Germany: Digitization in healthcare under the microscope

The new eHealth Monitor measures Germany’s progress on its journey toward digital healthcare

By Laura Richter and Tobias Silberzahn, McKinsey & Company

In the past years, German politicians have put digitization of the nation’s healthcare system at the top of their agendas. During this journey, one question has come up repeatedly: How much progress has been made since the Bertelsmann Foundation ranked Germany 16^th out of the 17 health systems assessed in its Digital Health Index in 2018? To generate a shared basis for discussion, an objective overview of the current situation was needed.

That overview has now been created with the new eHealth Monitor. Using 30 indicators, the Monitor allows for the exploration of digital technological maturity and infrastructure in German healthcare facilities; a review of the services and products available from providers, pharmacies, and health insurers; analysis on patients’ willingness to engage with digital health services; and evaluation of e-health-related benefits and evidence of those benefits as reflected in the latest published research. Furthermore, the eHealth app barometer measures the success of health apps based on total downloads.

Indicators are supplemented by exciting perspectives from guest contributors, which include the German Ministry of Health, the Federal Association of Managed Care (BMC), the Bertelsmann Foundation, and CEOs from three health technology companies. Also included: The patient voice and the physician perspective.

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Legislative agenda

Over the past two years, Germany has made considerable headway in building the “foundation” for digitization via its legislative agenda. Particularly where the creation of regulated market access for digital health applications (DiGAs) is concerned, Germany is taking the lead internationally. It now needs to maintain the speed of the transformation process. Furthermore, it needs to catch up with those countries that have already finished creating a foundation for digital healthcare and that are now hard at work creating measurable benefits for patients, healthcare professionals, and other stakeholders.

Key insights

In recent years, Germany has progressed on the foundational elements of healthcare digitization: Progress was achieved in the areas of electronic health records, e-prescriptions, and DiGAs. Yet there are still many areas where digitization needs to be accelerated as quickly as possible: Many medical facilities are still operating in an “analog world”.

In 2019, for example, 93 percent of doctors still relied on paper-based means for communicating with hospitals. Options for ordering prescriptions via a website or for viewing documents online were available in just 15 percent of outpatient practices, and 59 percent of physicians offered their patients no digital services whatsoever^[1].

In contrast, patients are very open to digital solutions: One in three respondents of an online survey said that they already schedule doctor’s visits online, and two out of three Germans welcome the introduction of electronic health records and e-prescriptions ─ and this also held true for over 60 percent of respondents in the generation of individuals aged 65-years and higher^[2].

In the context of the COVID-19 pandemic, progress has been made in telemedicine service offers over the past 2 years: A survey of physicians conducted in the spring of 2020 showed that 52 percent of all outpatient doctors offered video consultations. That figure was just 2 percent at the end of 2017^[3].

Evidence of benefits

The eHealth Monitor also delivers fresh insights on the benefits of e-health solutions in Germany. An analysis based on the PubMed search engine shows that from 2000 to 2020, 158 articles were published on e-health solutions for Germany.

More than 80 percent of German medical research publications have confirmed positive benefits from e-health solutions, and these effects are most noticeable in improvements to patients’ health (found in nearly 80 percent of the studies analyzed), and in the form of greater cost efficiency and time savings^[4].

Of course, due to Germany’s new approval and reimbursement process for DiGAs, the number of published articles is likely to increase in the future, as e-health service providers are now required to scientifically prove the benefits of their solutions. More evidence is crucial and will be a success factor in the further implementation of e-health solutions.