Saturday, September 23, 2023

Lecture Notes: German Health Minister Sets Goal for Fast Digital Advances in German Healthcare

Some readers notice that I am a lifelong German-language hobbyist, and I know more about the health system in Germany than any other European country.  Sometimes this pays off, like this week, when I attended a fascinating lecture by Germany's Health Minister on dramatic new goals for a digital push forward in the German healthcare system.   The event was a joint Q&A with Dr Karl Lauterbach and Dr Micky Tripathi, the National Coordinator for Health Information Technology at the US HHS.  It was held at the Kennedy School at Harvard on September 22.

Dr. Lauterbach, who holds a PhD in health policy from Harvard, became well-known in Germany during the COVID crisis but did not ascend to the position of Health Minister until the change of  government in late 2021.   As preparation, I ran across a 30 minute interview that Lauterbach gave a few days ago with the German newspaper DIE ZEIT, on AI in healthcare (German; here).   He recapitulated many of the same points in Boston this week.

Lauterbach focused on 4 or more pieces of legislation just now moving through the writing, Cabinet-approval, and parliamentary process in Berlin.   The results would connect doctors' offices, hospitals, and pharmacies throughout German with a unified electronic health record.   

Moreover, there would be an "outer ring" and an "inner ring," per Lauterbach.  The outer ring would be encrypted but patient-specific, and patients (who could opt out entirely) could easily allow transfer of clinic visits and history to new providers.   The inner ring would be anonymized and constitute a regulated secure "Federal Research Space" as a learning health system and for research.  AI could help create retrospective narrative structures from original free text.  

Other features mentioned by Lauterbach included a reform of the research approval process so that high standards of patient safety could be maintained while shrinking the burocractic approval process to 30 days.   Both at DIE ZEIT and at Harvard, he referred several times to 2025 as the goal for putting major pieces in place (this seemed remarkable to me).  

In the DIE ZEIT interview, countries like Israel and Sweden were used as models and goals for electronic health records for the great-leap-forward in Germany.   In addition, online, the interviewer noted that Germany was not only working with or learning from nations, like Israel and Sweden, but Microsoft and Google were at the forefront of digital health and AI.   Echoing this exactly, at Harvard, Dr. Tripathi closed by noting in the last few days he hsd keynoted at meetings where he was preceded or followed by Microsoft or Google.   


Context.  It's difficult for me to entirely place this "new plan" in context, as a quick Google search the last five years shows a plethora of articles about prior legislation and prior goals and deadlinees to help Germany "leap forward" from its backward position in digital health records and interoperability ("Digitalisierung.")  E.g. this page is dated 2020.  Compare a 2023 essay here (also McKinsey 2022 here, ICTH 2023 here, 44-p German ministry depiction of its goals here).  Other articles talk about the shaky status of German hospital economics, and Covington just published an article updating us on pending major inpatient DRG reforms in Germany, here.

AI Corner

I left the Lauterbach-Tripathi session with a roughly-typed  page of fragmented phrases and keywords.  I dumped them into Chat GPT and asked it to edit them into a smooth journalist-style essay.   Here.

Bonus Book

Health care change, let alone health care reform, has always been messy and chaotic and confusing.  See a 2021 book by a Yale professor, Peter Swenson, covering 150 years of zig-zagging US health policy - Disorder.

November 9-10, Berlin

Robert Koch Institute, 9-10 November, Berlin, AI in Public Health, here.

44p German 2023 guide to digital reform and adoption

ONC Rulemaking on AI and EHR 3/2023

A few links to more information about Spring 2023 ONC rulemaking on uses of AI esp. in EHR, here.