Not all digital health tools are created equal: The reality of digitalization in healthcare

• As evidenced by the COVID-19 pandemic, digital health technologies are crucial to improve care for patients
• Healthcare leaders need to ensure that digital tools are created and implemented with the end-user in mind
• “Smartifying” physical processes for healthcare providers and establishing partnerships with policymakers are necessary to create a successful digital health ecosystem

Digital health tools are becoming increasingly commonplace in healthcare systems. Already an emerging trend before the pandemic, the need for alternative routes to deliver healthcare during COVID-19 galvanized greater adoption of digital technology. From telemedicine, to online pharmacy delivery, to remote care, the digital health ecosystem is growing significantly. The global digital health market size in 2019 was estimated at USD $175 billion.¹ By 2025, experts believe the market will grow to nearly USD $660 billion.¹

But creating tools that alleviate, rather than add to, the burden on healthcare providers is not always easy. Nurses have struggled with this problem since the introduction of Electronic Health Records (EHR), an issue highlighted by Stoyan Halkaliev (CEO of NursIT Institute GmbH) in our latest Startup Creasphere series interview.

Stoyan explains the key issues his team has identified, the opportunities for nurses, the role governments can play, and the importance of new partnerships—all in the context of supporting meaningful digital health solutions.

HT: What have you observed about the way in which the healthcare sector is implementing and embracing digitalization?

Stoyan Halkaliev: The shift to digitalization is a complete change management task. It requires that everyone is on board and that everyone is using digital health technologies in the proper way. But that has not always been easy. When it comes to nurses and gaining their buy-in, I have noticed that the technology in nursing that have been introduced so far have not been designed with nurses and their needs in mind. Take hospital EHRs for example. They were designed for hospital administrators or physicians and one study that was published 10 years ago showed that a majority of nurses surveyed felt that digital tools were actually hindering their work.²

Entering data into a system can be time consuming. Today, staff need to log in, search for patients, find the right forms, make sure all fields are completed and then make sure the forms are all saved in the right place. What we are finding is that in the end, nurses might need three to four times longer to enter data digitally than they did when they were using more traditional paper-based methods.

Making sure digital health tools are designed with the end-users in mind is absolutely critical, especially given the fact that staff shortages mean nurses have even less time to embed new tools into their daily practice.

HT: Why do you think the healthcare sector lags other industries when it comes to digital health technologies?

Stoyan Halkaliev: I think that one key problem in the healthcare sector is that it has never really used KPIs to measure and track the outputs that are being delivered in the same way that other industries commonly do. It’s also worth noting that healthcare is not necessarily a “business” in the way that we usually understand the term business.

In this regard, it’s interesting to observe a huge difference between Europe and the United States. In the United States, hospitals function more as enterprises than in countries like Germany, France, or England, and we have seen more progress being made in terms of digitalization in the United States than in Europe, where systems are not necessarily incentivized to drive this kind of change.

As a result, we are probably at least 10 years, maybe even 15 years, behind every other industry when it comes to digitalization. If you look at the software systems that are in the hospitals right now, you will see that most of them were designed in the nineties and the early 2000s when you basically had to jump from paper to something else.

This is why we need external forces, like governments or other institutions, to provide these incentives.

HT: Are governments starting to take action?

Stoyan Halkaliev: Governments really started to appreciate the need for action during the pandemic. They realized that there were considerable benefits of digitalization for society as a whole and that they needed to do something about it. Germany was the first actually to act upon this with the Hospital Future Act where they introduced around 4 billion euros and told hospitals that they would need to buy specific software for nursing and treatment documentation in order to optimize their processes and improve their interoperability.³

Essentially, the government incentivized hospitals by providing extra funding. However, if changes are not implemented by 2025, the government has said it would reduce the hospitals’ budget by 2%.⁴ We’ve also seen Germany leading the way when it comes to supporting the prescription of apps that are covered by insurance companies. The French government is also taking action with its France 2030 program.⁵

HT: How important are partnerships when it comes to creating the right environment for digitalization in healthcare?

Stoyan Halkaliev: I think people are starting to realize that the market is moving away from a single product market to a systems market. People don’t want to buy just a single product. They are thinking in systems. They want to know how everything will fit together in their system and overall strategy. This is why we are thinking in terms of IT systems. We need smart work initiatives and we need interoperability across the back-end so that anyone who needs our data can jump in and use it. Taking this approach also means we will build solutions that can be more easily integrated into other systems. On top of that, it’s really important that hardware systems connect with software systems. We’re at the beginning of this journey right now, but it is exciting to be teaming up with Roche on this.

HT: How could digital health tools help nurses?

Stoyan Halkaliev: Staff shortages are one of the biggest issues that most hospitals face right now. Many nurses are leaving the workforce and we don’t have enough new nurses joining. We have to figure out different ways of mitigating the workload, or at least make sure that nurses are concentrating on the things they are there to focus on, and that they are not having to spend too much of their time on the organizational administrative tasks that often end up falling to them. There are studies that show that nurses spend more than half of their time on documentation and administrative tasks.⁶

For nurses, we can help decrease their burden on documentation by “smartifying” physical processes. One example is taking blood to measure blood glucose in diabetic patients. The typical approach is taking blood, reading results on a device, and then typing results into the EHR. Afterwards, a physician may need to analyze the results and then tell the nurse what insulin dose is required for the patient. We could significantly reduce these steps through digital devices and a system that, once the measurement is taken, everything is documented and digitized immediately, and doctors can make rapid decisions and nurses can take the appropriate actions.

This approach could even be done with vitals, where digital devices can automatically take measurements and collect data without nurse intervention. We can potentially combine point-of-care devices with software management systems and digital workflows that are designed to address the challenges nurses encounter.

HT: How can digital tools support the healthcare system more broadly?

Stoyan Halkaliev: One way is by ensuring different parts of the system are getting insights that they need in order to function as effectively as possible. A good example of this is the way the hospital billing system works. At the moment, hospitals receive money depending on the medical diagnosis of a patient. What this fails to account for is how much care different patients need, even when they have the same condition. An elderly patient and a younger patient may both come to the hospital and need treatment for an ear infection. However, the elderly patient may need a lot more nursing because he or she is more frail. This is not reflected in current systems.

By collecting key data points and making the nursing process more transparent with digital health tools, hospitals would be able to get reimbursement for the work that is done rather than for the conditions that they treat.

HT: How do we get the proper framework and building blocks put into place to ensure success when it comes to the digitalization of our healthcare systems? What kind of support would you like to see from policymakers and governments?

Stoyan Halkaliev: With the interconnectivity of healthcare, where patients can essentially receive care anywhere in the world, it is crucial that policymakers and government offices push the agenda for better digitalization of processes so data can be shared easily, safely, and efficiently.

In that regard, regulators must push for interoperable systems. Many of the vendors today are not interested in sharing data but more in line with keeping their own data silos. We need to make more investments in systems that enable data exchange between organizations. Digitalization brings data, which allows for better planning and improves the availability of resources. We need external regulatory forces to push in this direction.

NursIT successfully participated in Startup Creasphere, a leading digital health accelerator that strives to transform healthcare together with startups.