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- Herausgeber: MWV Medizinisch Wissenschaftliche Verlagsgesellschaft
- Kategorie: Fachliteratur
- Sprache: Englisch
As modern healthcare becomes increasingly personalized and data-driven, traditional healthcare is being transformed into a dynamic, multi-layered and highly connected global ecosystem. New players, such as medical entrepreneurs and tech giants like Apple, Amazon, Google and IBM Watson are continuing to expose and challenge the current healthcare market by providing innovative digital products and know-how. Digital health offers both—a suite of new capabilities and new approaches that unlock health(care) from constraints of time, place, distance and knowledge. It opens up entirely new ways to address and understand people and their health needs. This is how XPOMET© was born, and has been continuously growing as a platform, that is dedicated to innovative trends in medicine and care and at the same time creates a community that promotes cultural change in the healthcare industry. In 2019, the XPOMET© Medicinale has become an international event to showcase best practice, highlight trends in global healthcare and forecast future developments in health and tech. The book offers a broad collection of the extensive knowledge of contributors to the XPOMET© Medicinale 2019. International experts share their novel ideas, challenges and achievements in the global healthcare market. The reader is invited to join in the XPOMET© community’s vision and to be inspired by the latest discoveries and technological know-how in healthcare.
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Veröffentlichungsjahr: 2020
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Ulrich H. Pieper | Alois G. Steidel | Jochen A. Werner (Eds.)
XPOMET©
360° Next Generation Healthcare
with contributions by
A. Albu-Schäffer | J. Ansorg | T. Bahls | K. Becker | I. Bergen | H.M. von Blanquet | J. Bocas | S. Borsdorf | N. Brasier | K.F. Braun | C. Bug | I. Cinelli | F. de Castro Soeiro | B. de Francesca | F. De Ieso | C. Dickenscheid | P. Drauschke | S. Drauschke | J. Eckstein | J.P. Ehlers | A. Ekkernkamp | M. Eusterholz | P. Gausmann | M. Gennat | M. Grinberg | D. Grishin | N. Hachach-Haram | V. Hancox | S. Heinemann | T. Heiß | M. Henningsen | L. Henrich | J. Hofferbert | M. Hofmann | I. Horak | A. Jonietz | M.A. Katterbach | S. Kernebeck | G.H. Kiss | J. Klodmann | C. Kobza | S. Kopp | M. Krauß | A. Krzeminska | S. Kudick | A. Kulin | S. Lachmann | T. Langø | L. Lee | C. Liu | M. Livne | F. Manstad-Hulaas | S. Märke | D. Matusiewicz | P.-M. Meier | P. Merke | L. Middendorf | S.D. Moré | P. Mukharya | M. Mutke | H.O. Myhre | J. Natzel | R. Pasel | R. Patnala | D. Pförringer | U.H. Pieper | J. Pikani | K. Pilgrim | M. Prilla | I. Rascher | H. Recken | K. Ritter | O. Rong | J. Saget | Y. Sakaki | C. Sander | E. Scheuer | C. Schlenk | H. Schönewolf | J. Schumann | A. Schwier | J. Sebhatu | M. Shah | J.G. Skogås | A. Struchholz | K. von Thurn und Taxis | D. Tzalis | R. Unterhinninghofen | C. Vetterli | M. Vurucu | D.J. Walker | M. Ward | J.A. Werner | A.M. Wilcke | J. Witt | N.F. Wittig | T. Wüstner | O. Zakrzewski
Medizinisch Wissenschaftliche Verlagsgesellschaft
Editors
Ulrich H. Pieper, Dipl.-Ing.
XPOMET© Founder
XPOMET Innovation in Medicine GmbH
Tucholskystraße 13
10117 Berlin
Germany
Alois G. Steidel
XPOMET© Co-Founder and Investor
K|M|S Vertrieb und Services AG
Inselkammerstraße 1
82008 Unterhaching
Germany
Prof. Dr. Jochen A. Werner
XPOMET© Medical Board
Universitätsmedizin Essen
Hufelandstraße 55
45147 Essen
Germany
MWV Medizinisch Wissenschaftliche Verlagsgesellschaft mbH & Co. KG
Unterbaumstraße 4
10117 Berlin
Germany
www.mwv-berlin.de
ISBN 978-3-95466-498-6 (eBook: ePub)
Bibliographic Information of the German National Library
The German National Library (Deutsche Nationalbibliothek) has listed this publication in its German National Bibliography. Detailed bibliographic information is available online at http://dnb.d-nb.de
© MWV Medizinisch Wissenschaftliche Verlagsgesellschaft Berlin, 2019
This piece of work, including all of its individual parts, is protected under copyright. The rights established thereby, in particular those regarding translation, reprinting, oral presentations, extraction of illustrations and tables, broadcasting, microfilming or any other types of duplication or storage in data processing plants, remain reserved, even only for partial use.
The reproduction of common names, trade names, product names, etc., in this work, even without special permission, does not justify the assumption that such names should, in the sense of trademark and brand protection legislation, be regarded as free and therefore usable by anyone. In this publication, only the masculine form has generally been used for the generic naming of persons of any sex, unless stated otherwise. If a contributor wished to have specific gender formulations used in his/her respective text, we were more than happy to adopt them in his/her contribution.
The authors have attempted to make sure that the technical and subject-specific content was up-to-date at the time of going to press. Nevertheless, errors or misprints cannot entirely be ruled out. Especially in the case of medical articles, the publisher cannot accept any liability for recommendations on diagnostic or therapeutic procedures, instructions regarding certain dosages, types of application or treatment, and so on. Such information must be verified by the reader for their accuracy in each specific case in accordance with the information provided by the respective manufacturer’s instructions and those found in other relevant literature. Errata, should any exist, can be downloaded at any time from the publisher’s website.
Project Editor: Bernadette Schultze-Jena, Berlin, Germany
Editorial Assistance: Jubin Shah, XPOMET Innovation in Medicine GmbH, Berlin, Germany
Layout, typesetting & production: zweiband.media, Agentur für Mediengestaltung und -produktion GmbH, Berlin, Germany
E-Book: Zeilenwert GmbH, Rudolstadt, Germany
Cover image: © Stefan Hoederath
Please address all comments and criticism to:
MWV Medizinisch Wissenschaftliche Verlagsgesellschaft mbH & Co. KG, Unterbaumstraße 4, 10117 Berlin, Germany
Foreword
Future! Europe?
Healthcare systems worldwide are undergoing massive changes. Health politics in the EU are still a responsibility of the national states. However, the European dimension will become increasingly important.
Among the drivers of a stronger European health policy are, in particular, the free movement of employees, hence of patients, demographic change and digitalization. The digitalization of healthcare must take place within a European framework. It is, therefore, imperative for the EU to increase its activities in the fields of integrated healthcare and e-health. In the coming years, the agenda will also include a greater convergence of healthcare systems between northern and southern Europe. Europe must become a global player in the field of healthcare policy. Otherwise we risk becoming insignificant, trailing behind the USA and China. The digital transformation will improve both the cross-border demand for health services and the supply of healthcare providers.
Digitization acts like a catalyst: it can make extensive health knowledge accessible and give individuals sovereignty over their health data.
A European health policy that combines the two principles of equity and efficiency can become a model for the development of inclusive and sustainable health systems worldwide. Asia and Africa, in particular, tend to prefer systems of social cohesion. The new European pillar of social rights proclaimed in 2017 by the EU Council, the EU Parliament and the EU Commission points the way in the right direction. The Council, the Commission and Parliament are committed to 20 standards that are to be applied across the EU. This also includes the right to “timely, high-quality and affordable health care and home care”.
In view of the European elections in 2019, it is time for the Commission and Parliament to invigorate the agenda and follow up on promises. Internal market and social systems should be handled in a similar fashion. Without further harmonization of living conditions in Europe, the EU will fall behind in the international competition. The US and China also know how to do market economy but so far only Europe knows about social cohesion.
Citizens expect European politics to protect and strengthen them in times of a globalized and digitized economy. A sovereign and strong Europe can only succeed through greater integration and cohesion. A European health market may still be a distant vision—a global healthcare industry is, in fact, already daily practice.
Next Generation Healthcare
One issue will play a decisive role in the future of healthcare: generational change. The largest group in the healthcare industry to date, the so-called baby boomers, will have mostly retired by the end of the next decade and will leave the field to future generations.
Today, baby boomers are defending a system based on innovations dating back to 1883. A health insurance system based on solidarity was established with the introduction of social security obligations. At the time, this was a revolutionary idea and viable solution. Since then, this system has improved and adapted to the needs of a modern society but it has led to the system itself being frozen.
We, as participants of the healthcare economy, find our way in this system. We have found our professional niches and financial livelihood. However, many market participants and experts, especially in Germany, consider the healthcare system to be inefficient, cumbersome, rigid and hostile to innovation. One particular shortcoming is that we experience the healthcare system a kind of deficient economy—the patient has long since ceased to be the focus of attention.
New and completely “crazy” technologies are already knocking on our market’s door. They have the potential to completely disrupt our understanding of healthcare:
The creation of a digital twin for patients will vaporize today’s value chains in healthcare. A digital patient can be diagnosed and treated anywhere in the world and completely independently by machines. The human being, if necessary, will submit to the competence and speed of artificial intelligence in the process. The physical patient will remain in his living space and will be treated and cared for by a “free domestic”. Who then needs such a large number of hospitals? That’s right, nobody.
Robots will take over the activities of today’s human resources. It is difficult to ignore the advances in robotics, from hospital logistics to therapy and surgery. The shift of healthcare tasks to machines is already visible today. And doctors, nursing staff, etc. will care for the patient with the necessary time and attention. Salutogenesis will be the next mega market.
The code in medicine does not merely consist of “0s” and “1s” but of an exact image of DNA strands. By breaking down the molecular-biological key of each individual, medicine will penetrate into the causes of diseases and health and find their therapeutic equivalent.
And, of course, there is so much still left unknown and yet to be discovered.
By 2025, far more than 50% of the workforce in companies will probably belong to the Y, Z and ALPHA generations. In the meantime, this has heralded not only a generational but also a cultural change in our market segment. Doctors, nursing staff, pharmacists, bio-technologists, computer scientists and engineers of these new generations are very well-trained, but are also highly impatient, demanding, and their loyalty is no longer a given. They live and breathe for technology and are great networkers. Their focus is on flexibility, creative freedom, freedom of decision, recognition, sense and a balanced work-life balance. Ideas such as those presented above are shared and promoted by these generations.
It is interesting to note that currently only few forces in the market have taken the trouble to listen to representatives of this generation. This is all the more surprising as we find ourselves in a “concentric” labor market, characterized by a hand-wringing search for workers. Employers who try to ignore these cultural changes should rethink: According to digital pioneers, employees of Generation Z have “less loyalty to their employer than to their sneaker brand”.
What Makes XPOMET© Special?
Innovation occurs when you stop agreeing with the old or when it is no longer useful enough. Innovation arises in the tension between the old and the desire for something new.
With XPOMET©, we have created a platform that is dedicated to innovative trends in medicine and care and at the same time creates a community that promotes cultural change in the healthcare industry. We work on an international basis and are starting with an annual Healthcare Festival in Berlin, the XPOMET© Medicinale. We aim to build the next generation healthcare ecosystem as a global marketplace for healthcare and life sciences.
We also want to reintroduce Germany as a business location in Europe. We, in Germany, are great at inventions and research—but we emigrate as soon as the monetarization process begins. XPOMET© wants to offer international founders and researchers a platform where they can present themselves, connect and get a glimpse at what is to come. We want to push research and new ideas forward for the institutions. We want to give international and local innovative companies a future perspective in Germany—as the country with the strongest economic power in Europe—when it comes to implementation or scaling. We want to establish a showcase, where European companies present their products and research results in an international and competitive comparison—especially regarding the US and China.
The future of healthcare is not about how the status quo is best maintained—it is about evolving and having one’s finger on the pulse of the zeitgeist. Perhaps we do need a Ministry of State for Digital Affairs. However, the need for a Ministry of Economics that improves the framework conditions for the future, removes obstacles, and creates incentives for innovation and new entrepreneurship is far more urgent. If you can’t imagine how quickly a once leading industry can miss the boat, all you have to do is look at how the textile, coal and, more recently, the automotive industry in Germany have fared.
With this book we give you an excerpt from the program and showcases of the XPOMET© Medicinale 2019 with best-practices and impactful trends in global healthcare and forecast future health and tech developments. Find inspiration in the vision of a future health and care environment created in this book and join in the XPOMET© community’s vision.
Ulrich H. Pieper, Alois G. Steidel and Jochen A. WernerOctober 2019
Editors
Ulrich H. Pieper, Dipl.-Ing.
Ulrich H. Pieper has been working in the healthcare industry for over 20 years. As a consultant, he has gained experience in more than 100 different projects and enjoys an excellent reputation in the industry as an IT specialist and strategist. SAP projects, new software developments and the design of complex digitization strategies are currently the main focus of his consulting firm PIPITS Business Management GmbH. While searching for a new event format for innovations in the healthcare sector, he founded XPOMET© in 2017.
Alois G. Steidel
Alois G. Steidel is founder, owner and CEO of K|M|S Sales and Services AG, Unterhaching (Munich). With the innovative software solutions eisTIK.NET® and EYE ON HEALTH®, K|M|S positioned itself as market leader for management information systems in the German healthcare/hospital market. Before founding K|M|S, Alois G. Steidel has been involved in several companies working on innovative IT products and solutions, including software for airlines as well as clinical pathways for patient care. Investments in various organizations and his membership in several supervisory boards help strengthening his network and relevant partnerships. Alois G. Steidel is co-founder and investor of XPOMET©.
Prof. Dr. Jochen A. Werner
Jochen A. Werner studied medicine at the University of Kiel, Germany. In 1987 he did his doctorate and started working as a doctor and scientist at the Department of Oto-Rhino-Laryngology at the University Hospital Kiel. 1998 Jochen A. Werner became Professor and Chairman of the Department Oto-Rhino-Laryngology of the University of Marburg. Jochen A. Werner was also Dean of Medical Education from 2004 to 2006. From 2011 to 2015, he became Medical Director of the University Hospital of Gießen and Marburg, Germany (UKGM GmbH). Since 2015, in his function as Medical Director and CEO, Jochen A. Werner has dedicated himself to the digitization of medicine and set the University Medicine Essen on its way to becoming a Smart Hospital.
Contents
IInnovative Health Systems
1The Future Health Insurance: Social Equality Is Neither Desirable nor Beneficial
Ulrich H. Pieper and Christopher Dickenscheid
2The Future Patient Room
Meik Eusterholz, Melanie Alessandra Katterbach and Celina Sander
3The Sky Is the Limit—E-Learning and the Future of Healthcare Education
Victoria Hancox
410 Misconceptions About Healthcare Management and Why Many Hospitals Act Like Sabre-Toothed Tigers
Tanja Heiß
5The Digital Patient
Stefan Märke, Christophe Vetterli and Daniel Joseph Walker
6The Digital Healthcare Ecosystem in Society 5.0
Filipe de Castro Soeiro
7From the Deconstruction of Business Processes to the Disruption of Business Models
Pierre-Michael Meier
8Reducing Staff Shortages—Digitalisation for the Care Sector
Michael Krauß and Karl Ferdinand von Thurn und Taxis
9It’s Never Too Early for Change—The Way of a Young Entrepreneur in Healthcare
Jan Schumann
10Three Reasons Why the Future of German Healthcare Companies Lies in China
Chenchao Liu
11The German Digital Health Market: Hard but Fair?
Jared Sebhatu
II Future Hospital
1Patient Communication at Hospitals: Dilemma and Opportunity
Admir Kulin
2Patients and Hospitals of the Future—How Much Variety Do We Dare to Offer?
Thomas Wüstner
3Patient Safety and Clinical Risk Management in the Age of Digitalization
Peter Gausmann
4Superfluid Hospital—Process Mining Taken to the Next Level
Nils Florian Wittig
5Change Project “Smart Hospital”—Communication First
Jochen A. Werner and Achim Struchholz
6Operating Room of the Future: An Arena for Minimally Invasive Intervention in Trondheim, Norway
Gabriel Hanssen Kiss, Frode Manstad-Hulaas, Thomas Langø, Hans Olav Myhre and Jan Gunnar Skogås
7MIRO Innovation Lab—A New Collaborative Platform for Applied Research in Medical Robotics
Christopher Schlenk, Julian Klodmann, Thomas Bahls, Andrea Schwier, Szilvia Borsdorf, Roland Unterhinninghofen and Alin Albu-Schäffer
8Cooperating Human/Robotic Teams in Healthcare
Ingolf Rascher
9Telesurgery: Multiplying Skills, Enabling Innovation and Driving Consistency of Care
Nadine Hachach-Haram
IIIPatient Empowerment
1Patient-Oriented Health Information—From Zero to Digital
Ansgar Jonietz
2How Consumers Advance Digital Health to a New Level of Seriousness
Laura Henrich
3Hacking Health: A Patient-Centered Approach to Foster Innovation in Healthcare
Joscha Hofferbert
4The B2C Opportunity in Personalized Medicine
Mary Ward
5The Expansion of Self-Optimization in the Field of Personal Healthcare: Questions and Perspectives
Agnieszka Krzeminska
6The Self-Determined Patient Drives the Development of the Healthcare System
Oliver Rong
7Digitization in Medicine—Empowering a Patient-Centered Care
Karl F. Braun and Dominik Pförringer
8Access to Personal Health Data—Are We Ready to Be Empowered?
Dennis Grishin
IVArtificial Intelligence
1Artificial Intelligence in Medicine and How to Open the Black Box
Kerstin Ritter
2Artificial Intelligence and a Paradigm Shift in Healthcare
Jonas Witt
3How AI and Technological Innovation Changes the Role of the Medical Practitioner
Inga Bergen and Larissa Middendorf
4Precision Medicine in Stroke Powered by AI— Promises and Challenges
Michelle Livne
5Wearables Combined with Artificial Intelligence Will Be the Game Changer for Healthcare
João Bocas
6Explainable AI in the Health Industry with Machine Teaching
Murat Vurucu
7Sensors and AI in Healthcare—Who Takes Responsibility for Failures?
Jens Eckstein, Fiorangelo De Ieso, Markus Mutke and Noé Brasier
8Artificial Intelligence for Space Medical Capabilities: A New Frontier
Ilaria Cinelli
VBig Data and Blockchain
1The Role of Quantum Computing in the Future of Healthcare
Brian de Francesca
2The DATATOWER—A Digital Ecosystem. Systemic Interoperability as a Foundation for Needs-Orientated Healthcare
Stefan Lachmann
3Creating Solutions for Value-Based Precision Medicine
Henri Michael von Blanquet
4Data and Health—Field Stories and Technology in India
Prerna Mukharya
5Access to Health Data in a Decentralized World
Eberhard Scheuer
VISmart Diagnostics and Therapy
1How Virtual Reality is Shaping the Future of Dialysis Training
Jonathan Natzel
2Augmented Reality Glasses in Intensive Care
Michael Prilla and Heinrich Recken
3Digital Health Avatar—Genetic Models for Nutrition and Exercise
Kurt Becker
410 Millimeters at a Time: A World Without Needless Breast Cancer Deaths
Carman Kobza
5Disease Interception—Turning a Vision into Reality
Christoph Bug
6Rethinking Female Health in the Age of Digitalization
Maike Henningsen
7The Journey of a Type 2 Diabetes Patient with and Without Digital Health Solutions in a German/Swiss Comparison
Helene Schönewolf
8Potential of Music Playing to Train and Monitor Cognitive Functionalities
Yayoi Sakaki
9Managing Breakthrough Innovations in Drug Discovery
Sören Kudick and Dimitrios Tzalis
10From Solving the Opiate Crisis to Targeted Drug Delivery
Sam Dylan Moré
11Cannabis-Based Medicine as Whole Person Therapy
Moran Grinberg
13Digital Health and Ageing: Bringing Together the Two Titans of Our Time
Maliha Shah
13Personalized Approach in Public Health Disease Management
Jaanus Pikani
VII Next Generation Healthcare
1Transhumanism and Ethical Issues in Medical Science
Axel Ekkernkamp
2Factors Influencing Digital Change in the Healthcare System in Germany
Ingo Horak
3Leadership and Humanity in the Digital Transformation Age
Pia Drauschke and Stefan Drauschke
4The Human Touch—How the Warmth of Human Closeness Heals
Alexandra Marisa Wilcke
5Leadership in the Digital Age—Of Self-Management, Heterarchy and Digital Competence
Patrick Merke
6The Changing Landscape of Communication in the Healthcare Ecosystem
Radhika Patnala
7Maggie’s Centres—The Importance of Architecture for Health
Laura Lee
8Urban Living—Enhancing Livability by Adaptive Housing Strategies
Ralf Pasel
9From Moon Shot to Mars Shot Thinking
Jeremy Saget
10Smart Learning Revolutionizes Postgraduate Medical Education
Jörg Ansorg and Olivia Zakrzewski
11Digital Literacy in Health Curricula
Jan P. Ehlers, Sven Kernebeck, Katharina Pilgrim, Markus Gennat and Marzellus Hofmann
12Beyond Smart Hospital: Making Hospitals Great Again
Jochen A. Werner and Stefan Heinemann
13Corporate Culture Eats Digital Health Strategy for Breakfast
David Matusiewicz and Silke Kopp
1
The Future Health Insurance: Social Equality Is Neither Desirable nor Beneficial
Ulrich H. Pieper and Christopher Dickenscheid
The German health insurance market is characterized by a dual funding system that consists of a statutory health insurance market and a private health insurance market. The fundamental differences between these two markets result from differing interpretations of the word “fairness”.
Within the private health insurance market, the situation is considered to be fair when, over the entire period ensured, the expected insurance premiums are equal to the expected insurance claims (principle of equivalence). Following this principle, people who entail greater costs should pay a higher insurance premium with no regard to the individual’s financial capabilities. Given that the insured must pay the costs that they entail, it is essential to the stability of this market that the insured possess above-average financial capabilities and income (Schradin and Wende 2006, p. 12).
In contrast, within the statutory health insurance market, individual healthcare costs have no impact on individual healthcare premiums. Here it is considered to be fair when the premiums are based on the individual’s financial capabilities and people with a higher income pay higher premiums. This guarantees that even people with no income have health insurance. Thus, solidarity is a cornerstone of the statutory health insurance market (Schradin and Wende 2006, p. 4).
Solidarity in itself is a social principle that violates basic economic principles. As a result, it brings forth a multitude of inefficiencies that in turn lead to the financial destabilization of the market. Over the past two decades, this effect has been visible within the German statutory health insurance market, as a 70 percent increase in public healthcare costs could only be mitigated by increasing the individual’s insurance premiums (Bundesministerium für Gesundheit [Federal Ministry of Health] 2018). With the ongoing demographic change resulting in an aging society, this trend is likely to continue and the German public healthcare system is in need of reform.
Any reform proposal needs to answer two fundamental questions:
Firstly, who will be insured?
Secondly, what is going to be the basis for the insurance premium calculation?
In political discussions, the answer to the first question is often the unification of the two health insurance markets. This would integrate the rather wealthy insured people of the private health insurance market into the statutory health insurance system and therefore increase solidarity. Furthermore, this would lighten the financial burden of insurance premiums for the working class that is currently put on the middle class. Overall, this would increase solidarity (at least temporarily), stabilize the market financially and, therefore, would be beneficial to society.
The answer to the second question is rather complex and has a great impact on the financial stability of the resulting system.
Fortunately, these problems are for the most part not unique to the German health insurance system. Some of our European neighbors have faced similar problems, therefore have had to answer similar questions in the past and it is worth taking a look at how they have chosen to handle them. Good examples are the Netherlands and Switzerland.
Both countries have chosen to reform their healthcare system in the past 25 years. They introduced a basic health insurance system that is mandatory for every citizen. This basic health insurance, in both cases, covers the inpatient and outpatient care as well as the prenatal care. Should an individual’s need or desire for health insurance exceed the coverage provided by the basic insurance, s/he may purchase private supplementary insurance. In effect, the Netherlands and Switzerland both introduced a dual health insurance system. However, they implemented vastly different financing structures for their basic health insurance.
Health insurance system in the Netherlands
Within the Dutch system (see fig. 1), the healthcare costs are financed equally by income-dependent and non-income-dependent premiums (Greß et al. 2006, p. 16). The income-dependent premium is paid by the employer and is calculated as a percentage of the individual’s gross monthly salary. The non-income-dependent premiums are paid by the insured directly to the insurer in the form of a capitation fee. In addition, the policyholders have to pay a yearly deductible. Since the non-income-dependent premium and the deductible create a disproportionate financial burden for low-income households, financial support in the form of transfer payments is provided by the Dutch government (Arentz 2018, p. 8). Additionally, the government also pays all premiums for minors under the age of 18. These payments for minors as well as the income-dependent premiums are not paid directly to the insurer but to a central fund instead. From here each insurer is assigned a certain amount as compensation based on the risk structure of the people they insure.
Health insurance system in Switzerland
Within the Swiss basic healthcare system (see fig. 2), the insured contribute to financing the healthcare costs in four ways (Spycher 2004, p. 25):
by paying a health insurance premium in the form of a capitation fee,
by paying roughly ten percent of their individual healthcare cost as co-insurance,
by paying a yearly deductible, and
in the form of tax payments.
It is worth mentioning that the premiums, co-insurance, and the deductibles are all non-income-dependent payments. Even the tax payments can only be considered as income-dependent to a small extent, which indicates the overall low level of solidarity within the Swiss health insurance system. The Swiss Government provides financial aid for people in low-income households, who may otherwise struggle to pay for their basic health insurance (Gerlinger 2003, p. 8). Additionally, tax payments are used to subsidize the construction and operation of hospitals. Roughly two-thirds of the healthcare costs are financed by non-income-dependent premiums, the remainder is government-funded.
Both countries implemented a dual insurance system with mandatory basic health insurance and with similar insurance coverage but chose completely different financing structures, resulting in different levels of solidarity and healthcare expenses within the two systems. Even after factoring in the high costs in Switzerland and looking at healthcare expenditures as a share of the national GDP, the Swiss healthcare system still entails much greater costs than the Dutch system (see fig. 3).
Since this is a rather brief and shallow comparison, it is not possible to derive an unequivocal correlation between the level of solidarity and financial stability of a system, but it does indicate a positive correlation between them.
One could conclude that increasing the level of solidarity has a positive impact on the financial stability of the system and is beneficial to society. In other words: The marginal utility for solidarity would be positive.
In a theoretical healthcare system without any financial solidarity, a large percentage of the population would not be able to afford any form of health insurance, so introducing any form of solidarity into the system would be beneficial to society overall. This coincides with the correlation found in the comparison of the Dutch and Swiss healthcare systems, however only for low levels of solidarity.
If this correlation remains unchanged for any level of solidarity, it would imply that it is beneficial to society and the financial stability of the system to continuously increase solidarity until absolute financial solidarity is achieved. In consequence, there wouldn’t be a correlation between the income or financial capabilities of an individual and the quality of healthcare s/he receives. This can only be achieved in one of two ways:
Either purchasing private supplementary insurance will be forbidden, thereby limiting every citizen to the insurance coverage provided by the statutory health insurance.
Or by broadening the insurance coverage of the statutory health insurance so that it includes every possible current and future treatment, making private supplementary insurance redundant.
Newly developed medical treatments are often more effective in treating a disease, but are also more expensive. Limiting every citizen to statutory health insurance would prevent such new treatments from being offered, lowering the overall quality of healthcare. Additionally, this reduces or destroys any incentives for further innovation or investment in the healthcare market. The German healthcare market, for example, is a multi-billion Euro industry. It cannot be in the interest of the German people or beneficial to society to reduce these incentives.
Broadening the insurance coverage of the statutory health insurance, on the other hand, would be ideal but it would increase the costs to such an extent that it is simply not financially feasible.
This indicates that the correlation regarding solidarity is only positive for low levels of solidarity and is negative for high levels of solidarity. As such, solidarity witnesses diminishing marginal utility.
In conclusion, solidarity is an important, necessary and beneficial part of any healthcare system, but it should not be taken to extremes. The ideal level of solidarity is somewhere in the middle, where society provides health insurance for every citizen to cover the basic needs for medical care and where incentives for further innovation or investment in the healthcare market are existent. This means that a market for private supplementary insurance and the social inequalities that come with it need to be integrated into the health insurance system, one way or another. When it comes to health insurance, social equality is neither desirable nor beneficial.
References
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Bundesministerium für Gesundheit [Federal Ministry of Health] (2018) Gesetzliche Krankenversicherung — Kennzahlen und Faustformeln 2018. URL:https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/3_Downloads/Statistiken/GKV/Kennzahlen_Daten/KF2018Bund_Juni-2018.pdf (accessed July 31, 2019)
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Ginneken et al. (2006) Erste Erfahrungen mit der Mischung aus Kopfpauschalen, Bürgerversicherung und einem zentralen Fonds. G&S Gesundheits- und Sozialpolitik 60(7–8), 10–18
Greß et al. (2006) Krankenversicherungsreform in den Niederlanden: Vorbild für einen Kompromiss zwischen Bürgerversicherung und Pauschalprämie in Deutschland?. Diskussionsbeiträge aus dem Fachbereich Wirtschaftswissenschaften der Universität Duisburg-Essen Nr. 150. URL: https://www.boeckler.de/pdf_fof/96722.pdf (accessed July 31, 2019)
OECD (2019) Health expenditure and financing: Health expenditure indicators. URL: https://www.oecd-ilibrary.org/social-issues-migration-health/data/oecd-health-statistics/system-of-health-accounts-health-expenditure-by-function_data-00349-en (accessed July 31, 2019)
Schradin HR, Wende S (2006) Krankenversicherung in Deutschland: Eine vergleichende Analyse gesetzlicher und privater Krankenversicherung. Mitteilungen, Institut für Versicherungswissenschaft an der Universität zu Köln, Nr. 1/2006. Köln: Universitat zu Köln. URL:https://www.ivk.uni-koeln.de/fileadmin/wiso_fak/versicherung_institut/documents/Mitteilungen/m1_2006.pdf (accessed July 31, 2019)
Spycher S (2004) Bürgerversicherung und Kopfpauschalen in der Krankenversicherung der Schweiz: Vorbild oder abschreckendes Beispiel. GG Wissenschaft 4(1), 19–27
Ulrich H. Pieper, Dipl.-Ing.
Ulrich H. Pieper has been working in the healthcare industry for over 20 years. As a consultant, he has gained experience in more than 100 different projects and enjoys an excellent reputation in the industry as an IT specialist and strategist. SAP projects, new software developments and the design of complex digitization strategies are currently the main focus of his consulting firm PIPITS Business Management GmbH. While searching for a new event format for innovations in the healthcare sector, he founded XPOMET© in 2017.
Christopher Dickenscheid, M.Sc.
Christopher Dickenscheid (MSc Economics) graduated from the University of Cologne in 2019. Christopher’s past research has focused on the role of solidarity in public health insurance markets. He also completed a six-month internship at the insurer Generali Deutschland AG and will soon begin working as a business consultant for the insurance industry.
2
The Future Patient Room
Meik Eusterholz, Melanie Alessandra Katterbach and Celina Sander
Introduction and Vision for 2025
Digital transformation is driving companies in the healthcare industry to redesign their entire organizational structure. It also provides patients and hospitals enormous benefits. The term Smart Hospital signifies an organizational shift towards patient-centered facilities in which the use of modern technologies is triggering new processes, automating non-value adding activities, thus improving the quality of outcomes and treatment (Eusterholz 2019).
The patient room alone offers numerous possibilities for value-added patient care in hospitals thanks to the integration of new technologies. From an objective point of view, however, the patient room is a functional room. The patient remains here between examinations, surgical interventions or various other treatments. This room may not be of great importance for medical staff in hospitals. It is a common room and in most cases does not even earn much money for the hospital. However, from the patient’s subjective point of view, the lounge-like area is a central place. This is where patients spend most of their time during their inpatient stay. Therefore, devices and amenities have much more influence on the patient than on the doctors, nurses, hospital management and other service providers.
The patient room of the future will be full of innovations and technical highlights. In addition to enabling optimum control in medical care, the furnishings provide the patient and guests with a certain feel-good factor. It is also patient-friendly thanks to its barrier-free design and the fact that it maintains the highest possible hygiene standards. The room is digitally networked with smartphones, laptops, notebooks and telemedical software. This allows for seamless and automated patient monitoring and documentation. Through networking solutions, the traditional exam room can be shifted to the patient’s room—where services are provided directly to the patient since patient data can be retrieved from any location. Lighting and acoustic concepts are also “smart,” facilitating the control of these systems. The patient room of the future can be compared with the standards of an attractive and modern hotel. Service quality is increasingly coming to the forefront so that the focus is on the healing architecture of the room (Leydecker 2017). The patient’s emotional and physical well-being is promoted by an attractive design in the single room concept, thus contributing to the overall healing process.
Trends in Healthcare
The State of Technology
When it comes to digitalization on both international and national levels, the German healthcare system is at the bottom of the list. In comparison to other German industries, it is regarded as a digital beginner. In the future, however, it is a fair assumption that the degree of digitalization will increase. Nevertheless, at a mere 20 percent, highly digitalized processes in the healthcare sector are still rare. According to the DIGITAL 2018 economic index, around 32 percent of the companies surveyed stated that they use applications in the “Internet of Things” (IOT) area, but only two percent use “Big Data” applications (BMWi 2018).
In hospitals, innovative technologies are used primarily in the field of imaging and other specific, functional areas. Through individual initiatives, more and more innovative solutions are finding their way into the hospital where they provide significant, everyday working life support. These solutions are based on artificial intelligence (AI), clinical decision support systems or intelligently networked solutions such as smart mattresses (Bauer 2019).
A major shortcoming, however, is Germany’s inadequate IT infrastructure. The development of a uniform telematics infrastructure (TI) has been going on in Germany for more than 10 years and is hampering the rapid networking of digital processes. With the help of TI, service providers will be networked, making cross-sector communication and the transfer of patient and case data possible (PwC 2014).
Taking a glance at neighboring countries shows how this expansion can function better. Denmark is at the forefront. The state is investing € 5.6 billion to digitalize and network its healthcare system for the future use of state-of-the-art technology. By 2025, 18 ultra-modern super hospitals will be built. In addition, Denmark has been utilizing electronic health records (EHR) for the past 10 years and telemedicine is already a part of everyday life. Track & Trace has also helped to significantly optimize the use of resources through the set up an infrastructure based on the location of all people, objects and devices. This infrastructure enables medical devices such as mobile ultrasound devices to be localized and treatment planning can be adapted based on the availability and location of the device. A bed management system, for example, can be used to locate free beds via the infrastructure, organise the cleaning and disinfection, as well as the maintenance processes. Now Denmark is five to ten years ahead of other countries when it comes to innovative health solutions (Gonser 2015).
Future Developments in Healthcare and Technology
On average, the healthcare market for digital and innovative technology is growing faster than the overall economy (Sauer and Storz 2018). When new technologies are seamlessly integrated into a system landscape, significant benefits can be achieved for both the hospital and patient. Efficient processes effectively relieve staff and significantly improve the quality of care (Bauer 2019). In the future, five key technology areas will arise in healthcare:
The first is Artificial Intelligence (AI). About one-fourth of all patients believe that a more accurate medical diagnosis can be achieved using AI. The use of big data and AI plays an important role. Both can significantly support physicians in analyzing clinical data and interpreting data from imaging procedures or contribute to optimizing clinical research (vbw 2019).
Second, wearables can be used to monitor multiple parameters such as heart rate, sleep quality, training programs and much more.
The third technology area is virtual reality (VR) and augmented reality (AR). With AR-based apps, surgeons can practice every step of an operation in advance.
The IOT is the fourth area. Although it is not yet represented, networking and the integration of different medical devices in hospitals, databases and patient management software will provide a great deal of valuable data.
Last but not least, various breakthroughs have been made with 3D printing, such as in the treatment of burn victims, tracheal splints, and printing living tissue with blood vessels. Thanks to advancing digitalization, it is now possible to calculate exact 3D models in real time, which in turn simplifies the planning of an operation for the physician (BNP PARIBAS 2018).
Nevertheless, challenges for German hospital managers are, in particular, an additional burden on the organization and employees. Change management requires more attention and plays an important role for sustainable implementation. In addition, high investment costs, as well as the lack of digital expertise and data security by relevant stakeholders, are large obstacles (Berger 2018).
However, many digitalization projects are already failing due to the lack of infrastructure, complicated approval procedures, inadequate reimbursement regulations, and high regulatory requirements. Although responsible politicians and public authorities have an acknowledged willingness to take action, an enormous need to do so still remains (Reinhard 2018).
In addition, the issue of data protection has been raised repeatedly in the context of digitalization. Health data (patient-related or -referable) represent a special type of personal data and must be, therefore, protected. The handling of this data and, above all, its integration into IT systems is linked to high demands and is complex, which is why its usability has been restricted. However, there are already solutions that meet the data protection requirements from an IT perspective (Lux and Breil 2017).
Changes in the Patient Room
Benefits of the Patient Room
Although the multi-bed room concept is predominantly widespread in German hospitals, many clinics are now responding to the high demand for single rooms by offering ‘comfort wards’. The amenities in these rooms differ considerably in comparison to those in normal wards. Hospitals are orienting themselves towards hotel standards in terms of comfort and offering patients’ laundry and ironing services, internet, flat-screen TVs, and a wider selection in terms of meals. However, these luxuries only apply to patients who can pay accordingly. The price per night in a single room is between € 80 and € 150 unless a patient has additional insurance that covers this cost. Access to better rooms and healing is denied to all other patients, especially those with statutory health insurance who cannot afford the service for financial reasons. The standard room for those with statutory health insurance is a multi-bed room (Gurr and Stelter 2016).
In addition, although many hospitals emphasize that the quality of medical care in single room wards does not differ from that on the multi-bed wards, the single room structure alone is associated with a better recovery process.
It has been scientifically proven that single rooms ought to be used more frequently, especially from a hygienic point of view. Numerous advantages significantly increase patient satisfaction, avoid unnecessary bed blocks for isolated patients and shorten the overall length of stay. Some of these include separate sanitary areas, fewer medication errors, fewer bed transfers, lower risk of infection, greater privacy and data protection, better communication between staff and patient/relatives, less noise and disturbance from a roommate and better quality of sleep (Detsky and Etchells 2008). Years ago, the German Society for Hospital Hygiene argued that single rooms should be the focus of new construction projects. However, this is still not being practiced in Germany, while other countries are already implementing the increased use of single bedrooms. In England, a quota of 50 percent was agreed upon for the use of single rooms. Canada and the US are demanding that only single rooms should be built in new hospitals (Exner and Popp 2011). In Denmark, the advantages of having single rooms have been fully taken into account—their super hospitals are being built on the single room concept.
The Future Goals of Various Stakeholders
The patient room of the future has three main stakeholders:
the staff
the management
the patient and his or her relatives
From these three different perspectives, different requirements (see fig. 1) can be derived in order to fully exploit the potential of the future patient room and to provide maximum satisfaction to each stakeholder.
Care processes focus on the patient, who wants to recover fully. From the patient’s perspective, requirements are derived which, facilitate communication, improve hygiene standards and safety, increase comfort and well-being with a pleasant atmosphere as well as adequate service offerings. Ultimately, satisfaction should be improved through increased transparency and individualized treatment.
The primary importance for the staff is to be relieved of redundant documentation and administrative activities, as well as gaining a high level of occupational safety. With the help of efficient processes, they wish to eliminate possible sources of error and, for example, anticipate risks by using comprehensive sensor technology in order to have more time available to perform their main duties.
For management, there are requirements, such as the optimal use of resources, that aim to achieve both strategic and operative goals. In addition, maintaining high-quality results and processes is important for management to improve both patient and staff satisfaction. A pleasant working atmosphere and a high level of patient trust promote the recovery process and personnel error rates. In the long term, the following can be achieved through higher efficiency in capacity utilization: savings potentials, reduced lengths of stay and higher occupancy rates.
Future Processes
With the establishment of the single room concept and the technological possibilities it provides, the patient room will play an increasingly important role in the care process of the future.
To ensure that stakeholder objectives can also be met in the patient room, there will be a shift in the provision of services from the traditional examination room to the patient room.
In the future, a large number of processes (see fig. 2) can be carried out directly on the patient’s bed from the time of admission. The room will be digitally networked with medical devices, medical software and the patient can control light, infotainment, door or bed settings directly via mobile devices. Clinical and administrative data acquisition, as well as medical documentation, is possible via mobile devices independent of location and thus takes place directly at the bedside. Point of Care Testing replaces the transport of samples to the laboratory and enables fast diagnostics of blood values etc., directly at the patient’s bedside. With the help of smart, mobile medical devices, smaller examination units such as ultrasound, EEG or X-rays and the discussion of findings can also be moved to the patient’s room.
Nursing care is facilitated by wearables, which automatically measure blood pressure, temperature, pulse, and intelligent wound care. The visit can take place via telemedicine communication, during which specialists can be called in at the same time, if required. The administration of medication and infusions can be controlled via various applications. Finally, there are also functions that can be fully automated, such as bed management for hygiene.
Outlook
Digital transformation is making its way into the patient’s room, opening up numerous opportunities to significantly improve the efficiency and effectiveness of a clinic and, in particular, to improve patient and staff satisfaction.
In order to develop the enormous potential and, above all, to meet the goals of the stakeholders, it is urgent to set the course for the single room concept in Germany. This will form the basis of the patient room of the future.
For this to happen, a new way of thinking must first and foremost be acknowledged in the political sphere so that fair financing solutions are created and two-tier medical system is avoided. The advantages of the single room clearly dominate and should be made available to every patient as a standard service. The incentive for hospitals to charge extra for this type of accommodation must cease, and instead be directed towards quality-oriented care with the use of new technologies.
References
Bauer M (2019) Auf dem Weg ins digitale Krankenhaus. URL: https://healthcare-startups.de/auf-dem-weg-ins-digitale-krankenhaus/ (accessed April 29, 2019)
Berger R (2018) Digitalsierung im Krankenhaus—Umfassende Digitalisierung befindet sich noch in den Anfängen. URL: https://www.rolandberger.com/de/Point-of-View/Digitalisierung-im-Krankenhaus.html (accessed April 29, 2019)
BMWi — Bundesministerium für Wirtschaft und Energie (2018) Monitoring-Report Wirtschaft DIGITAL 2018. wei-dner.media München
BNP PARIBAS (2018) Der Einfluss von Leasing auf das Gesundheitswesen URL: https://leasingsolutions.bnpparibas.de/wp-content/uploads/sites/6/2018/08/Whitepaper_Welchen-Einfluss-Leasing-auf-die-Gesundheitsbranche-hat.pdf (accessed April 29, 2019)
Detsky ME, Etchells E (2008) Single-patient rooms for safe patient-centered hospitals. JAMA 300, 954–956
Eusterholz M (2019) Smart Hospital—das Krankenhaus der Zukunft. In: Hellmann W (Ed.) SOS Krankenhaus-management. Kohlhammer Stuttgart
Exner M, Popp W, Deutsche Gesellschaft für Krankenhaushygiene (2011) Einbettzimmer im Krankenhaus. Hyg Med 36(10), 400–401
Gonser B (2015) Die Zukunft hat schon begonnen. URL: https://medizin-und-technik.industrie.de/allgemein/die-zukunft-hat-schon-begonnen/ (accessed April 29, 2019)
Gurr G, Stelter L (2016) Komfortstationen im Krankenhaus—Darf’s etwas mehr sein?. URL: https://www.tagesspiegel.de/berlin/komfortstationen-im-krankenhaus-darfs-etwas-mehr-sein/12962248.html (accessed April 29, 2019)
Leydecker, S (2017) Patientenzimmer der Zukunft. Birkhäuser Verlag GmbH Basel
Lux T, Breil B (2017) Digitalisierung im Gesundheitswesen: bessere Versorgungsqualität trotz Kosteneinsparun-gen. Wirtschaftsdienst 97, 10, 687–692
PwC—Pricewaterhouse Coopers (2014) European Hospital Survey: Benchmarking Devployment of eHealth Services (2012–2013), Final Report. European Union Joint Research Centre Luxembourg
Reinhardt P (2018) Medizin 4.0. Digitale Revolution in der Medizin: Stand der Technik und Ausblick. URL: https://www.devicemed.de/digitale-revolution-in-der-medizin-stand-der-technik-und-ausblick-a-758066/ (accessed April 29, 2019)
Sauer A, Storz F (2018) So hilft innovative Technik, die Digitalisierung im Gesundheitswesen voranzutrei-ben. URL: https://www.aktiv-online.de/news/so-hilft-innovative-technik-die-digitalisierung-im-gesundheitswesen-voranzutreiben-2701 (accessed April 29, 2019)
Vbw—Vereinigung der bayerischen Wirtschaft e.V. (2019) Neue Technologien im Gesundheitsbereich. URL: https://www.vbw-bayern.de/vbw/Aktionsfelder/Innovation-F-T/Forschung-und-Technologie/Neue-Technologien-im-Gesundheitsbereich.jsp (accessed April 29, 2019)
Meik Eusterholz, Dipl.-Kfm.
Meik Eusterholz is an authorized signatory and Head of Business Area with a focus on healthcare at UNITY. Since 2005, he has worked on over 100 projects and designed processes in and around hospitals, simulated hospital reconstruction or the construction of new hospitals while taking into consideration the concept of “smart hospitals”. Many of his projects have received national awards. Before starting at UNITY, Meik Eusterholz conceptualized and introduced lean management processes for the automotive and machinery and plant engineering industries.
Melanie Alessandra Katterbach, M.Sc.
Melanie Alessandra Katterbach, consultant in the focus area on healthcare at UNITY since 2018, completed her B.Sc. in Health Economics in Cologne in 2015. This was followed in 2017 by a Master’s degree in Healthcare Policy, Innovation and Management (M.Sc.) from Maastricht University. Since then she has supported projects related to process optimization and digital transformation in the healthcare industry.
Celina Sander, B.Sc.
Celina Sander is studying Healthcare Economics at the University of Bayreuth for her Master’s degree (M.Sc.). She holds a Bachelor’s degree in Health Economics from the University of Applied Sciences RheinMain. Since January 2019, she has been working as a student assistant at UNITY, supporting projects and consultants with a focus on healthcare.
3
The Sky Is the Limit — E-Learning and the Future of Healthcare Education
Victoria Hancox
Thanks to the rapid-fire pace of technological innovations, the face of e-learning has changed considerably over the last two decades. We’ve come a long way from Encarta CD-ROMs.
It can be argued that e-learning is essential in supporting professional development in healthcare. After all, the skills required to confidently and competently engage with e-learning are the very attributes needed by professionals in dealing with technological innovations that arrive in the workplace (McDonald 2017). But how will this look in practice?
What seems likely is that the trend for self-directed learning will gain strength, taking learners away from the traditional, didactic environment. A future of increased autonomy has been envisioned, with people identifying their own knowledge-gaps and selecting the content they need in a format that works for them.
[The] backbone to this [self-directed learning] is more integrated, searchable, catalogued systems.” (Greany 2018)
The providers of massive open, online courses (MOOCs) could take a crucial part of this backbone. Some medical schools already use exemplar courses from MOOCs in their curriculum (Doherty et al. 2015), which is a practical solution that reduces costs and time spent by educators in producing their own courses. In addition to allowing students a desired flexible access to the lessons, it also enables them to pursue topics outside the mandated curriculum. Such flexibility can boost enthusiasm, however, there is the thorny issue of accreditation, as institutes have an obligation to not only formally assess students but also provide empirical evidence of this and incorporating MOOCs may be problematic in that regard. There is also a high drop-out rate associated with MOOCs that may relate to student motivation. Are MOOCs victims of high, initial enthusiasm followed by a rapid decline, and if so, what can be done to prevent this and promote self-directed learning?
E-learning is an active process, requiring more interaction from the learner. This has many advantages—significantly, active learning has a greater impact on the acquisition of higher cognitive skills, as opposed to traditional, passive lectures (Freeman et al. 2014) and the deliberate practice facilitates the transition of information from short-term to long-term memory. It should be noted though, that active learning does not simply mean being physically active by clicking through a written text. It requires the student to be actively engaged in the content. Yet current e-learning is often a series of slides to be shown on a PC—text, diagrams, videos and multiple-choice questions, which does not reflect how people wish to learn. In order to grasp people’s attention and engagement, e-learning has to evolve.
Enhancing Content Engagement
One stand-out way to achieve this is to switch to game-based learning or gamification and although some may doubt the efficacy, gaming results in high levels of engagement, concentration and active participation. Throw online gaming into the mix and you’re also enhancing interactive team working skills (Walsh 2014).
The skill in designing educational games is, like in all games, to find the sweet spot between being too easy and, therefore boring, and too frustratingly difficult, so that the learner gives up. (Prince n.d.).
It could consist of simple word games, such as hangman, to practice medical terminology or creating backstories and narratives for interactive case studies that allow each individual to make decisions that take them down a certain route (see fig. 1). It inevitably leads to long-term consequences that they have to face and can’t correct— just like in real life.
Phones and tablets continue to gain traction as the devices on which people access e-learning. The content needs to be modified to this aim. This doesn’t mean simply making it fit onto a smaller screen but rather, considering how people use their phones on a regular basis. Think about your daily commute—you see your fellow passengers:
reading books or articles,
watching films or videos,
playing games.
The trick is to use these activities in the delivery of educational packets and to illustrate this, just consider how difficult it is to click forward through a series of text-filled slides on your phone. However, scrolling is intuitive, so content could be rewritten in the form of an article or even a story.
Talking of commutes—where and when people want to learn is also important.
Micro learning is the buzzword here—the days of hour-long lectures are in the past— people want to access short and focused modules of learning which can fit conveniently into their daily routine. But how do you decide just what goes into these bite-sized courses?
One Size Does Not Fit All
Healthcare professionals need to address different components—theory and practical skills such as assessment, problem-solving and critical analysis. Therefore, e-learning providers need to present these in varying but appropriate formats.
The theoretical component— the related anatomy or disease pathology, for example—could be demonstrated through interactive diagrams that combine key facts with associated images.
Practical skills could be delivered via short videos, e.g. commentaries that complement the individual steps of the procedure, meaning that both visual and aural learning preferences are catered for. When learning any new practical skill, it’s commonplace to watch a more experienced colleague carry out the task, so a short video, which can be replayed again and again, supplements and reinforces this knowledge. Costs and technical skills used to be prohibitive, but as editing becomes cheaper, we can expect short video clips to be incorporated into most e-learning (Arshavskiy 2019).
Simulations give access to a safe practice that provides learners with the opportunity to make mistakes and see the consequences of those mistakes. In doing so, it bridges the gap between theory and practice, as the feedback secures the theoretical knowledge by underpinning the interactions and connections. Research has shown there is a direct correlation between retaining knowledge and quality of performance in a simulated exercise (Francis u. O’Brien 2019).
Depending on the skills required, the type of simulation can vary. For example, manikins are useful for hands-on practice in clinical skills such as cardiopulmonary resuscitation, venepuncture and urinary catheterisation. These simple tools have been a concrete part of healthcare training for decades now but the 21st-century versions have been taken to a whole new level. There are now products with palpable pulses, bowel sounds and varying pupillary responses; features which alter according to a variety of programmable scenarios and also provide real-time feedback on the efficacy of resuscitation attempts (Laerdal n.d.).
Broader skills relating to diagnosis and patient management can be developed by simulations using avatars as virtual patients, nurses or doctors—practicing in context allows for a more authentic experience and generates greater student satisfaction, motivation and engagement.
Virtual and augmented reality (VR/AR) is a breakthrough technology that, while it hasn’t quite enjoyed the anticipated take-up with the general public, looks set to consolidate its place in future e-learning (Arshavskiy 2017). Augmented reality involves the projection of an image onto a real environment. There are plenty of applications that use Smartphones as the viewing device. However, with improved resolution and location tracking in eyewear devices, AR is becoming a tour de force in medical imaging (Craig 2016). Cutting-edge HMD (head-mounted display) devices can transform the information from a patient’s CT or MRI scan into an immersive visualisation of their internal structures and currently, this is mostly being used in the diagnostic stages but it also segues perfectly into surgery planning and rehearsal. A further exciting opportunity arises from the ability to connect multiple HMD devices. Seeing the same scene from different angles opens up collaborative working and learning opportunities (Bergonzi 2019).
The total immersive environment provided by virtual reality, via headset and earphones, could have, among others, a role in a different aspect of learning: Sampling the patient experience and using that to inform future practice. Relias produced a course based upon a person living with dementia which allowed people to empathise with the confusion and disorientation produced by certain actions of their carers. It can be a powerful tool that has an impact on how healthcare professionals relate to and treat the people they care for (Craig u. Georgieva 2017).
Curating the Curriculum
However, making engaging content is not the end of the story when it comes to encouraging self-directed learning. A curriculum that relies solely on e-learning courses and activities might suffer due to the lack of collaboration between students or personalised support from a tutor, and ultimately, lead to reduced motivation (Warriner u. Morris 2018). Here’s where blended learning enters the equation.
The curriculum should have a topic-specific approach, which means curating the e-learning resources so that you have the best strategies for teaching the subjects and skills required. A scaffold approach should be adopted, incorporating levels of theory and practice opportunities that build on previous instruction and allow for reflection and evaluation (Power u. Cole 2017). Importantly, learners are able to review and repeat at their own direction, and have access to tutors whose main role is to provide support and feedback—a paradigm shift that educators themselves will need support in adjusting to (Back et al. 2015).
One More Trick Up the Sleeve
E-learning has a further significant part to play in healthcare education as the realm of learning analytics starts to find its feet. We can envisage a fluid system comprising of both curriculum and management system that gathers data about the learner and provides informed adjustments for their subsequent learning—personalised and adaptive learning instead of a generic curriculum for all (Doherty et al. 2015). It would provide tailored feedback, warnings and motivation, and customise the individual’s learning plans which, ultimately, enables them to take on responsibility for their own performance. Adaptive learning paths have been shown to be efficient and decrease the time taken to master a skill or acquire knowledge, which in turn, enhances learner satisfaction and motivation.
Taking this a step further, it seems inevitable that the evolution of analytically-driven adaptive learning will lead to Smart Learning Environments (SLEs) (Koper 2014). Learning can be supported by these interventions:
being asked a question,
working on tasks,
receiving information,
gaining feedback.
Usually, the educator manages these interventions, walking the learners through until they arrive at a pre-determined outcome. With SLEs, the selection and sequence of the interventions would come from a data-driven decision. For this to work effectively, the learners must have an interface with the environment. To achieve that, SLEs will make use of the Internet of Things (IoT) as a mechanism for providing input and monitoring output. Just as a SmartHome can make use of temperature sensors to control the thermostat, SLEs can analyse the data derived from portable EEGs, eye-trackers or prior learning activities. The hub can then send specific information or suggested educational tasks to the learner’s mobile device (Hwang 2014). It may sound like a futuristic way of delivering education but its core value is simply in providing the right information at the right time.
We’ve come a long way from the blackboard but it’s imperative to not lose sight of what’s really at stake here, after all, innovations in e-learning are worthless if they’re not used wisely and safely to improve patient care and wellbeing.
