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EF: When first appointed, what was your main objective, and how has the pandemic impacted the implementation of e-health and e-digitalization since then? 

MD: After 14 years of serving as the central agency for digitalization, the organization was taken over by the government and other shareholders, resulting in significant improvements to the company. Prior to the takeover, Germany ranked low in healthcare digitalization despite being a highly technological nation, and the country needed to catch up with other major players in the rankings. 

As the GM of Gematik, I was appointed to lead the organization toward new opportunities in digital currency. However, just nine months after my appointment, the outbreak of Covid-19 challenged our cultural grip and contact. Despite this setback, the pandemic ultimately had a positive impact on digitalization efforts in Germany and two major nationwide digitalization initiatives were implemented: the Corona Warn App and the Covid Pass. Gematik was involved in the latter and distributed more than 243 million vaccination certificates, which is an example of how people tend to support technology and digitalization when they trust it. 

One of the most intuitive and wisest people I know once pointed out that having a high-quality analog healthcare system creates comfort and decreases the pressure to digitize. However, despite Germany's strong analog healthcare system, certain indicators, such as low HPV vaccination rates, suggest that there is still room for improvement. Professor Harald zur Hausen, who received a Nobel Prize for creating the connection between the HPV virus and cervix cancer, invented the HPV vaccine in Germany. However, ironically, German women have the lowest vaccination rate in all European countries. 

The COVID-19 pandemic also highlighted the need for better data gathering, as doctors were not reporting on administered vaccinations, hindering Germany's ability to contribute to international efforts. 

Germany is undergoing a significant transformation by adopting a system similar to the other Nordic countries, which involves constantly contributing health data. Only recently, the government published its digital strategy on the Ministry of Health website. Aligned with this strategy, Gematik will become a state-owned agency, and electronic health records will be mandatory with an opt-out option. By the end of 2025, 80% of Germans are expected to use electronic health records, which is critical for effective data collection. Despite previous resistance, e-prescriptions will now become mandatory starting January 1st of next year, a measure that will also favor industry research. This is a significant breakthrough since governmental institutions previously opposed data distribution to the industry. Secondary data will be made available to the societal research industry, which is a revolution for Germany. 

EF: How is the industry adapting to the switch from analog to digitalization in Germany? 

MD: Looking at electronic records as more than a tool is crucial. The electronic healthcare system records normal findings such as ECGs and labs. Autoimmune diseases, like multiple sclerosis or Alzheimer's, however, have complex histories, and it takes a long time to determine their cause. For example, an Epstein-Barr virus infection can increase the risk of developing multiple sclerosis by 80% even thirty years later. Electronic records can help to correlate and pursue research faster, making it easier to test theories without involving thousands of people in a double-blind random trial.  

In previous years, Gematik used to program on proprietary standards, but now we are transforming to international standards, starting with the E-prescription tool. This allows us to access the European health data space according to European Union standards. It is a significant move towards interoperability and international standards because and vital for fulfilling the nationwide mandate. Additionally, we are embarking on digital innovation to stay current with the latest trends.  

EF: What can we expect in the future in terms of improving the pace of digitalization in Germany? 

MD: Germany needs to speed up its digital transformation efforts to keep up with other European nations. To achieve this, every quarter, an external interoperability board of specialists define international standards for certain parts of the ecosystem. The aim is to have organized and easily accessible electronic records for everyone, similar to Denmark's healthcare system. The significance of digitalization lies in its ability to transcend physical and cultural barriers, as well as barriers related to patient activism, making it a crucial factor in advancing the digital transformation process. 

The current healthcare system's inefficiency can already be improved with smart digital tools like appointment reminders. Gematik, with its 420 employees, operates fully as part of the healthcare system and plays a crucial role in its backbone. The goal is to create a base of structured data and research for better health services from sick funds, health insurance, doctor associations, and patient associations. With a structured data foundation, logical consequences for patients can be properly deduced. 

EF: How can Gematik or similar companies build trust for the end consumer and the patient to keep their data safe? 

MD: At Gematik, data safety is paramount, and we adhere to the European philosophy of treating data. We emphasize the significance of safety and efficacy, which are the two pillars of growth, to promote the adoption of new technologies and digitalization. We do not follow a profit-driven or authoritarian approach, and we make sure that our systems are exceptionally safe to protect the public's safety. In most European countries, electronic health records are coded within 100 to 1000 patients with the same cryptographic coding. Germany is one of the only countries that cryptograph every patient individually, making it one of the safest ways to store patient data. In addition, to file encryption, our safety measures encompass a wider range of protocols, and we are working towards upgrading our systems to match the computational capacity of supercomputers. Amid the COVID-19 pandemic, Gematik played a crucial role in tracking vaccination records and ensuring secure data storage. 

Germany is renowned for its excellent resources, research institutions, and population capabilities. However, all that talent becomes pointless without data openness and a drive toward innovation. In healthcare, there exists a balance between utilizing patient data for benefits and excessively overprotecting it, which can result in losing such benefits. At Gematik, we believe that closely guarding data is counterproductive and unhelpful. Consider a patient with a rare disease, who, on average, takes five and a half years to receive a diagnosis, leading to irreversible harm by the time of diagnosis. Structured lab data can help doctors easily access and search for similar cases, leading to faster results. 

Raising awareness about digitalization and Gematik's role in driving it is crucial, as it can result in early diagnosis and prevention through using health data and electronic records. Germany places a high priority on data privacy. It is one of the few nations with descriptive versions of data, an essential aspect of research, innovation, and collaboration critical for patient-centered care. 

EF: How can Gematik enhance awareness about the importance of adapting to digital tools, especially around the healthcare delivery frontline? 

MD: Reaching international standards and ensuring a high level of security increased the trust of our frontline customers. Gematik has focused on single-doctor practices for the last fourteen years. However, now, with the German Hospital Association as a shareholder, hospitals and multiple-doctor practices are gaining more attention. Many of our products were initially designed for single and double-doctor practices, as tracking a doctor's prescriptions in a small clinic is easier than in a large hospital. For hospital software systems, interoperability plays a crucial role. Gematik's objective is to integrate physician-based and software-based solutions to address this challenge. 

Two years ago, the Krankenhaus-Entlastungsgesetz, Germany’s Hospital Relief Act, allotted 4.4 billion for hospital IT upscaling. Gematik has played a crucial role in assisting hospitals to avoid the expenditure of funds on inappropriate commercial offers. Given the fragmented nature of having 1900 hospitals in Germany, each with its unique software systems, hospital systems needed to adjust gradually to this connectivity. Gematik offers standardized programming software that fosters interoperability and connectivity, allowing for structured data to link various stakeholders and enhance patient-centered care, resulting in earlier diagnoses and better financial stability for payers 

Effective management of data and improvement of healthcare delivery require interconnectedness. The German government introduced e-health, which includes telemedicine, and abolished the 30% rule that previously limited doctors to spending only 30% of their cases on telemedicine. The removal of the 30% rule will attract telemedicine companies back to Germany, allowing for state-of-the-art healthcare delivery, particularly in remote areas. Traditional face-to-face doctors must also adapt to the telemedicine model, and companies specialized in telemedicine can provide training to obtain as much patient information as possible. 

EF: What achievements would you like to celebrate in the future? 

MD: Currently, Gematik is commemorating two significant achievements. The first milestone involves adopting international standards for all tools designed since I joined the company. Gematik has implemented the Matrix Foundation protocol for its team messenger, which is widely used by ten million people across Europe. This protocol ensures the safety and security of the messenger. 

The second milestone is the successful opening of Gematik to actual healthcare professionals, which was achieved through significant effort. The company is proud to have direct communication with patients, caregivers, doctors, and pharmacists. Gematik's employees now engage in dialogues with these groups, and, in collaboration with 17 other medical associations, therapists, and healthcare professionals, we have designed a new healthcare record. 

Looking toward the future, I am excited for the day when we will reach the Danish level and have organized data for everything. With well-structured records, healthcare access will improve for everyone. The company introduced the electronic record two years ago and realized that a patient-driven health record was the best option The government is thrilled that we are offering something convincing to the Nordics and Germany. This is the milestone that is motivating me to continue working at Gematik. 

May 2023