Almost two months ago, I was asked whether I could write an article for the Italian science magazine "Chi Cubo" about my work in the digitalization of healthcare. I was happy to take this opportunity and, as a result, wrote a five-page article about the problems and opportunities of digitalization here in Germany.

The article was translated into Italian for publication in the magazine, and I am now publishing the English manuscript of the article here. If you would prefer to read the article in Italian, feel free to click through the pages of Chi Cubo, which is generally a very exciting magazine, if you know the language well or have access to a good online translator. The article in Italian was published under the title "Sul futuro della digitalizzazione della sanità".

Many thanks to Irene for the translation and for accompanying the entire process.
Below the download button you will find the text in its raw form embedded on these pages.

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On the future of the digitalization of healthcare

Picture this: a world where your doctor's prescription arrives like a friend request on Facebook, and your medical records are protected by the same security measures as your grandma's famous meatloaf recipe. Welcome to the digital healthcare revolution that never quite figured out how to become reality.

And then came the computer

In the annals of healthcare history, the promise of a digital revolution in medicine has tantalized both healthcare professionals and the public for decades. From the earliest attempts to digitize patient records to ambitious visions of comprehensive national digital health transformations, the journey toward a seamlessly interconnected healthcare system has been a long and arduous one.

The idea of digitalizing healthcare is almost as old as the computer itself: the first large-scale integration of electronic health records (EHRs) began in Rochester, Minnesota, at Mayo Clinic in the 1960s | one might expect the entire healthcare sector to have entered the digital age over the last 60 years. However, in most countries we are still very much in the transition away from paper and pen. So now more than ever, it is worth taking a look at the status quo of digitalization in healthcare and what has to change in order to truly achieve digital healthcare.

Policies and politics

There are few fields in our daily lives that are as strictly regulated as healthcare and medicine in general: in most countries, in order to work in the field, you are required to have a proper license, and there are strict guidelines on how to treat patients. Everything you do while working needs to be documented, and the requirement of confidentiality is as strict as it can be.

Many policies are not dictated directly by your employer, but are controlled and monitored by third parties; for example, standardization bodies or the government set the rules of the game. And that makes perfect sense: only a strictly regulated environment as critical as the healthcare sector can provide the high medical standards patients expect.

Different regions, different laws

Having a legal framework spanning thousands of pages does not help standardization and certainly does not speed up the development of digital solutions for the field, especially if the framework created is applicable only to a single country or even region. Given the expected complexity of solutions for the healthcare sector, adopting systems across different regions and markets is necessary in order to be feasible for every healthcare provider. If every market for digitization products requires a custom solution, the costs will be immense.

Learning from past mistakes

To make my point clear: Epic Systems, a private American healthcare software company, was tasked in the United Kingdom with adapting its EHR solution to the market for £200 million. After transferring around 2 million health records, the system became unstable and unusable. As a result, ambulances had to divert to different hospitals and, among other things, issues arose with blood transfusions. Two years later, Danish authorities tasked Epic Systems with implementing its solution in the Danish healthcare system for 2.8 billion DKK (around 350 million euros). After a similarly poor start as in the UK, serious concerns about the quality of the solution were still being raised even two years after the initial rollout.

Epic Systems was not the only company to have its fair share of problems adapting its systems worldwide; most North American companies have struggled to adapt and expand their solutions in Europe, for example McKesson Corporation, Cerner Corporation, and Allscripts Healthcare Solutions, just to name a few. This is, of course, linked to the widely different healthcare systems in North America and Europe, and I am not arguing for alignment in terms of operating procedures; at this point, we are far too deep into our different ways of thinking about healthcare. Instead, I am calling for these differences to be factored in when adapting software from abroad (in terms of cost, time spent testing the software, and listening to feedback) and for healthcare systems that are already similar in their approaches to be aligned. So far, even digitalization efforts within the EU have had a long list of problems when being adapted to a different region. Aligning the legal frameworks within the EU would be a huge step toward the interoperability of soft- and hardware and would allow for faster implementation in general.

Data security and cybersecurity

With an average cost of about 10 million euros per breach, healthcare is the largest and fastest-growing industry to experience multi-million-dollar penalties. Protecting the data of patients and employees is crucial for the trust placed in the healthcare system. If we want to speed up digitalization, we need to put measures in place that prevent avoidable incidents.

The role and opportunities of startups

I am in a position to share my own experiences of founding a startup in the medical sector: my company "Dotreflection" aims to develop software solutions that help medical professionals communicate their knowledge and medical content to everyone (e.g. by providing a self-hosted and flexible digital video course solution). Note that this automatically places me in the perspective of founding and running a German startup with national requirements and laws, but also national funding measures. Not every point in this topic is directly applicable to everyone, but I try to approach the topic in as general and internationally relevant a way as possible.

Why startups are essential for digitalization

In my opinion, startups play a pivotal role in driving the digitalization of healthcare, revolutionizing the industry in numerous ways: these agile and innovative companies bring fresh perspectives and long-awaited technologies to address longstanding challenges in healthcare. From telemedicine platforms that improve access to care to AI-driven diagnostic tools that increase accuracy, startups are at the forefront of developing solutions that increase efficiency, reduce costs, and improve patient outcomes. Their ability to quickly adapt to evolving healthcare landscapes, new technologies (like AI), and regulatory environments positions them as catalysts for transformative change, making them indispensable partners in the ongoing digitalization journey of the healthcare sector.

A special market

Despite the legal complexity, market size, and peculiarities of the healthcare sector, there are many reasons to enter it: from my perspective, the main reasons I founded a company in healthcare are the industry's resistance to recession and the huge opportunities for innovation with long-lasting partnerships, even between startups. In Germany, around ten percent of all newly founded startups in Q2/2023 chose healthcare as their main market. Those 73 startups have to deal, in Germany alone, with 16 different legal frameworks for data protection, one for each federal state. The cost reduction for those startups that would result simply from merging those 16 slightly different legal frameworks into one nationwide framework would be immense. The healthcare market is a very unique one | in Germany in particular because of deeply embedded federalism, which further highlights the importance of widely adopted interoperable legal frameworks.

A bright future for startups?

In my opinion, the future of the healthcare startup ecosystem holds immense promise and potential for transformative change. We can expect to see continued innovation in areas such as telemedicine, remote patient monitoring, AI-driven diagnostics, and personalized medicine. Startups will likely play a central role in addressing persistent healthcare challenges, including improving access to healthcare, reducing costs, and enhancing patient outcomes. Interoperability and data-sharing standards will evolve, enabling seamless communication among healthcare systems and facilitating the secure exchange of patient information. Regulatory bodies will continue to adapt to accommodate new technologies, striking a balance between innovation and patient safety. Moreover, as the digital health landscape matures, we may witness increased collaboration between startups, established healthcare institutions, and insurers to create comprehensive, patient-centered healthcare ecosystems. Of course, the healthcare startup ecosystem faces challenges related to regulatory complexity, where navigating stringent healthcare regulations can be a formidable barrier to market entry and scalability. Additionally, ensuring data security and privacy remains a persistent challenge, given the sensitivity of healthcare information and the growing threat of cyberattacks in the digital age.

Everyone is needed

Despite the promising and disruptive role that startups play in healthcare digitalization, it is essential to emphasize that everyone in the field, including established healthcare institutions and government agencies, remains indispensable. As stated, healthcare is a complex and highly regulated sector, with unique challenges related to patient safety, data privacy, and public health. Established healthcare institutions bring a wealth of experience, infrastructure, and expertise in managing these complexities and ensuring the highest standards of care. Moreover, government agencies provide the necessary regulatory framework to safeguard patients' interests and maintain the integrity of healthcare systems. Collaboration between startups, healthcare incumbents, and regulatory bodies is crucial for striking the right balance between innovation and safety, ensuring that the benefits of digitalization can be harnessed effectively while upholding the fundamental principles of healthcare delivery: the synergy between startups and established players is vital for a sustainable and successful transformation of the healthcare landscape.

The bottom line

Learning from past mistakes in the digitalization of healthcare is essential to pave the way for more successful and effective efforts in the future. Here are my top ten points that I see as crucial for the coming years when it comes to digitalizing healthcare efficiently:

1. Interoperability is crucial: one of the most significant challenges in healthcare digitalization has been the lack of interoperability among different systems and platforms.
2. Engage stakeholders early: successful digitalization efforts involve all stakeholders, including healthcare providers, patients, regulators, and technology developers, from the outset.
3. Prioritize data security and privacy: breaches of patient data have raised concerns about data security and privacy in the past; policies must address the fundamental right to privacy and give clear instructions on what to do in the event of cybersecurity incidents relevant to data security.
4. Healthcare workforce training: providing comprehensive training for healthcare professionals so they can effectively use digital tools and navigate the changing healthcare landscape.
5. Avoid over-complexity: some digital healthcare projects have failed due to overambitious goals or overly complex technological solutions. Simplicity and a focus on solving specific problems or improving specific processes can lead to more successful outcomes.
6. Regulatory alignment: regulatory frameworks need to evolve in tandem with digitalization efforts. Past mistakes illustrate the challenges that arise when regulations lag behind technological advances. Close collaboration between regulators and innovators is essential to strike the right balance.
7. Support startups and new ideas. To challenge the status quo, we need to implement new approaches and ideas into the current system.
8. Ethical AI and data analytics: implementing ethical AI and data analytics practices to harness the power of data for predictive analytics and personalized medicine while respecting patient privacy.
9. Change management is critical: resistance to change is a common hurdle in healthcare digitalization. Successful projects prioritize change management strategies to help healthcare professionals adapt to new technologies and workflows.
10. Transparency and accountability: transparency in data handling and accountability for errors are vital components of digital healthcare. Mistakes made in the past underscore the importance of clear communication, responsibility, and accountability in healthcare data management.

To wrap up, I am quite hopeful about the development of new digital approaches in healthcare, including newly emerging fields like artificial intelligence. It remains to be seen how policymakers will handle the ever-increasing pace of the market, which needs clarity on national requirements and international cooperation in legal frameworks sooner rather than later. Including the private sector, patients, and professionals in the field can help create practical policies that meet market demands while providing urgently needed data security.

If we do all that, give it a few years, and wait for the stars to align, I am certain that one day there will be a scenario in which "a doctor's prescription arrives like a friend request on Facebook"—while keeping personal data safe and making room for emerging technologies.