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PROMOTING HEALTH

An anniversary is always the moment to look back and appreciate what has been achieved. At the same time, it is an opportunity for the Bertelsmann Stiftung to recognize that more remains to be done and, as a result, to begin focusing on the challenges that will affect our everyday lives in the future.

Health from the Web

Author: Steffan Heuer, Thomas Röbke
Photography: Shutterstock / blackzheep, Shutterstock /Jne Valokuvaus

The pacemaker reports to the smartphone, the pulse monitor around the chest talks to the clock, the scale in the bathroom exchanges data with a health-care website. Mobile apps now make it possible to recognize symptoms and identify possible health threats long before patients enter the waiting room. For example, people with diabetes can …

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… monitor their blood sugar and receive a reminder, based on their individual needs, of when it’s time for the next dose of insulin. Patients and their families can join discussion groups or go online to find out more about treatment options. In the future, doctors, hospitals and patients could even become part of the same digital network, giving them round-the-clock access to lab results, MRIs and other health-related data.

Better-informed patients

Never before have patients and their families had better access to such a wide range of information. Thanks to mobile devices in every pocket and a growing number of sensors on more bodies, an “electronic nervous system” is being created – a system in which each person is both a researcher and the subject of research. According to International Data Corporation, two years from now more than 150 million so-called wearables will be sold annually.

That means patients will be better informed and better prepared for a consultation with their doctor. They will also be in a better position to monitor their own treatment. For this to work, however, medical practitioners are needed who are willing to look beyond their own practice and integrate their experience and knowledge into a more dynamic, data-driven health-care system.

Experts estimate that there are more than 100,000 sports, fitness and health apps available worldwide. In 2013, the 20 most popular were used by more than 230 million people.

150

million wearables

will be sold each year until 2019 (Forecast: Internal Data Corporation)
An estimated
100000

health apps

are currently on the market
230

million users

snap up the 20 most popular health apps

Every other diagnosis is incorrect

Not everything is functioning the way it should, however – symptom-checker sites, for example. According to a Harvard Medical School study, when users input their symptoms into a website or app, every other diagnosis they receive is incorrect.

The researchers entered 45 fictional medical histories normally used for training purposes into 23 popular symptom-checker sites. Only one out of three sites supplied the right diagnosis. In almost two out of three cases the correct answer was hidden in a list of 20 other possible diagnoses. That means, in terms of empowering patients to make better health-care choices, online tools are only a first step – one people should take with caution. “They’re better than a random online search, but they can’t replace seeing your doctor for a thorough examination and diagnosis,” says Dr. Ateev Mehrotra, lead researcher for the Harvard study.

“The new digital solutions are making it possible for patients to become better informed and decide for themselves – by supplying them with information on their specific condition and allowing them to connect with others or engage in self-directed treatment, for example by taking an online course.”
Timo Thranberend, director of The Digital Patient project

Through its project The Digital Patient, the Bertelsmann Stiftung is investigating the impact that digitization is having on health care. The point is not to see what is possible from a technological point of view, but to weigh opportunities and risks and develop useful strategies. The ultimate goal: providing individuals and society with the greatest possible benefit.

Platform for expert advice

The expert network 30 Under 40 supports the project The Digital Patient by supplying it with new ideas and a broader perspective on topics, opinions and developments relating to digital health. It also allows experts to enter into dialogue with each other. The network brings together 30 young thought leaders from a range of organizations – start-ups, service providers, health insurance companies, research institutes, government agencies and the media.

The project is addressing a number of issues, such as how health-care innovations can be introduced more quickly into everyday settings and the possibilities and limits of using big data in medical contexts. And, of course, how digitization is changing the patient’s role. “The new digital solutions are making it possible for patients to become better informed and decide for themselves,” says Timo Thranberend, project director of The Digital Patient. “For example, there are apps that supply patients with information on their specific condition and help them choose a therapy. They also allow patients to connect with others in the same situation or engage in self-directed treatment, for example by taking an online course.” At the same time, the market for apps seems to be driven by lifestyle needs. “Most of the providers are targeting the broad mass of healthy consumers,” Thranberend says. “What plays a more limited role is what people need who are at risk of disease or who have a chronic condition. This is where there is still a lot of potential.” According to the Bertelsmann Stiftung expert, another aspect that needs a closer look is the unwanted “side effects” caused by technology, such as the overdiagnosis that can result when patients monitor themselves.

FURTHER INFORMATIONS

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The Digital Patient

Author: Tanja Breukelchen
Photography: real444 / iStockphoto.com

Through its project The Digital Patient, the Bertelsmann Stiftung is carrying out a range of analysis and activities and creating discussion platforms. The goal is to ensure new technological solutions are used to promote health. Questions that need to be answered include: What is behind the growing number of online health apps and medical websites? What is really relevant for improving health care? A Bertelsmann Stiftung study systematically analyzed the market in order to create a comprehensive classification system for digital health applications.

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Seven types of apps were identified based on the study. The category Analysis and Monitoring includes applications that sporadically record health data. Indirect Intervention includes digital diaries and medication reminders. The findings show that smartphones in particular could become an especially important tool for patients. The potential these apps offer remains largely untapped, however, and few of the relevant solutions are widely used. The study shows, for example, that the market’s development is largely supply-driven and most products are offered by lifestyle and fitness companies.

Digital health applications for citizens: seven types

Improve health literacy
Information regarding health or illness-related issues (e.g., health portals, provider comparison portals
Analysis and awareness
Spot-check and evaluate items regarding healt hrelated information (e.g., symptom checker, hearing tests)
Indirect intervention: Promote self-efficacy, adherence, and security
Monitor and evaluate health-related information (e.g., digital diary for the chronically ill, medication reminder, patient communities)
Direct intervention: Change in abilities, behavior, and condition
Prevention or therapy (e.g., online courses, tutorials, smartphones as hearing aids)
Health and illness history documentation
Save and manage data and diagnostics (e.g., electronic patient records)
Organization and administration
Process management in healthcare (e.g., online offices, making appointments)
Retail and supply
Shop for products (e.g., online pharmacy)

Tapping health apps’ potential

The Bertelsmann Stiftung also used the study to develop eight insights on the current state of digital health solutions, publishing them in a Spotlight Gesundheit policy brief. Based on these findings, the foundation has called for medical professionals and health insurers to take an active role in tapping the potential health apps offer and to promote the use of apps that truly benefit patients. It also believes research on care provision should look more closely at risks and benefits, and procedures should be developed for introducing innovations into standard care. A follow-up project is being carried out to develop recommendations for such procedures.

FURTHER INFORMATIONS

Digital-Health-Anwendungen für Bürger
Kontext, Typologie und Relevanz aus Public-Health-Perspektive
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Health apps
A powerful – but underutilized – patient empowerment tool
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The Digital Patient
We aim to help ensure technology is used to serve medicine. The goal of new digital developments should be to incorporate as many patient users as possible.
Website
Digital-Health-Anwendungen im Versorgungsalltag
Gallery
www.gesundheitsmonitor.de/
www.weisse-liste.de

Current Health

Videos, policy briefs, books, events – those are just some of possibilities for providing information on promoting health, a topic that is especially important in times of demographic change and digitization.

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Author: Tanja Breukelchen
Photography: Pixtal

People are living longer. And digital apps are now everywhere. Fortunately, technology can make life much easier for the sick and elderly. A recent issue of the Bertelsmann Stiftung’s Spotlight Gesundheit policy brief looks at how patients can videoconference with medical professionals – a form of consultation that is much in demand. As the publication shows, almost 50 percent of all patients would speak with their primary care physician or a specialist using an online app if they could.

Current topics pertaining to health care and health policy are examined in other issues of the policy brief, including findings from the Bertelsmann Stiftung’s Health-Care Fact Check, the On-Site Care project and the Integrated Health Insurance initiative. The current issue discusses Choosing Wisely, an international campaign designed to reduce overtreatment.

FURTHER INFORMATIONS

Faktencheck Gesundheit
Medizinische Versorgung auf dem Prüfstand Der Faktencheck Gesundheit liefert Daten und Fakten zum Gesundheitswesen, denn gut informiert können Patienten bessere Entscheidungen treffen.
https://faktencheck-gesundheit.de
Video-Sprechstunde
Diese Ausgabe des SPOTLIGHT Gesundheit befasst sich mit den Möglichkeiten und Grenzen von Video-Sprechstunden in der ambulanten Gesundheitsversorgung. Basis sind eine Analyse internationaler Quellen, eine Befragung von Experten sowie eine repräsentative Bevölkerungsbefragung.
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Digital Apps Ensure Participation

Author: Tanja Breukelchen
Photography: Technische Fakultät der Uni Bielefeld, Barbara Proschak und Frank Hegel

Germany’s constitution guarantees an equal standard of living throughout the country. Unfortunately, that guarantee can no longer be met in many regions. For example, urban areas benefit from high-speed Internet access, while many rural areas are literally cut off from online media. Certain social groups are similarly isolated, regardless of where they live. The divide that runs through Germany is growing wider every day.

When it comes to technical infrastructure, digital innovations are additional options that can counteract some of the negative consequences resulting from demographic trends. They are also the basis for ensuring more participation and …

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… more equitable access to a range of opportunities. Only people with high-speed Internet can make use of the benefits it brings. That is why nationwide high-speed access should be placed at the top of the political agenda – and not least because of its implications for Germany’s international competitiveness. The Bertelsmann Stiftung’s Smart Country project aims to contribute solutions in this area.

The ‘Flobi’ robot head was developed by the technical faculty of the University of Bielefeld, for future deployment as a social and interactive robot in household and care contexts.

Imagining a digital future

Imagining a digital future is crucial – and so is turning it into reality in rural areas through the use of practical applications. This will allow rural regions to retain their inhabitants and businesses and not only survive, but thrive. A key question is how participation can be promoted without causing large segments of the population to be left behind. The megatrends of demographic change and digitization cannot be stopped – especially not in the working world, where the changes are particularly pronounced. To ensure that no one is left behind, conditions at the local level must be adapted to reflect these new forms of working and value creation. What exactly is changing, and what is necessary to ensure the resulting transformation is successful?

Crowd-sourced knowledge

Policy makers and public administrators in particular must do their part to shape digital change. That means increasing the transparency of decision-making processes and the subsequent implementation of any decisions made. It also means including the public in these processes to a greater degree. Modern information and communication technology can help here – together with crowd-sourced knowledge. Access to information and the ability to manage that access are key elements for ensuring everyone can be part of society. New digital forms of disseminating knowledge and information make it possible for those groups to join in who have previously been disadvantaged, socially and geographically. Turning this into reality is both an ambitious goal and a major challenge for all of society. Yet many social groups have stopped participating – in part because they are disadvantaged and in part because they no longer feel included.

People who live far from major metropolitan areas are the ones who are most at risk of being left behind. Digital technology must always be seen only as a useful tool. The real goal is to help people living in regional and rural settings by ensuring high living standards there, along with competitive opportunities for gainful employment.

“The new digital offers give patients the option to respond in a more competent and self-determined way – be it through individually tailored information and decision-making support, communication with other affected people or through self-controlled therapies, in the form of online courses, for example.”
Marco Maas, Journalist

Opportunities for better health and care

Maintaining access to adequate medical and nursing care throughout the country is also becoming more difficult, a challenge that is taking on greater significance given the rapid aging of German society. The use of digital technologies such as telemedicine and robotics can make it possible for people to remain self-sufficient and in their own homes longer, while also lowering the barriers to health and nursing care. In turn, this can benefit the economy. Robots are now facilitating the provision of nursing care, more and more telemedicine applications are being developed, and new possibilities are being explored for using sensors and other helpful technology in everyday settings.

“Of course a great deal of caution is warranted, since we’re talking about machines taking care of people,” says Dr. Bernd Holtwick, head of Exhibitions at the DASA Working World Exhibition in Dortmund, talking about the use of robots in nursing care. “In Japan, for example, there is much less concern about using robots. In coming years people will have fewer reservations. Robots can carry out certain care-related tasks, but it is not true that we will be able to do without humans completely. Nursing care is much too complex and cannot be reduced to just a few basic procedures.”

Many things will be possible, affirms journalist and digitization expert Marco Maas in the latest issue of change, the Bertelsmann Stiftung magazine. “But what is also clear is that we need a dialogue,” he says, “one that is as transparent and simple as possible and one that even people who have not studied computer science or law can understand. In other words, we need a discussion among the general public on which data is important for society and which should remain private.”

FURTHER INFORMATIONS

Smart Country
Interview mit Dr. Bernd Holtwick
Video
Smart Country
Infographic

Certified Quality of Care

Stiftung Praxissiegel is an independent organization established by the Bertelsmann Stiftung and TOPAS. Its mandate is to certify quality management procedures in medical practices.

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Photography: Archiv Bertelsmann Stiftung

The Bertelsmann Stiftung and the nonprofit organization TOPAS Germany joined together in 2004 to found Stiftung Praxissiegel e.V., an independent association that increases quality and transparence in the health-care sector. Stiftung Praxissiegel accredits quality management procedures, service providers and medical evaluators. It also gives a three-year certification to medical practices that use a recognized quality management system to meet quality standards defined by the Bertelsmann Stiftung. This “seal of quality” is one of the few independent and reliable quality designations in the health-care sector.

This “Praxissiegel” (practice seal) is one of the few independent and reliable marks of quality in the health services.

This effort to improve quality began with the 2000 Carl Bertelsmann Prize, which focused on health-care reform. The prize called attention to a very promising approach developed in the Netherlands, one that evaluates primary care practices using objective indicators while also providing the practices with practical suggestions for improvement. Based on visits by external evaluators, the “Visitatie” model is particularly effective given its practical approach and favorable cost-benefit ratio. Further developed as part of an international project, the Dutch approach was adapted to meet conditions present in other health-care systems.

In 2013, the Bertelsmann Stiftung relinquished its role in Stiftung Praxissiegel to the AQUA Institute. The foundation continues to focus on ensuring quality in outpatient care, for example through projects such as Weisse Liste and tools that allow patients and doctors to work together to decide on appropriate treatment.

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