Although European health systems have faced the most challenging public health threat they have ever experienced, the promising side effects have undoubtedly been the disruptions catalysed by digital health. During this time of crisis, digital health has stepped in to provide expedient health care services that offer effectiveness, safety and even humanity for patients suffering from chronic conditions or who need immediate health care. In recognition of this, the European Commission recently proposed the EU4Health programme as part of a COVID-19 recovery response programme. The initiative aims to raise €5.1 billion for the digital transformation of the EU health sector and ensure preparedness for future cross border health threats.

Germany

Germany has steadfastly remained at the forefront of the digital health transformation during the pandemic by continually innovating and adapting legislation accordingly. In 2019, DiGA Fast-Track was created by the Digital Healthcare Act (DVG) and various legislative changes, which meant that apps could be prescribed by doctors and costs are reimbursed through German health insurance. On 5 October, eleven months after the Germany federal government passed the DVG, two health apps officially became available for prescription.

However, the acceptance of digital health has not always been so widely present in Germany. Dr Susanne Ozegowski, head of corporate development and digitisation at Techniker Krankenkasse (TK) and HIMSS EMEA advisory board member, told Healthcare IT News: "In Germany, until three years ago, digital health didn't play a big role. There were a few fitness and wellness apps but hardly any digital health applications which had a relevant impact when it came to the diagnosis and treatment of diseases.

"That changed when the minister of health, Jens Spahn, came into office three and a half years ago who really pushed the issue of digital health overall."

Since January 2021, all statutorily insured 72 million German citizens have been legally entitled to a national electronic patient record (ePA). Discussing this recent initiative, Dr Ozegowski added: "The technical infrastructure is in place,  it is clear now what the parameters are. Patients already actually have access, because as of January 1 of this year, they have the opportunity to use an electronic health record, which is part of that telematics infrastructure. The decisive next step will be that providers get access and that the ePA really becomes a relevant part in the standard procedures of care.

"I think the electronic patient record is one of the major things that we need in Germany. Otherwise, you're going to have all this fragmented health data here and there, but you need a common digital infrastructure in order to have real exchange of information, and the opportunity for better care decisions based on each individual's health data."

Reflecting on the region-wide benefits to come from the pandemic, Dr Ozegowski explained: "COVID has also helped in the acceptance that we need to do more in healthcare on a European level. Here two things came together: COVID, of course, but then also the fact that Germany had the EU presidency in the second half of 2020."

"That has led to Germany pushing for a European health data space - which requires interoperability on a European level - but also the implementation of the EU patient summary in Germany, which is in essence a shortened version of the electronic health record that will be interoperable with the EU standard."

Telemedicine platforms are also a large component of Germany's plans to rapidly roll-out digital health services. Earlier this month, operators of telemedicine platforms reported a growth rate of over 1,000%, with more than 20,000 medical doctors and psychotherapists offering appointments through video-consultations. Online appointments are reimbursed, provided that one of the 20 platforms certified by the Federal Association of Statutory Health Insurance Physicians (KBV) is used.

Discussing the increase in teleconsultations, in a Q&A for the Deutsches Ärzteblatt, Professor Jürgen Debatin, head of the Health Innovation Hub of the German Federal Ministry of Health, said: "[…] it is above all digital technologies that keep us together as a society in this situation. This also applies to medicine." 

As a consequence, manufacturers of practice software are bolstering investments in integrated solutions for online health consultations. During the pandemic, German CompuGroup Medical (CGM) decided to create its own video-consultation solution called “Clickdoc” available to all doctors free of charge until further notice. According to CGM, since its launch, around 5,000 doctors have registered for this KBV-certified video-consultation.

German video-consultation platform, Doctor Konsultation.de is also one of the providers who have experienced strong growth in demand in the wake of the pandemic. "We are currently experiencing an openness to the video-consultation that is new to this extent," said a company spokesperson. 

France

France adopted a new healthcare act in 2019, based on the government's 'My Health 2022' plan which seeks to expand the country's eHealth focus. Amongst its plans, France wants to improve interoperability; roll-out nationwide electronic health records (EHR) to become the cornerstone of eHealth platforms; leverage the use of AI in health; establish a data hub for healthcare data sets; and invest further in the recent introduction of telemedicine by the public health system.

Telemedicine usage has been breaking records in the country, prompting health minister, Olivier Véran to announce a decree to ease the conditions for the practice of telemedicine. Furthermore, the country has recently kick-started trials for a digital vaccine passport and is showing promising progress in utilising health tech to get the country back to normality. Starting from this month, the International Chamber of Commerce (ICC) AOKpass app will be trialled for passengers travelling to the French Caribbean territories of Martinique and Guadeloupe.  

Norway

In Norway, the Directorate for eHealth has encouraged healthcare professionals to leverage video-consultations and has set up an overview of solutions already in use in the sector - either as a standalone video platform or from the EHR system. The main EPR solutions with video for doctors in Norway are The PatientSky, which works directly in the browser, and Pridok, a cloud-based system with integration of standalone video solutions, Confrere, Helseboka and Helsenorge.

For psychologists and psychiatrists, the directorate has suggested a number of standalone video solutions and EHR solutions with integrated video such as Aspit Psykbase which integrates with Aspit Meet or Confrere (on request).

The Norwegian Health Network (NHN) / Helsenorge is actively encouraging more providers to offer video-consultations in collaboration with helsenorge.no, enabling more widespread access to video solutions for residents.

The Norwegian Directorate of Health and the Norwegian Directorate for eHealth have recently put together a 'corona portfolio' to collate input from small and large actors on digital solutions that can help solve the crisis. The input is categorised and disseminated for further assessment from various working groups with representatives from NIPH, the Norwegian Directorate of Health and the Norwegian Health Network.

Rune Pedersen, director of Patient Pathways, at the Norwegian Centre for eHealth Research told Healthcare IT News: "A large national digital platform is currently planned and partly operative. This platform will in the future contain interoperability and semantic solutions. FHIR is a national interoperability standard, and SNOMED-CT has been chosen as common terminology.

"National services for patients and professionals are included. These are several and in progress. The work is hosted at the Directorate of eHealth, and led by the government. One of for regions has bought and will implement EPIC in both the primary and specialist healthcare. The implementation is planned started in 2022. The municipalities are planning a national procurement of common HER systems through KS, a municipal common organisation."

Although this procurement is at an early stage, three of four regions have adopted an open EHR driven system for specialist healthcare, which is being implemented from 2021. Pedersen added that this approach aims for efficiency and safety, with a large focus on interoperability between services.

Digital health technologies here to stay 

As a result of the pandemic, the use of virtual care and telemedicine has been established as a major component of delivering care. Europe's health system governance will continue to invest and reimagine health systems to ensure that telemedicine and other digital health technologies are improved and adapted to emerging regulations and ever-changing patient demand.

These digital health models reduce the risk of infection for the patient and for hospital staff and also free up hospital resources for prioritised areas. Most importantly, and paradoxically, digital health models that were once critised for dehumanising care have played an invaluable role in connecting clinicians and patients across Europe. As this area evolves, the European Commission's Communication on Digital Transformation of Health and Care aims to continue gaining support and momentum in empowering citizens and building a healthier society through the greater use of digital products in the sector. 

Find out more about the European digital health strategy at the 'A New Agenda for Europe: Leveraging the European Health Data Space' session at the HIMSS21 & Health 2.0 European Health Conference on 7 June, 2021. 

Healthcare IT News is a HIMSS Media publication.