In our digital world, we are used to having access to our most important data – via apps, for example. This need also applies to our health data, says Sebastian Zilch, Managing Director of the German Health IT Association – bvitg e. V. In the interview possible areas of application for mobile health applications such as health apps and describes the benefits of digital helpers for patients and doctors.
aconium: How widespread are mHealth applications in Germany?
Sebastian Zilch: There are currently around 90,000 health apps, of which around 8,700 are from German-speaking countries. The selection and use of mobile applications varies greatly, as they are geared towards the needs of patients. Mobile applications are made available either on the open market or by health insurance companies as part of their healthcare mandate. mHealth applications are also popular and widely used as lifestyle or fitness apps. However, such applications are not actively integrated into everyday healthcare, meaning that neither doctors, hospitals nor nursing staff can use them in a meaningful way. This is mainly due to the high requirements for proving evidence – the medical benefit – in the Joint Federal Committee, the highest decision-making body of the joint self-administration in the German healthcare system. Currently, no digital-based applications are available to insured persons in Germany via standard care.
aconium: What opportunities do mHealth applications offer patients and doctors?
Zilch: Whether fitness, health, lifestyle, sports or medical apps – mobile applications improve quality of life through health promotion, prevention and aftercare. It makes limited sense to classify mobile applications in the health sector, as they differ considerably both in terms of their objectives and their use. On the one hand, there are relatively simple applications with which users can measure and evaluate their vital data or keep pain or diabetes diaries. On the other hand, there are applications that intervene directly in diagnostics and/or make therapy recommendations, i.e. represent a medical device of a higher risk class and are only used to a very limited extent in healthcare due to the current legal framework.
One application that will also be available to patients on mobile devices from 2021 is the electronic patient record (EPR). Patients will be able to manage their data centrally via their mobile devices and make their medical records available to doctors. Service providers can therefore quickly research important findings or previous illnesses in the ePA and thus determine treatment more precisely. This prevents duplicate examinations and drug interactions.
What all applications have in common is that they can save and prolong lives. This is illustrated by the Fontane Study conducted by Charité in 2018. The results show that telemedicine significantly reduces overall mortality in patients with cardiovascular disease thanks to digital services.
aconium: What challenges does the healthcare industry have to deal with when using data from mHealth applications?
Zilch: In order to fully exploit the potential of mHealth applications, a smooth data flow across sector boundaries must be ensured so that the data is available to doctors in the course of anamnesis – the recording of medical history – diagnosis and treatment. Meaningful and useful mHealth applications enable the transfer and management of data from outpatient to inpatient and even to nursing aftercare. A basic prerequisite for this is semantic and syntactic interoperability – i.e. a standardized language – which enables data to flow into and across the primary systems. Particular attention should be paid to the use of international standards and profiles so that the applications can also be used across borders in the future.
Practicable data protection regulations are another requirement that needs to be implemented. For example, it is unacceptable that in some federal states, data collected during inpatient treatment is not allowed to leave the hospital’s physical server room. This is diametrically opposed to innovative, networked care with the help of mHealth applications. For most applications, there are already extensive legal requirements under the General Data Protection Regulation (GDPR), the Federal Data Protection Act, state-specific data protection laws and specialist laws.
aconium: How can these challenges be overcome?
Zilch: For mHealth applications to develop their full potential, they must be fully available to insured persons and integrated into everyday healthcare. New mechanisms that take account of the highly dynamic nature and short innovation cycles of digital applications are absolutely essential for this. Federal Minister Jens Spahn’s Digital Healthcare Act is moving in the right direction with the digital health directory.
The expansion of telemedicine infrastructure and digital infrastructure in general (fibre optic and broadband expansion) is a prerequisite for the successful use of mHealth applications in both urban and rural areas.
Certifications or “seals of approval” that check all healthcare applications for a uniform set of requirements do not correspond to the heterogeneity of mHealth applications and their different approaches. On the other hand, educational work and patient empowerment would be important tasks: Only if patients are informed clearly and comprehensibly about the benefits and potential, but also about possible risks, can they decide for themselves whether to use the applications. Here, it is particularly important to take into account the recommendations of the individual medical associations.
aconium: In your opinion, what would the optimal use of mHealth applications look like?
Zilch: Mobile applications must be available to insured persons in standard care from the outset and be actively integrated into care. mHealth applications can already play a decisive role in the prevention of illnesses, for example by raising awareness of cardiovascular risk factors or preventing cancer. With the help of telemedical applications such as remote treatment and teleconsultation, care in rural areas is ensured in the course of demographic change and also relieves the burden on clinics. Mobile applications also play a major role in aftercare and care, for example in the real-time monitoring of vital data following the use of heart or vascular valves. In the digital information age, we want to be available at any time, anywhere in the world and have access to our data. It is therefore only logical for our healthcare system to take this into account.