With the help of successful digitization, Federal Health Minister Karl Lauterbach (SPD) wants to improve care. So far, there has only been “ambitious talk”, but the electronic patient record (ePA) is nothing more than an illusion, Lauterbach said on Wednesday at the “Europe 2023” conference. There are major problems in the digitization of the healthcare system everywhere. Two bills and a strategy that Lauterbach announced at the conference are intended to change that. In a keynote speech, Lauterbach presented himself as a convinced European. As an example of the European spirit of research, he cited “Alphafold” from London, which can use AI to “develop and derive the structure” of all known proteins.
At the heart of digitization is the opt-out ePA, which all those with statutory health insurance should receive automatically. Findings and results should then be transmitted to the ePA. Hospital information systems (HIS) that communicate with one another should also be connected to the file. This and other data should then be able to flow into a “secured data room”. Lauterbach criticized that the data is currently only in silos.
Implementation of the EHDS required
For the implementation of the European Health Data Space (EHDS), the data must be available in pseudonymised form – a proposal for this has been available since May 2022. The data includes, for example, genome data and registry data. In the future, all data should be encrypted in the EHDS, including the billing data of all statutory health insurance companies. Pseudonymized, but according to Lauterbach an assignment to the patient is possible. Then, as in Israel, it will immediately be possible to use the ePA to write to patients with disease X who are not taking drug A and to recruit them for a study.
It is also planned to make the data available to companies for research. According to Lauterbach, a “good European data protection solution” is needed. Data could then be evaluated with “artificial intelligence algorithms”. He admitted that the data available in the US “is not all gold either”. Useful data is available in Europe, but he believes that a better system is needed to get data processing permits.
AI only as a support
A panel discussion had previously dealt with the role of eHealth on the way to a networked European healthcare system. Under the impression of the “successes” of ChatGPT, the role of the AI was first discussed. For the medical ethicist Alena Buyx, a sophisticated AI could take over the routine work of medical documentation. Jens Baas, CEO of Techniker Krankenkasse, raved about an AI of the future that could be responsible for medical education. You can ask an AI “stupid questions” that you wouldn’t ask a doctor, said federal data protection officer Ulrich Kelber. “AI will be like electricity around us.”
Europe 2023: eHealth Discussion Speech
In connection with the increased use of AI methods, he also referred to the Artificial Intelligence Act, which the EU Parliament is currently working on. In the high-risk area, such as triage, they do not want to use AI methods. AI is still intended as a support for the doctor and not a replacement. Many doctors believe that they have to spend a lot of time on digitization. Digitization should save work. Accordingly, it is not expedient to simply provide the doctors with a connector – a router for the healthcare sector. It would be a step forward if doctors were supported with tasks that need to be digitized away – such as finding appointments.
After the excursion into the future, the focus was on the European present and the EHDS. Kelber sees a lot of work in this before the data room can function. “For example, there are significant differences in Europe in how I authenticate myself. The data room alone cannot help there”.
Google and Co.
According to the chairwoman of the German Ethics Council, Alena Buyx, “Dr. Google” is now the first source when it comes to possible diagnoses. 25 years ago this was different. Baas described the fact that people search for their illnesses in Google as a data protection meltdown. The Federal Commissioner for Data Protection and Information Security (BfDI), Ulrich Kelber, is also critical of the fact that people use private services for DNA analysis. This is a non-anonymous data set that is sent to China, for example, where different standards apply in terms of data protection.
According to Buyx, they don’t want to do it like China. High data protection standards should be considered a unique selling point, even if data protection costs lives in their opinion. In the meantime there is a “wild growth from tens of thousands of health apps”. Nevertheless, people in Germany pay too much attention to the risks and too little to the opportunities of digitization.
Baas even sees data protection as an opportunity to differentiate itself from China and the USA. In his view, the main problem with the lack of digitization in the healthcare system lies more in the different interests of the various players, such as the pharmaceutical industry, but also those of the health insurance companies. In addition, data from video consultation hours must not simply be tapped or even sold. If that happens, the companies would have to pay a penalty of up to four percent of their worldwide annual turnover, explained Kelber.
Hospital reform is pending
As a further change, Lauterbach repeatedly announced a modernization of hospital care and ways to save it from bankruptcy. Hospitals should be better equipped in the future and get off the hamster wheel. You have to get away from the current system, which is designed for economy. Hospitals should no longer be designed for profit in the future. Lauterbach described the fears of the Bavarian Health Minister Klaus Holetschek (CSU) that many hospitals would disappear as a result of the hospital structure reform as scaremongering. Planning sovereignty remains with the countries with which one continues to work.
(mack)
