The digitalisation of medicine has been driven forward for years, but it only experienced a rapid upswing in recent years due to the Corona pandemic. During this time, telemedical applications, such as online consultations, became established in the health sector. Another winner in this context is the integration of digital health applications.
Would you have expected this turn of events – from digital health apps on prescription to real-time online consultations to tele-surgery? Find out more about the opportunities and challenges, as well as current trends, market insights and an exclusive expert interview on telemedicine and digital health apps (DiGAs) in the new arcoro INNOVATIONS.
|Telemedicine & digital health applications – history, facts,
trends and fields of application
|Current main trends in the health sector
|Gamechanger (national / international)||8|
|Challenges & Outlook||19|
Telemedicine and digital health apps (DiGAs) as tools of digitalisation have not only changed the structures of medicine, but also maintained access to healthcare during the Covid 19 crisis. But what is actually behind the term telemedicine and what is meant by digital health applications?
Telemedicine is the provision of medical care and counselling services where the patient and doctor or therapist are physically separated. These remote services allow patients with limited mobility to easily exchange information with their medical contact during routine appointments using a reliable internet connection. Telemedicine services include the provision and support of medical health interventions, specific medical and general health education, general public health interventions and administrative functions.
Even though telemedicine platforms have only gained awareness and importance in recent years and are thus considered a new technology, the principle has actually existed for much longer. For half a century, healthcare providers and tech companies have been researching and developing the provision of remote services for the medical sector. To better understand the technology behind it, it is worth taking a look at the origins of telecommunications technology.
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While the birth of the telephone, radio and telegraph dates back to the late 19th century, by the turn of the century the technology had already expanded and was also being used for medical purposes. An 1879 article in the medical journal “The Lancet” predicted that the telephone could reduce the number of visits to the doctor’s office in the future. In 1925, Hugo Gernsbeck developed the idea of a teledactyl, an instrument for the tactile examination of patients from a distance using radio technology and a connected video feed. Although the invention could not be implemented at that time, it represents the origin of video-based remote medical services.
In the 1950s, X-ray images were first exchanged between two health centres in the USA using telephone technology and later developed into a teleradiology system. This early form of telemedicine was intended to compensate for the lack of medical facilities and specialists, especially in more rural areas. Soon, however, further potential was recognised, such as the simple exchange of patent data, test results or the general reduction of waiting times and travel distances. Since then, the technology has been further optimised and had its big breakthrough in 2020 with the onset of the pandemic.
The national market for digital health is growing rapidly. In 2020, a global turnover of 200 billion USD was generated and forecasts indicate that a turnover of around 979 billion USD will already be achieved in 2025. This rapid growth and the optimistic figures are due in no small part to the pandemic, which experts say has accelerated the introduction and establishment of digital health solutions by two years. While telemedicine applications were only offered sporadically in 2017, namely by around 2% of registered doctors, around 50% offered online consultations as of 2020.
In Europe, the market has been driven primarily by remote consultations and other telemedicine services since 2020. Forecasts from 2020 promised a global turnover of 80.5 billion USD for telemedicine based on demand in 2021. Experts even expect an increase to 218.5 billion USD by 2025.
Digital health applications are low-risk medical devices (I and IIa) that are based on a digital technology – namely apps or desktop/browser applications – and are CE certified. DiGAs do not have to be software-based either, but can also include additional devices, sensors, and other hardware such as wearables. In everyday use, health apps and DiGAs are often equated, but in reality this is strictly distinguishable. Unlike ordinary health apps, DiGAs are tested by the Federal Institute for Drugs and Medical Devices (BfArM), are to be prescribed by doctors and the costs are reimbursed by health insurance companies. Even though both app groups serve to support diseases, DiGAs are subject to much stricter regulations as well as testing procedures. Digital health apps support on the way to a self-determined health-promoting lifestyle through the detection and targeted treatment of diseases. DiGAs have to pass a 12 to 24-month trial period and are then included in the DiGA directory either permanently or temporarily based on available test evidence of positive care effects. With the help of ICD coding, indication groups can be defined by the manufacturers so that doctors and therapists can easily and efficiently find and prescribe suitable DiGAs for their patients.
DiGAs have been reimbursable since the end of 2020, but the digital trend has not yet fully established itself among the masses. In July 2021, only around 200,000 downloads were made. The most common areas of use so far are for chronic tinnitus and back pain, as well as obesity and migraine. The strongest user groups are currently patients between 50 and 59 years of age, followed by the 30 to 39-year-old patient group. However, the biggest challenge at present does not seem to be the openness of patients to new digital tools, but rather the acceptance and behaviour of doctors, who are still sceptical about DiGAs.
While technology has made significant progress in maintaining healthcare, especially in times of contact reduction, telemedicine and DiGAs are not a complete substitute for in-person doctor visits or other clinical services. As telemedicine applications and digital health apps rely only on verbal symptom descriptions or supporting facts through app evaluations, this cannot suffice for a definitive medical assessment, but further requires a face-to-face check-up where the doctor has the patient directly in front of him and can work on him. Nevertheless, telemedicine supports mainly short checks, initial diagnoses, prescriptions and sick notes.