COVID-19 and digital Health in Germany

Digitalization is not an end in itself but has its raison d’être in facilitating the everyday lives of practitioners and patients. The emergence of a vibrant digital health ecosystem in Germany.

Change is usually not implemented until the bureaucratic framework has been set. In this context Germans are not the quickest – they work thoughtfully. This applies especially to digitalization. Germany has been lagging behind for the last two decades. But some predict that a vibrant digital health ecosystem is on the rise in Germany. This development is largely due to the disaster management efforts to cope with COVID-19.

Jens Spahn, Germany’s health minister since 2018 placed digitization at the top of his agenda when he took office. Many health care systems of other European countries are faster and more modern already. Addressing the development gap, Spahn said the following: “I can only advise the medical profession and everyone in the health sector: If we don’t shape digitization together – especially faster than in the past ten years – then others will.” Large corporations like Google, Amazon, and Apple are the “others” that are increasingly turning to the health sector. Spahn highlights that medical consultation is still the ultimate standard. Dr. Henrik Matthies, the managing director of the Health Innovation Hub states that Spahn’s legislative actions to digitalize the German health care system enabled more effective handling of the COVID-19 pandemic.

Digitalization is not an end in itself but has its raison d’être in facilitating the everyday lives of practitioners and patients. Due to COVID-19, social distancing equals an increase in the use of telemedicine. For example, the DVG (digital care act) expands video consultations to all physicians and other medical staff. The DVG is a law that was passed by the German parliament in December 2019 and that revolutionizes the use of digital health applications (Digitale Gesundheitsanwendungen, DiGAs). Barriers and limitations were loosened. For example, the possibility to issue a certificate for sick leave without personal contact was provided. Additionally, digital health solutions can be prescribed to publicly insured patients by any physician in Germany.

There are three groups of Apps that emerged during the pandemic. Firstly, there are Self-diagnosis-Apps that communicate, if it’s necessary to get tested for COVID-19 or how long the quarantine has to be. This App exists in Spain for example. Another group is the Apps that monitor quarantine regulations for example by controlling people’s locations via GPS. This App is obligatory in Poland for example. Authoritarian regimes like in Russia also open access to public cameras to track people’s faces in case they violate regulations. The third and most common group is Contact-tracing-Apps. This supports tracing infection chains to hinder the further spread of the virus.

Developing an international data sharing platform for the global pandemic has been challenging for numerous states in the world. The idea of Contact-tracing-Apps is that it measures over a long period of time, if the smartphone user gets in contact with an infected person within a 2-meter radius. The collected data is saved on the phone. If a user is infected with COVID-19, the App alerts that person and every other person he or she interacted with. In 2021, around 45 states worldwide have developed a Contact-tracing-App.

In Germany, the “Corona-Warn-App” has been applied extensively since the 16^th June 2020. After a month on the market, the App counted 6.5 million downloads. That number rose up to 25.7 million downloads in February 2021. The App was developed by SAP and Deutsche Telekom AG, using software from Apple/Google, DP-3T, and TCN, and is completely decentralized and pseudonymously designed. People are traced either via GPS or Bluetooth Low Energy (BLE). Prior to the launch of the App, it was tested and simulated first. This is the same procedure as the services Kipoly is offering in the health care sector.

Contact tracing apps are subject to the network effect – the more people use them, the greater the benefit for everyone. Therefore, the decisive factor is the proportion of the population that carries a smartphone with them at all times that records their encounters with other devices. But the advent of COVID-19 contact tracing apps has led to concerns around privacy, the rights of app users, and governmental authority. In addition, initial problems to spread the use of the App include being put off by technical problems and not being interests in smartphone applications. A major ongoing problem is that there aren’t enough people using the App to get effective outcomes. At a time when 22% of Germans used the App, only 4% used it in France. This was major because this App was less anonymous. Norway stopped the use of an App for that same reason. “The privacy issue is a political choice: the higher the privacy, the more credible the app,” says social scientist Sean L’Estrange from the University of Dublin. Many scientists agree that around 60% of the population have to use the App for it to be effective.

The App is a very effective and successful example for the use of smart digital applications in the health care sector. Factors that are praised by users using the App include that it’s simple to operate and helps to measure local infection trends. One problem that remains is that it’s uncertain whether people constantly use the App after they downloaded it.

Due to the development of all the Apps around COVID-19, almost all telemedicine providers offer a free consultation for German citizens regarding the Coronavirus. A vibrant digital health ecosystem has emerged – diversified into all healthcare-related areas: from screening, prevention, diagnosis, treatment, and rehabilitation to elderly care. The majority of the emerging actors are medium-sized startups. They offer CE-certified medical products and solutions that follow international standards.
Many adapted instantly to the ecosystem during the pandemic and significantly relieve the healthcare system today. The core argument is that less physical interaction is required. For example, companies like Kipoly offer various AI solutions to improve efficiency and accuracy in medical diagnosis and other processes.

“The German healthcare stakeholders needed the intense discussions of the past years in order to trust digital solutions: requirements, reliability, medical-product certification, how to apply evidence-based medicine to digital health and how to deal with limitations of digital health.”
– Dr. Henrik Matthies, Health Innovation Hub

From January 1^st 2021 onward, every statutory health insured German which accounts for 85% of the population is entitled to the German version of a personal electronic health record (EHR). The EHR is a record that is provider-agnostic, thus works across the entire healthcare system. E-prescription are following later in 2021. It took years of discussions for Germany to finally pave way for Snomed CT membership. Now, all healthcare sectors are pushed to move towards international data formats and interoperability, including the very long rigid proprietary IT systems of physicians and clinics.

In conclusion, Germany is not a digital health nation yet – time is needed to catch up. The COVID-19 pandemic has been an urgent reminder that we live in a globalized world and that there is the constant threat of a pandemic or other disasters that need to be coordinated. Without the pandemic, it might have taken months or years to get patients, physicians, and other health care professionals to accept digital health solutions

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