the full potential of digital solutions in healthcare, the development of legislation and the expansion of digital care structures must progress even faster.

‍The following 10 requirements are essential for this:

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I. Expanding knowledge and creating more digital care offerings

Only when digital care offerings are known across the board will they benefit as many people as possible. So far, doctors, medical and nursing professionals, and patients still know too little about the possibilities and benefits of digital health solutions. At the same time, access to digital and hybrid healthcare solutions is still too complicated.

1. Increase digital health literacy (e-health competence):

Digital health must become part of medical, nursing and therapeutic education and training. This includes the transfer of knowledge about digital and hybrid forms of care as well as about their evidence, effectiveness and application in everyday care. Only with this knowledge can healthcare and care professionals develop a comprehensive understanding of digital care options. In France, for example, as part of the “eHealth Acceleration Strategy,” digital health was included in the curricula of all health care professionals and additional funding was made available for training.

2. Create patient-friendly access to digital healthcare solutions:

‍Direct and easy access routes to digital health solutions are needed, instead of complicated access (e.g. electronic health card (eGK) plus PIN for access to the electronic health record (ePA), activation of DiGA not directly from DiGA). These must ensure the protection of personal data without excluding people from care. This also includes making it easy to use the Health ID so that it can be used across the board. Access to digital health solutions must also be possible via various providers and must not be solely the responsibility of self-government.

3. Develop reimbursement channels for further digital health solutions:

In order to realize the full potential of digitalization in healthcare, further digital health services and digital diagnostic tools must be included in standard care, because reimbursement of costs is a prerequisite for use for many insured persons. Offers that have not yet been reimbursed can already significantly improve the health of those affected, relieve service providers and increase efficiency reserves in the healthcare sector. In particular, integrated, hybrid services (e.g. doctor+DIGA or doctor+therapist+DIGA), digital tools in the area of care services and diagnostics or asynchronous telemedicine and telephone care offerings.

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II. Improve funding for e-health companies and e-health research

The e-health market in Germany is still growing too slowly because there are insufficient financing options for the early phases of research and development and research takes an unnecessarily long time. We are therefore falling short of our potential to improve care, counteract undersupply and create more equitable care for patients. At the same time, the e-health sector offers great economic opportunities for our country and creates new jobs. Other countries have long recognized this and are investing specifically in the e-health sector (e.g. in France as part of the health innovation plan with 7.5 billion euros to strengthen French industry).

4. Alternative forms of financing for e-health:

‍Financing channels must be opened up for e-health innovations beyond venture capital funds. One option is to set up your own program to promote research and development in start-ups, universities and SMEs, which covers the entire cycle from initial idea to approval. Another option is a government investment fund for digital health innovations with various funding models.

5. Public tenders awarded to start-ups:

Start-ups and SMEs rarely benefit from public tenders in the healthcare sector. We join the Start-Up Association and suggest that at least 5 percent of public tenders be awarded to start-ups. This offers benefits for both sides: Start-ups gain access to important contracts, while the health and care system benefits from innovative solutions — ultimately for the benefit of insured persons. To achieve this, a uniform and simplified structure of public procurement law is necessary throughout Germany, supplemented by an explicitly start-friendly implementation.

6. Research funding for e-health solutions:

‍E-health solutions need accelerated research funding so that they can be put into practice more quickly. Temporary projects to evaluate new digital care concepts with patient participation should benefit from accelerated application processes and, if successful, from market
usual investors can be financed. The use of modern data management systems in approval processes should also be introduced as standard to enable faster implementation of clinical studies.

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III. Establish digitization and AI in accordance with international standards and reduce bureaucracy

Current legislation in the health sector includes the aspects of digitization and artificial intelligence (AI) only sporadically and selectively. In addition, additional requirements are being created in Germany that make it difficult to scale digital solutions.

7. Digitalization and AI in legislation:

Digitalization and AI should be an integral part of the drafting of legislative proposals in the healthcare sector from the outset. The aim should be to integrate digital approaches into care on an equal footing with analog care offerings.

8th EU AI Act:

‍We must promote the implementation of the EU Artificial Intelligence Act in Germany in such a way that innovative and trustworthy AI technologies can be established in healthcare.

9. Use of internationally recognized data standards:

Realizing the full potential of digital healthcare solutions requires data interoperability and scalability of digital solutions in everyday care. To do this, Germany must rely on international standards and cross-professional data terminologies (e.g. SNOMED CT) instead of sticking to individual national solutions (e.g. data protection certificates). By consistently implementing data standards and connecting digital health and care solutions to TI, patients also have the opportunity to simply store their data in the ePA and share it with other stakeholders.

10. Reduce bureaucratic expenses for companies:

‍Companies today are increasingly spending resources to meet growing requirements whose benefits for patients remain unclear, such as overlapping certificates or regulations A bureaucratization law for healthcare and care is therefore needed so that new digital solutions can continue to reach the market.

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In addition to the improved framework conditions for e-health in Germany described above, there is a need for very specific improvements in the following digital care areas:

Digital health applications

Digital health applications (DiGA) are a pioneering concept “made in Germany” internationally. They enable individualized, location-independent and time-independent therapies and improve care and care equity. But bureaucratic hurdles, increasing regulatory requirements and high costs are jeopardizing the development and application of DiGA. Establishing DiGA as an essential part of healthcare in the future requires simpler, barrier-free redemption channels (e.g. via e-prescription), a predictable and transparent BfArM process and significant reduction of bureaucracy. The financing of DiGA must be secured through differentiated, value-based pricing in order to make innovations economically viable. Integrating DiGA into medical education can further promote use. In addition, data protection-compliant use of data for clinical research should be facilitated.

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Digital care

Digital solutions can objectively and effectively support people in need of care, their relatives and care professionals. The regulation on digital care applications (DiPA) must be further developed in such a way that DiPA is finally available to people in need of care. For uniform digitization in care throughout Germany, the regional principle currently enshrined in SGB XI must be abolished. There is a need for a digital extension of nursing assessment by the medical service. In addition, it should be possible across the board to provide telemedicine care to care facilities and outpatient care recipients.

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telemedicine

Telemedicine services can usefully complement analog medicine close to home due to their diverse range of applications. For this to happen, telemedicine must be more integrated into care: telemedicine services must be fully made possible and paid equally. Providers of telemedicine services should be connected to the telematics infrastructure and their information options should no longer be curtailed by abolishing advertising bans for telemedicine.

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‍Digital prevention

A holistic prevention strategy is needed, which is implemented by a newly founded, higher-level institute that guides measures based on evidence. It is essential to simplify the use of digital primary prevention services: Direct reimbursement by health insurance companies and clear, transparent information remove barriers. More advisory services and financial support create effective prevention incentives.

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Digital health solutions have the potential to make the care situation in Germany better, more effective and more socially just. We must now lay the foundations for this. Because it is not just an opportunity, but our duty to use digital options to make sustainable, financially viable and future-proof care possible for all people in this country.