Transformation in Healthcare: Digitalisation doesn't have to hurt

The Hospital Rating Report 2021 and the Roland Berger Hospital Study 2021 attest hospitals in Germany a desolate economic situation. It is well known that digitalisation can relieve doctors and nurses and improve treatment. But the transformation is happening too slowly, as a recent Deloitte study also shows.

The new Hospital Rating Report 2021 speaks a clear language: many hospitals in Germany are economically at the limit, according to figures from almost 1,100 annual financial statements for 2018 and 2019. Only compensation payments for revenue losses due to the Corona pandemic should make the situation somewhat more bearable in 2020, the authors of the study predict. The results of the Roland Berger Hospital Study 2021 are even more drastic: according to the study, half of the hospitals in Germany would be in the red in 2020, more than half of 600 surveyed hospital managers in Germany expect revenue declines in 2021 and 83% expect their economic situation to worsen.

Charité: “We are far behind in the digitalisation of the health system.

The causes are manifold: more patients due to demographic developments, more chronically ill patients, and at the same time a lack of competent specialist staff, the Charité University Hospital lists in its strategy paper. Another challenge: digitalisation, which has the potential to provide relief, often still lags behind expectations: “We are far behind in the digitalisation of the health system,” Charité CEO Heyo Kroemer recently stated in Der Spiegel in view of the hesitant digital pandemic response, citing the electronic vaccination certificate, which came very late, and the ineffective Corona app as negative examples.

Symptom: Dealing with the Corona pandemic

The Corona pandemic shows well how ponderously the German health system reacts to change: It is true that the pandemic triggered “change management programmes” (*note: for digitalisation) in weeks that would otherwise have taken years. But Germany has still had a harder time with it than its European neighbours, Deloitte analyses. For the study “Shaping the Future of European Healthcare”, the consulting firm surveyed 1,800 doctors and nurses from the seven European countries Denmark, Italy, the Netherlands, Norway, Portugal and Great Britain. This includes, for example, using digital technologies to reorganise services, train staff accordingly and protect them in a targeted manner. Just under 40 percent of German doctors used digital approaches to support them in their work or virtual ways to treat patients. The situation is different in the other countries: Here, two thirds of the respondents use the advantages of digitalisation in the short term.

Source: Deloitte research and analysis based on survey commissioned from M3, 2020.
Survey question: To what extent has your organisation increased its adoption of digital technologies to provide virtual support and ways of engaging with patients in response to the Covid-19 situation so far?

Efficient, fast, simple: The expectation of a healthcare system in five years’ time

If you ask doctors which adjectives best describe the health system in their respective countries, only one thing is clear: it is slow, everyone agrees. Nevertheless, negative attributes such as bureaucratic, complex and fragmented compete with positive ones such as innovative and efficient. In five years, the experts agree, the battle will be decided: Then the health system will be efficient, fast, simple, paperless, innovative and progressive. It is not there yet, especially in Germany: outdated systems and networks, paper administration and overworked staff are standard and the potential for optimisation is high.

Digital transformation: Germany brings up the rear

While 88% of the medical or nursing professionals surveyed in Denmark feel very well prepared for the digital transformation, Germany ranks last with only two-thirds (66%) and lags behind the European average (74%).

Use of technologies: much untapped potential

While digital medical records (77%) and digital duty rosters (52%) are used by the majority of hospitals, speech recognition tools (26%), automation of clinical tasks (26%), robotics (13%) or artificial intelligence/AI (7%) are still little used in Germany. Yet the respondents mostly see great potential in these, about 35% in artificial intelligence, 53% in the automation of clinical tasks and 48% in speech recognition tools (see chart).

Obstacles: Bureaucracy slows down transformation

Bureaucracy in the health sector (Europe: 57 %, Germany: 61 %), the cost of technology (Europe: 50 %, Germany: 57 %) and identifying the right technology (Europe: 49 %, Germany: 42 %) rank highest across Europe. Surprisingly, the respondents in Germany see almost no obstacle in the lack of adequate offers to learn how to use technology. Only just under three percent (Europe: 37 %, Italy: 47 %) of the doctors surveyed saw a need for action here.

Potential for improving the supply of new technology

Source: Deloitte, 2020

Pandemic: The driver for digitalisation

The Corona pandemic was and is both a curse and a blessing: on the one hand, no one wants to fall seriously ill with Covid-19. On the other hand, development processes such as digitalisation are currently being accelerated enormously – through pressure from the population and support from politics. Digitalisation has the advantage, especially in times of pandemic, that it reduces personal contact and thus the probability of passing on viruses. It can also help to cope with the increased reporting requirements (such as the reporting of patient data from treated Covid 19 patients by means of software robots) in the most personnel-friendly way possible. In the medium and long term, new technologies ensure that processes are accelerated, made more efficient and simpler, and thus resources in the hospital are used more efficiently. Ultimately, new applications, robots and/or AI will save time in processes that will benefit treatment and thus the patient. Here are some examples:

Remote diagnosis, consultation and therapy: the patient is able to take the measurement of important parameters (insulin, blood pressure, etc.) himself. The consultation and agreement with the doctor can then simply take place via video. The patient does not have to wait in the practice and the doctor can spend more time on counselling. Pain management as well as physiotherapy are partly also possible under virtual guidance. Prescriptions can also be issued directly online.

Improve medical decisions: Artificial intelligence (AI) and deep learning (DL) is able to make suggestions to the doctor for the diagnosis and thus support him in deciding on the most successful treatments. The basis for this is data, optimally also historical data from the last few years, which the doctor can access centrally with the patient’s consent.

Automate repeatable processes: According to the Deloitte survey, bureaucracy in the healthcare sector is the biggest obstacle to digitisation across Europe so far. However, many processes in hospitals are repetitive and can be automated with the help of RPA (Robotic Process Automation), among others: Filling out questionnaires, making reports, documenting treatment steps, gathering information.

Digital before outpatient before inpatient: RPA as a platform strategy

According to the authors of the Hospital Rating Report, care should be designed according to the principle of “digital before outpatient before inpatient” in the future. Example of automation: Having repetitive, time-consuming and error-prone tasks done by computers – via a robotic process automation (RPA) platform – and thus relieving specialist staff, creates free space for the treatment of patients. This includes patient documentation, which can be used for ward lists, ward rounds, reports on current occupancy capacities or doctors’ letters. Or for documenting current virus developments. And it hurts no one: specialist staff are relieved, manual error-prone processes experience an increase in quality, while the patient ideally also experiences a more relaxed doctor or nurse.

As the example of the Aschaffenburg hospital shows, hospital management can save more than 15 percent of the working time spent on bureaucratic tasks through automated processes. Extrapolated to the German hospital landscape with almost 170,000 doctors and over 340,000 nurses in German hospitals, this means: if only every tenth working hour could be taken over by RPA, this would correspond to 17,000 full-time doctor and 34,000 full-time nurse positions. Chief physician Hubertus Schmitz-Winnenthal has meanwhile identified more than 30 processes that he wants to automate step by step. To do this, he relies on X1 Clinic, an RPA collaboration platform that makes it possible for defined processes to be easily automated in other departments. Those who automate use the opportunities of digitalisation. Digital success stories are created that can have a domino effect – towards a digital culture in the clinic.