Smarthealthsystems International Comparison of Digital Strategies

#SmartHealthSystems International comparison of digital strategies Health System Comparison Focus Digitalization #SmartHealthSystems International comparison of digital strategies Part I: International Benchmarking and Digital Health Index Part II: Success criteria and utilisation rates of digital applications – Comparative country study Part III: Analysis and Transferability Authors Rainer Thiel, Lucas Deimel, Daniel Schmidtmann, Klaus Piesche, Tobias Hüsing, Jonas Rennoch, Veli Stroetmann, Karl Stroetmann November 2018 #SmartHealthSystems Foreword The so-called Lipobay scandal can be considered a trigger for a political decision: As early as 2003, the German federal government at the time initiated the development of the electronic health card. The card was intended to help improve healthcare and to make it safer – possible drug interactions were to be identified before they can occur. It was hoped that the German healthcare system would then receive a modern IT infra- structure and become an international pioneer in e-health. Today, we have to say that this project has not been successful. At least not for the time being. While in other countries, the most important patient data is stored in electronic health records and prescriptions already have been digitally transmitted for several years, Germany is still working on the basics of digital health networks and is mainly exchanging information on paper. While we are talking about the application of intelligent algorithms on a theoretical level in Germany, these have long been in use in Israel for the early detec- tion of cancer, for example. Not surprisingly, the Digital Health Index developed in the context of this study shows that the German healthcare system is lagging far behind in terms of digitalization: In an international comparison, Germany is ranked 16th out of 17 countries surveyed. For the newly developed index, experts from the analysed countries gave their assessments on more than 150 individual items – on the political-strategic approach, on the technical readiness and on the actual use of the available technological possibilities. But the findings should not be a reason to bury one’s head in the sand – on the contrary. The study report shows that the digital transformation of healthcare systems is hardly a straightforward process in any country, and it is not always a successful story. We can see that countries like the Netherlands or the NHS in England, which have changed strategy after setbacks, are today on a good or at least on a better path. The report contains countless examples of successful and less successful digital health initiatives and approaches. For five of the 17 countries, we have analysed the development lines in more detail. The German health system can and should learn from these examples. At the political macro level, our analysis shows a clear pattern: digital transformation needs political leadership and coordination. Successful countries are characterised by a trio of effective strategy, political leadership and coordinating national institutions, i. e. “agencies for digital health”. The process of digitalization in successful countries is health benefit-oriented and is implemented in pragmatic steps. Politicians in these countries see the promotion of acceptance among patients, doctors and other health profession- 4 Foreword als as a central strategic task. Moreover: the end users of digital technologies, not (only) their professional representatives, are systematically involved in co-designing strategies and applications. From the empirical findings, we derive the recommendation that German health policy must continue along the path it has recently taken. Politics must act more decisively than in the past and expand its leading role in the design of digitalization. Finally yet importantly, we need to pick up speed. Not as an end in itself, but for the patients and their physicians, who in Germany still cannot fully benefit from digital health because of missed digital opportunities. There is no need for a new “exogenous shock” like the Lipobay scandal as further justification to advance digital health. We wish you an interesting read and look forward to exchanging views on the results of the study. Dr. Brigitte Mohn Uwe Schwenk Member of the Executive Director “Improving Board, Bertelsmann Stiftung Healthcare – Informing Patients,” Bertelsmann Stiftung 5 #SmartHealthSystems Introduction Digital innovations in healthcare systems can prove crucial to improving healthcare. provision. Digital solutions can improve patient safety and treatment outcomes while facilitating the economic efficiency of a healthcare system and its sustainability. A grow- ing number of international studies as well as post-pilot national and regional assessments show that under the right framework conditions, the digital transformation of a health sector indeed leads to improved service quality and access to services. In addition, international trends show that the networked exchange of data and digitalized healthcare systems are essential to fostering results-driven care because they keep healthcare professionals on top of the latest developments in medical knowledge and thereby improve the quality of care provided. In international comparison, Germany lags behind in efforts to effectively leverage the benefits of digitalization. Several European and other Western countries are much more advanced in terms of applying and adopting instruments such as an electronic health record, ePrescriptions or electronic communication between patients and physicians. These markers of progress are present not only in the Nordic states but also in several EU states with healthcare systems featuring a much wider and deeper adoption of digitalization than the German healthcare system. Knowledge about how healthcare systems operate is essential to formulating effective healthcare reforms that focus squarely on patient benefits. At the same time, it is also crucial to understand where, how and why the digital transformation of healthcare is suc- ceeding in order to develop or adapt digitalization strategies that ensure citizens, patients and society as such receive improved healthcare. Some countries that have proved quite successful with their digitalization strategies can serve as models for Germany. However, in order to derive realistic lessons learned and formulate specific recommendations for action, we must acquire a deeper understanding of each country’s framework conditions, the factors contributing to the success of their strategy and the extent to which digital services are actually used by patients and physicians (digital uptake). Efforts to advance digitalization in Germany can also benefit from the rich variety of digital applications implemented in other countries. Indeed, we see an impressive range and depth of digitalization strategies, rollout measures and actual use of patient data in several countries. The study presented here is part of an extensive international comparison of healthcare systems with a particular focus on digital transformation. It aims to deliver a cross-national survey and evaluation of the state of digitalization, the reach and depth of use, and success factors of an effective digitalization strategy. In so doing, the report showcases the rich diversity of strategies, their contextual features, and the factors contributing to a health 6 Introduction policy that successfully leverages digitalization in order to optimize patient care and health literacy. Two separate studies were conducted for this purpose. The first, “International Benchmarking and the Digital Health Index,” underpins the first part of this report. For this study, we developed a novel standalone Digital Health Index that evaluates the state of digitalization achieved in a national healthcare system. This index is comprised of 34 indicators relating to strategy, technical readiness, and the digital maturity and extent to which integrated healthcare data exchange is actually taking place. As part of a benchmarking process, data for 17 countries (i. e., 14 EU and three OECD countries) was collected by an international expert network. The results of this process are reflected in several rankings, each of which are an aggregate of scores achieved for a set of indicators. In addition to independent research conducted for the purpose of the benchmarking process, we designed and carried out a survey to examine and evaluate national digital health strategies in Australia, Austria, Belgium, Canada, Denmark, England (NHS), Estonia, France, Germany, Israel, Italy, the Netherlands, Poland, Portugal, Spain, Sweden and Swit- zerland. Data was collected on site by a national correspondent located in each country. In addition to the national correspondents’ involvement in the country analyses, the input of additional European and national experts was incorporated into the study for the purposes of validation and quality control. Ensuring the greatest informative value and capacity to derive lessons learned underlie the choices made in the countries to be included in the survey. The study thus includes countries that feature healthcare systems and state structures similar to Germany as well as those countries which, according to our preliminary research, have achieved an advanced state of digitalization. The second study, “Success Criteria and Level of Uptake of Digital Applications,” which comprises Part II of this report, examines in greater detail five of the 17 surveyed

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