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dr Alexander is the founder and managing director of EPatient Analytics GmbH in Berlin.

Want to avoid the digital gap in healthcare? Let innovations grow organically!

The adoption of digital health technologies, including apps and wearables, has gained momentum that forces politicians to embrace them in the healthcare systems – according to Dr. Alexander Schachinger, CEO of EPatient Analytics, a digital health market monitoring company.

How has the use of wearables and health/fitness/wellness apps by individuals over the past three years?

The COVID-19 pandemic was an unusually high driver for the use of smartwatches. The market grew in Germany from 4 percent pre-pandemic to 17 percent post-pandemic. Concerning a usually organic slow-growth diffusion – this is an explosion. Trackers are a bit less spread – around 10–12 percent of society uses them, and the same level of adoption refers to health apps. The growth of health apps is also driven by companies that offer them to their workers.

The most considerable increase was observed for health coaching, nutrition, and mindfulness apps, especially in the cohort aged 40-50. People started using them to stay mentally and physically healthy, and many stayed with them even after the coronavirus crisis. Many individuals realize they can manage their health independently, and digital solutions offer new insights into vital signs and statistics that are useful for staying on track. Besides, we have observed the rising deployment of health apps among older people driven by the growing adoption of smartphones in the 65+ cohort.

There is also a growing interest in prevention, further driving the digital health market.

If the acceptance of new technologies grows, why is their implementation so slow? And why are they still overlooked at the political level?

Nothing new at all. Looking back on technology innovation history, we have always seen governments and sometimes corporations neglect innovation paradigms. In the late 90s, one of the leading internet sociologists Manuel Castells (“The Network Society”), described that bureaucracy and government-heavy society segments are the least capable societal systems that can adopt digital innovation quickly.

We shouldn’t also so obsessively focus on the word “acceptance of the new technologies.” Reasonable tech solutions – Netflix, Amazon, Tesla – grow organically if they are not killed by regulations. In healthcare, I have an impression that many politicians repeat the word “acceptance of new tech” just to make a smokescreen to hide their impotence in creating good policies.

And what are your observations about individuals’ approaches to data protection at a time when they can use more and more technology?

Our Self-Tracking Report – the first independent quantitative observation of health data tracking of German society – showed that the acceptance of digital health data gathering and processing is far more advanced than the paradigm of German politicians on this issue. 4 out of 10 citizens track some of their personal health data with digital technologies.

Do you recognize a gap between the keenly discussed technological solutions and the actual health needs of individuals? 

Radical consumer-focused technologies (b2c) always have a 100% fit of supply and demand. An example is Apple’s iPhone. Otherwise, they would not reach the critical mass. In regulated markets like health care systems, this fit is quite often not the case because there is no economic driver for that. This is why most citizen-targeted digital health solutions from national health systems per se have a high chance of failure. There are exceptions, for example, Denmark. It’s mainly due to the usability and broad functionality of the Electronic Health Record implemented there. It’s also been supported by campaigns to inform about the benefits of EHR.

But we also have to remember that this gap should get smaller over time as soon as the prices fall and late adopters follow early adopters. Take a bicycle as an example. Over 200 years ago, the first bicyclists were aristocratic, wealthy people from big cities. It was a privilege for the few. Then, step by step, bicycles got cheaper, and today it’s the most affordable way of transport. Every technology must go through the technology adoption curve to get easily accessible and affordable. This refers to television, telephones, smartphones, and also to smartwatches.

On the other way, it’s the role of health systems to make health innovations available for those who need them most. For example, chronic people could already benefit from 24/7 health monitoring if such technologies were reimbursed in the statutory health system. Another factor to be considered is always health and digital literacy. Some people lack skills to use, for example, health apps, but this is manageable – to some extent – by introducing upskilling programs.

During COVID-19, teleconsultation made its way into health care. What do patients value in them, and which components need to be redesigned?

We would never have imagined that the adoption of web-based teleconsultations would rise to around 17%. It seems the place- and time-flexible convenience and on-demand quality are attractive arguments for many individuals. Before COVID-19, it was 0,5%! Unfortunately, in many countries, including Germany, this demand for online care was artificially suppressed by introducing limits for remote consultations. While this may be justified as a means of counteracting the replacement of on-site care infrastructure with cheaper online care, on the other hand, it hampers such a needed transformation in healthcare.

The challenge is a social divide: Most life digital doctors consultations occur among better-educated and higher-income patient segments.

Let’s elaborate on the digital divide

All our longitudinal or single-spot research data sets show nearly the same patterns: The higher the social status – mainly defined via education and income level – the higher the usage and competence of digital health solutions.

Actually, this is not unusual because, for centuries, all technological innovation started to diffuse at first at the most urban, privileged social segments. But if we talk of a digital health paradigm based on a solidary system, we have to consider political and ethical issues.

Ultimately, the goal is to accelerate the gap-bridging effect that can be achieved when digital care solutions have been embedded as a hybrid approach in the on-site care structures.

Whixx

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