What will it take for Germany to embrace digital health?BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2828 (Published 11 August 2020) Cite this as: BMJ 2020;370:m2828
All rapid responses
Embrace “digital health”. Heaven forbid.
The electronic nonsense has gone far enough.
Please try telephoning a surgery or a hospital. By the time you have heard the options - six , perhaps, you have forgotten the first few.
Please remember that some of us patients are in the twilight of life. Not very clever any more.
And digital health - do you want to outsource to China, or India, or the Philippines?
It is bad enough already. Hospital doctors are elusive.
There are no doubt some patients who find it embarrassing to talk to a human being.
I would prefer to look the doctor in the eye, be interrogated by him, interrogate him ( ever so respectfully), discuss the whys snd wherefores of my illness, the treatment proposed.
These little matters cannot be sorted out by a computer.
Am I wrong?
Competing interests: Patient. Very old
The article on COVID-19’s impact on Germany’s uptake of digital health provides useful insights into the UK’s difficulties with digitisation of healthcare. Matt Hancock, the Health and Social Secretary of the United Kingdom, strongly advocates integrating technology into healthcare. Although the UK is further along in its digitisation of healthcare, COVID-19 has pushed this issue to the forefront and revealed that despite this progress, much work remains to be done.
Secondary care specialties in the UK have utilised remote consults with good feedback.[3-5] Telephone consults have been a longstanding feature in primary care, with approximately 25% occurring over the telephone. Forays into e-medicine have been conducted by private companies and a few GP practices, but these remain at a local level.[7-9] The UK’s digitisation of healthcare lingers at the teething stage, unveiled by COVID-19 when the pandemic required an unprecedented, national move towards digitisation.
A significant barrier to remote consultation has been the lack of infrastructure to support it. Remote consults in general practice jumped to 85%, but systems were not in place to sustain this. 50% of GPs struggled to work remotely secondary to technological barriers, including problems with VPN connectivity, and a lack of the necessary hardware and software to conduct video conferencing. For remote consults to become a viable long-term method of patient care in the United Kingdom, the right infrastructure must be implemented.
Privacy and safety concerns have hindered digitisation’s progress, but little has been done to address these.[11-13] However, there is growing evidence that remote consults are well received by both physicians and patients alike in both primary and secondary care.[3, 6, 14-16] The concerns raised by physicians are legitimate. To help quell these worries, evidence-based guidance needs to be developed to mitigate risk and establish norms of practice. Best practice guidelines have already begun to take shape during the COVID-19 pandemic but more needs to be done urgently.
Digitisation has been trialled at a local level, but this needs to be scaled up into a complex system nationally. To help establish this, the correct infrastructure needs to implemented to ensure privacy and efficacy. Studies are required to support the development of evidence-based guidelines, which can address legitimate safety concerns. COVID-19 has provided us with plentiful data to help shape the digitisation of our healthcare system, so there may yet be an opportunity in a crisis.
1. Albert H. What will it take for Germany to embrace digital health? BMJ. 2020;370. https://www.bmj.com/content/370/bmj.m2828 (Accessed 14 August, 2020).
2. Department of Health and Social Care. Matt Hancock launches tech vision to build the most advanced health and care system in the world [Internet]. GOV.UK. 2018 [cited 2020 Aug 16]. Available from: https://www.gov.uk/government/news/matt-hancock-launches-tech-vision-to-...
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9. Armfield NR, Bradford M, Bradford NK. The clinical use of Skype--For which patients, with which problems and in which settings? A snapshot review of the literature. Int J Med Inform. 2015;84(10):737–42. https://pubmed.ncbi.nlm.nih.gov/26183642/ (Accessed 14 August 2020).
10. RCGP calls on Government for “Remote Care” plan for patients during COVID-19 [Internet]. RCGP. [cited 2020 Aug 16]. Available from: https://www.rcgp.org.uk/about-us/news/2020/april/rcgp-calls-on-governmen...
11. Randhawa RS, Chandan JS, Thomas T, et al. An exploration of the attitudes and views of general practitioners on the use of video consultations in a primary healthcare setting: a qualitative pilot study. Prim Health Care Res Dev. 2019;20:e5. https://pubmed.ncbi.nlm.nih.gov/29909798/ (Accessed 14 August 2020).
12. Marshall M, Shah R, Stokes-Lampard H. Online consulting in general practice: making the move from disruptive innovation to mainstream service. BMJ. 2018. https://www.bmj.com/content/360/bmj.k1195.long (Accessed 14 August 2020).
13. Greenhalgh T, Vijayaraghavan S, Wherton J, Shaw S, Byrne E, Campbell-Richards D, et al. Virtual online consultations: advantages and limitations (VOCAL) study. BMJ Open. 2016;6(1):e009388. https://bmjopen.bmj.com/content/6/1/e009388.full (Accessed 14 August, 2020).
14. Greenhalgh T, Wherton J, Shaw S, Morrison C. Video consultations for covid-19. BMJ. 2020:368. https://www.bmj.com/content/368/bmj.m998.long (Accessed 14 August 2020).
15. Ball SL, Newbould J, Corbett J, et al. Qualitative study of patient views on a “telephone-first” approach in general practice in England: speaking to the GP by telephone before making face-to-face appointments. BMJ Open. 2018;8(12):e026197. https://pubmed.ncbi.nlm.nih.gov/27087257/ (Accessed 14 August 2020).
16. Kew KM, Cates CJ. Remote versus face-to-face check-ups for asthma. Cochrane Database Syst Rev. 2016;4:CD011715.
17. Greenhalgh T, Koh GCH, Car J. Covid-19: a remote assessment in primary care. BMJ 2020a:368. https://www.bmj.com/content/368/bmj.m1182.long (Accessed 14 August 2020).
Competing interests: No competing interests