Healthcare: Changes are a daily fact of life

Which opportunities and risks the actors in healthcare see in the current and planned changes depend greatly on the glasses through which they see the world: Through those of the owner of a radiological practice, those of the Head of IT of a clinic group or of a chain of practices or through those of the radiologist in a clinical establishment. That's why it's so important to listen to different voices, in order to get an impression of the overall situation and mood. And this is just what we've done for the current edition of VIEW. And even though the interviewees cited different priorities, opinions and challenges, they were all just as unanimous on one point: changes are a daily fact of life in medicine. And the key to many challenges lies in IT.

"The fact that radiological practices and medical supply centers have become interesting for investors is just as understandable as it is logical. Owners of practices or shareholders of a medical care center are having difficulty nowadays in transferring their practice or their shares to the next generation. Now young radiologists no longer want to bear the responsibility and the financial risk of owning their own practice. In the case of medical care centers, the transfer of shares under company law has become – to put it mildly – impractical. Not only that, a digital investment backlog often prevails in the practices. This means: Although radiological practices are inherently already highly digital, they often lack digital networking capabilities with the outside world, i.e. with patients, with referral services, etc. – and to what will happen in the future.

In the matter of digitization – which primarily increases patient comfort and optimizes processes – companies that own numerous practices are ahead of the game. We are able to centralize services and set up practices as clients within one software system. And naturally we have to develop concepts and bid invitations only one time and are able to apply these to very many practices. Not to be overlooked: With many users behind us. we are also able to negotiate different conditions and set our own standards. 
The same is true for functional solutions such as patient portals, for example, and likewise for data protection and information security solutions.  

Such centralization will also fit well with new concepts of IT systems: More cloud-based web services, fewer on-premises activities. Fewer licenses, more concurrent-user models. Thus there's a lot going on – and that's a good thing."

"Increased switching of services to an out-patient basis and allocation of service groups among the clinics, as envisioned in the hospital reform project have mainly one prerequisite: Reliable, rapid and uncomplicated exchange of medical information across facility boundaries. And as yet no good solution for this has been found. Neither in registered private practices nor in hospitals has ePA (electronic patient records) been adopted to an extent that would do justice to this requirement. Moreover, it has been shown that its use is quite complex for patients. The hoped-for transfer of data sovereignty and and the associated self-empowerment of people have definitely not occurred. To the contrary, patients are often overburdened with the responsibility. Services such as KIM (Communication in Medicine) are indeed in the right direction. But they leave the patients out of the loop. Moreover, data transmitted with KIM may not automatically be incorporated into the IT of a medical facility. 

A further stumbling block with respect to practical exchange of medical information could be the strict data protection directives. As logical as high-level protection of sensitive data is, the current requirements make it just as difficult for the patients to take along their data when moving from one treatment unit to the next. Even within an organization such as ours, express consent is always needed for transmission between medical care center and hospital. With greater switching of services to an out-patient basis and the resulting fragmentation of healthcare, this is certainly not a viable option.

Inasmuch no thought is given to the routing of data and no practical approaches, media and rules for their exchange exist, switching of services to an out-patient basis to the desired extent will probably not work well from the patient's viewpoint.

Another consequence of the switching of medical services to an out-patient basis and the allocation of service groups for IT will be that the number of subsystems will be reduced and we will likely revert to generalized, monolithic solutions. This will be a logical consequence of centralization of medical services."

"The extent to which in-patient radiology will be impacted by the current and planned changes, most notably the Hospital Reform Act, depends on different factors. In the first place, it is unlikely that radiological services can be completely switched to an out-patient basis. In-hospital care imposes different requirements. We often have to deal with very sick patients, regularly exchange information with specialist departments, regularly take patient records along with us, regularly examine the laboratory values and match the nature and scope of examinations to the individual issue and set of findings. This narrow interdisciplinary exchange and the closeness to the patients cannot be imaged so well on an out-patient basis. Not only that, in institutions such as ours the proportion of radiological procedures is very high. The associated specialization and simultaneously large numbers of cases as well as the corresponding radiological and diagnostic know-how are not so easy to replace on an out-patient basis.

However: If it comes to the planned specialization of hospitals and the stricter subdivision into maximum and basic caregivers, presumably an independent radiology department will no longer be part of every hospital. We are already witnessing a trend toward outsourcing of radiological services, and this trend will probably continue in smaller hospitals. Thus it is possible that radiology departments will remain only in larger clinics. where the focus of care necessitates them.

In principle, no objection at all can be made to outsourcing of radiological services if the quality is maintained. However – and this is our experience – the quality of services for out-patient examinations varies – from recording the image to drafting the finding – and does so enormously. We work with registered private practices that deliver excellent images and findings. For some patients, however, we have to repeat the examinations or conduct them in a modified manner, because the quality and nature of the examination performed under out-patient conditions are inadequate for planning a therapy."