The Strategy’s Core Components

Through wider use of digital resources, healthcare and long-term care provision and management processes are improved and redesigned. Against this backdrop, the aim of the Digitalisation Strategy is to establish needs-based, efficient processes which ensure optimal digital assistance and support.

The following should be achieved:

• Digitally-assisted and purely analogue healthcare processes should initially be used on an equal footing if they are equally suitable and produce equivalent results. Duplication is to be avoided. The principle of cost-effectiveness must be taken into account.

• Care provision and administration processes will be digitalised. In all life situations, insurance members should benefit from digitally assisted healthcare provision and administration processes, including where they have only limited digital literacy skills. Appropriate arrangements will be made for insurance holders with special needs.
• Healthcare processes should be planned from the perspective of the recipient. The needs of the provider (in terms of user-friendliness and data security, for example) must also be taken into account. Digitally assisted processes should be developed with the participation of both groups.
• To ensure optimal use of digital solutions, digital healthcare and digital transformation literacy of all stakeholders will be enhanced and the necessary training and instruction provided.

Measures

Short term

• Design of model digitally assisted healthcare processes (starting with disease management programmes, DMPs) with integral digital components such as digital health applications (DiGAs) and electronic patient records (ePAs).
• In the second quarter of 2023, a messenger service will be launched for communication between service providers. A service for communication between service providers and insurance holders will follow in 2024.
• Planning of a digitally assisted medication management system: By the end of 2025, 80 percent of ePA users who take at least one type of medication will have a digital medication plan.
• Low-threshold telemedicine services will be made available to insurance holders. Their take-up and provision will be assisted by non-medical health professionals, for example in pharmacies and walk-in health centres (Gesundheitskioske). By 2026, at least 60 percent of regions with insufficient access to general practitioners will have an assisted telemedicine access point.
• To improve usability of potential digital solutions in long-term care, a Competence Centre Digitalisation and Care will be established to identify and spread the potential for improving and strengthening long-term care provision for patients and carers. Funding provisions for long-term care facilities will be expanded to promote implementation of digital solutions.
• To simplify the search for the right long-term care programmes along with support and advisory services, a dedicated information portal for long-term care and support services will be set up and operated to serve those in need of care, family caregivers, family members, friends, social welfare staff in hospitals, and in counselling and advice centres.

Medium-term

• Other digitally assisted healthcare processes will be successively developed and gradually rolled out. In 2026, 80 percent of communication processes in healthcare and long-term care will be paperless. The messenger service will be enabled to transmit structured information (such as for ordering follow-on prescriptions).
• Data for the ePA and the electronic medication plan (eMP) will be provided via the e-prescription service.
• The aim is that by the third quarter of 2026, 60 percent of public health service offices funded by the Federal Government under the “Pact for the Public Health Service” improve their digital maturity by at least two levels in at least three categories (in line with the digital maturity model for public health offices).
• The aim is that by the end of 2025, 50 percent of hospitals funded under the Krankenhauszukunftsfond (Future Hospitals Fund) improve their digital maturity by at least two levels in at least two categories (in line with the DigitalRadar maturity model).
• Use of electronic real-time reporting processes by all medical facilities and by public health authorities (public health service) required to report will be mandatory.
• Work towards establishing suitable digital continuous training programmes along with opportunities for dialogue and exchange, especially for service providers. In the course of vocational training reforms for healthcare professions, acquisition of digital skills will continue to receive consideration.

Long-term

• Healthcare and long-term care is increasingly based on digital data and its provision is personalised and tailored. On the basis of a population-based data analysis, personalised preventive healthcare programmes will be made available.

Both in healthcare provision and in healthcare policy management, data should help in enabling well-founded, informed decisions. The research community and the general public should benefit from the availability of health data. Also, Germany’s healthcare and long-term care system should be interfaced with the future European Health Data Space (EHDS) to enable quality healthcare provision and research across national borders.

The following should be achieved:

• i. Successively improve the quality of health and care data generated in healthcare provision and make it more easy to use.
• ii. Give insurance holders direct, secure access to their personal health and long-term care data and enable their low-threshold use to support and improve personalised treatment and care. This includes the right of insurance members to easily view their personal data, including with help from others.
• iii. Each and every individual has the opportunity to decide independently and without restrictions to accessibility on how their personal treatment, healthcare and long-term care data is used. This also enables an informed decision-making about non-use and its consequences, for example in connection with the electronic patient record (ePA).
• iv. Ensure the availability and possible linkage of data from various sources. This includes billing data, healthcare data from the ePA as well as study-related, genomic and/or registry data. It also fosters acquisition of knowledge on combating health risks such as pandemics, enables preventive and predictive action by means of personalised medical treatment and care, and takes the research data landscape to a new level. This increases patient safety, the quality of treatment and care, and also efficiency in the use of resources in healthcare, long-term care and the public health service. By facilitating
• v. secure access to data for research in both the public and private sector, Germany’s role as a leading science and industry hub will be further consolidated.
• vi. Promote the sharing of representative data for research and the development and use of data-driven technologies to secure more targeted support for provision and administration processes in healthcare and nursing, and place greater focus on people in research, development and application. For example, personalised treatment and care is facilitated by using AI to assist early detection of disease and, through early identification of complications in the course of healthcare and nursing.

To ensure these goals and objectives are met, the data used must be of high quality and available in structured form.

Measures

Short-term

• The research data landscape will be underpinned by the gradual introduction of a research pseudonym in healthcare-related registers as well as in routine and study-specific data to enable linkage between healthcare and long-term care data for use in research. In the medium-term, the research pseudonym should also enable linkage with electronic patient record (ePA) data.
• To improve public health and public health research, a Bundesinstitut für Öffentliche Gesundheit (Federal Institute of Public Health) will be established. The Institute will receive access to public health-related data from the various interconnected data sources, thereby making an important contribution to data-based decision-making on health policy concerns.
• Standardised and transparent division of responsibilities and roles in respect of interoperability issues in healthcare and long-term care. Moving away from system and sector-specific rules and regulations for interoperability and standardisation.
• A right to interoperability and data portability will be enshrined in law and gradually implemented into practice.
• Implementation of medical information objects (MIOs) which generate valuable healthcare benefits for a large section of the population (e.g. medication data) will be prioritised, thereby creating the foundation for harmonised availability and usability in practice. In both the short-term and medium-term, DMP datasets will be developed and established as MIOs (see the processes field of action).
• Initiate a paradigm shift towards enabling access to data via secure processing environments for specifically defined purposes, especially for medical science research, as data access authorisation criteria.
• Improve opportunities for health and long-term care insurance funds and other cost carriers, and also associations of SHI physicians to use – in the interests of insurance holders – available healthcare and long-term care data to identify regional care needs and deficits, design demand-based provision and conduct accompanying research.
• With further development of the leading data protection supervisory authority, a standardised data protection supervision practice in healthcare and long-term care will be promoted – with the goal of making use of data for care provision and research purposes safe and applicable.
• Working towards standardisation of digital documentation in long-term care (SGB XI). An assessment will also be made to see if the interoperability of long-term care documentation can be improved (syntactically and semantically interoperable data formats) and to identify the conditions that would need to be put in place (such as standardised care terminology and classification systems).
• For the benefit of patients, initially those with oncological and rare diseases, and as part of the model project on genome sequencing according to Article 64e SGB V, enable genomic medicine as a knowledge-generating form of healthcare and evaluate its use/benefits in practice. Monitor connectivity with relevant registers, the ePA, EU initiatives (1+ million genomes/Genomic Data Infrastructure) and the interface with the European Health Data Space (EHDS).
• The German Implant Register will initially go into operation to register breast implants.

Medium-term

• Establish a national access point for healthcare data as a touch point for stakeholders from research and the public health service to link healthcare and long-term care data from multiple sources (ePA, routine data, study-related data, etc.).
• By the end of 2026, no less than 300 research projects will be conducted or initiated using data from the Health Data Lab (HDL).
• Gradual development towards achieving the realm of the ideal in real-time availability of healthcare and long-term care data. Work towards ensuring that selected routine data from SHI healthcare provision is transferred to the ePA and to the Health Data Lab in a structured format and on a monthly basis at minimum. Service providers will be required to meet appropriate deadlines.
• Drive harmonisation and standardisation of IT infrastructures and an across-the-board increase of the digital maturity level of healthcare and long-term care institutions – especially among service providers not previously covered by digitalisation activities (such as physiotherapy/rehab).
• Create rules and regulations for secure use of healthcare and long-term care data in AI testing and training. The EU legal framework as well as prevailing national, EU and international initiatives will be taken into account.
• In a first phase, certain data from all Länder-specific cancer registers nationwide will be compiled by the German Centre for Cancer Registry Data (ZfKD) at the Robert Koch Institute. In a second phase, all cancer register data should be compiled as needed, linked with other data via a common platform and made accessible. Transparency regarding data storage sites will be ensured and duplicate structures dismantled.
• Following successful evaluation of the model project on genome sequencing according to Article 64e SGB V, its integration into standard healthcare provision will be enabled and an assessment made regarding its expansion to other indications and datasets for personalised medicine. This also ensures connectivity with other national and EU data infrastructures.
• Operation of the German Implant Register (IRD) will be expanded to cover endoprostheses and aortic valves.

Long-term

• Technical and organisational infrastructures will be expanded to ensure that access to healthcare and long-term care data is available for healthcare provision and research across EU borders.
• With the model project on genome sequencing according to Article 64e SGB°V, a sustainable structure for personalised medicine is created – among other things for use by various omics datasets in healthcare provision and research.
• Operation of the German Implant Register (IRD) will be expanded to cover additional implant types.

Innovative digital technologies and applications can help prevent disease, improve treatment and restore good health. People in need of long-term care can be helped to lead the most independent life possible, while the burden on family carers and nursing staff is relieved.

The following should be achieved:

• As part of an ongoing process, the electronic patient record (ePA), in which all personal health data is digitally stored, will be further developed into a platform where value added services (such as automatic checks for medication interactions) can be used.
• Digital applications will be connected in a way so as to facilitate seamless exchange of data and allow for information such as MRI images or other examination results to be accessed by the attending service provider directly after examination.
• Those concerned will be included in the development of digital applications at an early stage to improve the quality and acceptance of applications.
• When using and developing digital applications and technologies, sustainability issues, such as energy consumption, will be taken into account.

Measures

Short-term

• A Digital Health Agency will be established as the authoritative body for digital applications in the German healthcare and long-term care system, especially with regard to the telematics infrastructure. When identifying and formulating the requirements for appropriate applications, users are to be involved at an early stage.
• Lifting of the restriction on telemedicine to 30 percent of consultations and the establishment of performant structures and services enable the potential of telemedicine to develop and unfold.
• Digital healthcare and long-term care apps (DiGAs and DiPAs) will be developed as integral components of digitally assisted healthcare processes. In the future, DiGAs and DiPAs can not only export data to the ePA (opt-out), but can also read data from the ePA where it is necessary and useful for DiGA/DiPA personalisation.
• Beneficial digital medical devices (risk classification IIb) will be reimbursed as DiGA.
• In the future, DiGAs will include detailed telemedicine treatment plans with doctors’ involvement.
• Use of secure, cloud-based systems in outpatient and inpatient healthcare and long-term care facilities as well as for TI applications will be made easier – among other things, by adapting the regulatory framework.
• By mid-2023, the technical conditions for nationwide use of the e-prescription will be created and preparations will be made for an accelerated, mandatory rollout in 2024.
• The existing funding programme for digital and technical procurements in nursing care facilities to relieve the burden on nursing staff will be expanded to include additional items in accordance with Article 8 (8) SGB XI.
• The Innovation Fund will be continued, further developed and enhanced. This will pave the way for innovative forms of healthcare to be tested over time and transferred to everyday healthcare routine.

Medium-term

• All service providers are required to connect to the TI, and the capabilities for automated ePA population will be continually expanded (in the short-term, via the electronic patient summary – ePKA).
• By 2027, at least 80 percent of laboratory results will be stored in the ePA and can be forwarded to the Health Data Lab (HDL).
• The ePA will be further developed to enable algorithm/AI-based healthcare interventions and public health measures in real time.
• Enabling low-threshold access to digital applications: After receiving detailed information on the potential risks, users can select the data security/data protection level for authentication in digital apps. IT security in healthcare and long-term care apps should thus be simplified for first-time users. Awareness to this issue must also be promoted.
• Develop simple, transparent opt-out solutions regarding use of the ePA and a transparent and simplified ePA authorisation management system that takes the insurance holder’s perspective.
• Digitally assisted long-term care documentation is to be used across the board in day-to-day care and, in particular, contribute to a noticeable reduction in the workload of healthcare professionals and to their efficient use.

Long-term

• The ePA will eventually be developed to become a cross-Social Code portal, services – such as from health and long-term care insurance, and from statutory pension and accident insurance –) will be integrated, and a joint database is to be created.