Bertelsmann Stiftung: #SmartHealthSystems International comparison of digital strategies

Executive summary:

Digital innovations in healthcare systems can prove crucial to improving healthcare. provision. Digital solutions can improve patient safety and treatment outcomes while facilitating the economic efficiency of a healthcare system and its sustainability. A growing number of international studies as well as post-pilot national and regional assessments show that under the right framework conditions, the digital transformation of a health sector indeed leads to improved service quality and access to services. In addition, international trends show that the networked exchange of data and digitalised healthcare systems are essential to fostering results-driven care because they keep healthcare professionals on top of the latest developments in medical knowledge and thereby improve the quality of care provided.

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In international comparison, Germany lags behind in efforts to effectively leverage the benefits of digitalisation. Several European and other Western countries are much more advanced in terms of applying and adopting instruments such as an electronic health record, ePrescriptions or electronic communication between patients and physicians. These markers of progress are present not only in the Nordic states but also in several EU states with healthcare systems featuring a much wider and deeper adoption of digitalisation than the German healthcare system.

Knowledge about how healthcare systems operate is essential to formulating effective healthcare reforms that focus squarely on patient benefits. At the same time, it is also crucial to understand where, how and why the digital transformation of healthcare is succeeding in order to develop or adapt digitalisation strategies that ensure citizens, patients and society as such receive improved healthcare.

Some countries that have proved quite successful with their digitalisation strategies can serve as models for Germany. However, in order to derive realistic lessons learned and formulate specific recommendations for action, we must acquire a deeper understanding of each country’s framework conditions, the factors contributing to the success of their strategy and the extent to which digital services are actually used by patients and physicians (digital uptake). Efforts to advance digitalisation in Germany can also benefit from the rich variety of digital applications implemented in other countries. Indeed, we see an impressive range and depth of digitalisation strategies, rollout measures and actual use of patient data in several countries.

The study presented here is part of an extensive international comparison of healthcare systems with a particular focus on digital transformation. It aims to deliver a cross-national survey and evaluation of the state of digitalisation, the reach and depth of use, and success factors of an effective digitalisation strategy. In so doing, the report showcases the rich diversity of strategies, their contextual features, and the factors contributing to a health policy that successfully leverages digitalisation in order to optimise patient care and health literacy. Two separate studies were conducted for this purpose.

The first, “International Benchmarking and the Digital Health Index,” underpins the first part of this report. For this study, we developed a novel standalone Digital Health Index that evaluates the state of digitalisation achieved in a national healthcare system. This index is comprised of 34 indicators relating to strategy, technical readiness, and the digital maturity and extent to which integrated healthcare data exchange is actually taking place. As part of a benchmarking process, data for 17 countries (i.e., 14 EU and three OECD countries) was collected by an international expert network. The results of this process are reflected in several rankings, each of which are an aggregate of scores achieved for a set of indicators.

In addition to independent research conducted for the purpose of the benchmarking process, we designed and carried out a survey to examine and evaluate national digital health strategies in Australia, Austria, Belgium, Canada, Denmark, England (NHS), Estonia, France, Germany, Israel, Italy, the Netherlands, Poland, Portugal, Spain, Sweden and Switzerland. Data was collected on site by a national correspondent located in each country. In addition to the national correspondents’ involvement in the country analyses, the input of additional European and national experts was incorporated into the study for the purposes of validation and quality control. Ensuring the greatest informative value and capacity to derive lessons learned underlie the choices made in the countries to be included in the survey. The study thus includes countries that feature healthcare systems and state structures similar to Germany as well as those countries which, according to our preliminary research, have achieved an advanced state of digitalisation.

The second study, “Success Criteria and Level of Uptake of Digital Applications,” which comprises Part II of this report, examines in greater detail five of the 17 surveyed countries: Denmark, France, Israel, the Netherlands and Switzerland. The authors of this study conducted on-site visits to each of these countries in order to acquire a deeper understanding of the success factors and barriers to digitalisation efforts. Interviews with representatives of national digital health agencies, ministries, healthcare providers and associations as well as independent experts were carried out in each country. This second study examines in closer detail the political actions and structures in each country as well as their framework conditions. It describes how they work and identifies key factors of success as well as barriers to advancing the digital transformation of a healthcare system.

Part I of this report looks at the issue of healthcare digitalisation from a macro-perspective and is informed by quantitative methods. Questions as to “what,” “how much,” or “how often,” inform this section. Part II, however, is driven more by qualitative questions and aims to explain “why” or “how” certain developments have transpired.

Our cross-national analysis of policies and strategies, combined with the precise observations of national efforts to integrate digitalisation into the everyday provision of care allowed us to identify criteria of success that can be applied to a transferability analysis of other countries and healthcare systems. Part III of this report addresses the issue of transferability.

Our results are intended to provide inspiration in deepening and accelerating the digital transformation of Germany’s healthcare system. They also identify what Germany can learn from the experiences of other countries. Our findings and conclusions drawn are thus intended to facilitate the formulation of improved digitalisation strategies while advancing and accelerating implementation solutions.

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