Digital Health

A Country Doctor in a Backpack

telearzt dpa
Getting to grips with telemedicine in Dresden.
  • Why it matters

    Why it matters

    As the number of doctors decreases in Germany, there aren’t enough to properly care for the aging population in rural areas.

  • Facts

    Facts

    • Telemedicine is the use of telecommunication and digital tools to provide healthcare to rural communities.
    • German doctors resisted the concept for many years, fearing they would lose patients.
    • Many healthcare professionals now think telemedicine can help in rural areas, where shrinking numbers of doctors are struggling to meet patients’ needs.
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  • Audio

    Audio

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Forests, lakes, and dozens of tranquil villages mark the scenic landscape in the Oberbergisch District in the German state of North Rhine-Westphalia. On the weekends, day-trippers from nearby Cologne come here to relax. But for country doctor Thomas Assmann, life here is pure stress.

“I often drive 40 kilometers to visit a single sick person,” he said. Mr. Assmann likes to make home visits, but the 52-year-old general practitioner has grown weary of all the driving. It costs precious time that he would rather spend with patients, he said.

So the doctor and his assistant, Frauke von Wirtz, cooked up an alternative: She makes the home visits, driving from patient to patient with telemedicine devices from the e-health company Vitaphone in her backpack.

Then she transmits data such as heart rate, respiratory volume or blood sugar via a secure data connection to the doctor’s office. In principle, she can connect any medical device using Bluetooth with her laptop. If she gets stuck, she connects her boss via video conference.

“That’s my trump card,” said Ms. von Wirtz. “I have the doctor in my bag.”

Their initiative has now been developed into Tele-Landarzt, which translates to Tele-Country Doctor, the first project of its kind in Germany. Set to launch on Oct. 1, it already has the support of the German association of general practitioners, and plans to enlist health insurers to help cover costs — which might the biggest challenge of all.

“Many doctors in private practice want to become more digital.”

Thomas Assmann, Rural physician

“There is a great deal of interest and willingness,” said Nicole Richter from the general practitioners’ association. She has joined Mr. Assmann and Vitaphone to spread the Tele-Landarzt idea across Germany.

Twenty years after the country introduced its electronic health insurance card, doctors are finally starting to embrace telemedicine — the exchange of medical information via telecommunication to provide rural healthcare. While hospitals have long been experimenting with such options, and are currently cooperating in some 210 projects with e-health start-ups and medical technology firms in the country, private practices have lagged when it comes to digital medicine. Fearing that patients might find alternative treatment, they put up strong resistance to the electronic card or any kind of telemedicine.

But now there is a veritable “grassroots movement,” said Mr. Assmann. “Many doctors in private practice want to become more digital.”

The reasons for the change of heart are multifaceted. With health apps booming, some professionals seem to have bowed to the inevitable. But many, in particular younger doctors, see a great deal of room for improvement in digital medicine. And it is sheer necessity that drives medical practitioners in rural areas to seek such solutions.

There is a real healthcare deficiency in structurally weak regions, both in terms of medical specialists and general practitioners, whose numbers have been sinking all across Germany. While there were 51,400 general practitioners in 2010, there were only 48,920 in 2014. In 2018 it will be a mere 46,090. And according to the German association of statutory health insurance physicians (KBV), the trend will continue. By the same token, the number of home visits is increasing because patients are becoming ever older, sicker and less mobile.

Thus, the growing willingness of many practicing physicians to try efficient, digital solutions.

Markus Müschenich, the leader and co-founder of the BiM association of Internet medicine, sees the industry at a real turning point. The delegates at this year’s German congress of physicians committed almost euphorically to digital therapy. They even gave their blessing to a resolution stating more or less that “Internet medicine can be better than conventional medicine,” Mr. Müschenich said.

Pioneers in the industry are pushing ahead with pilot projects across Germany. Together with the Lübeck-based start-up Patientus, the German Dermatological Society recently launched an attempt at bringing the doctor right into the living room via online consultation.  “If the patient was in my office once, a quick look or a short chat are often sufficient follow-up,” said Association president Klaus Strömer, who uses the system.

The likelihood of health insurers covering the costs will depend on whether telemedicine gains broad acceptance.

There has also been another important development: Techniker Krankenkasse, Germany’s biggest health insurance company, is on board. It reimburses its members for the service, while other patients have to pay out of their own pocket.

This is an important signal, according to Patientus CEO Nicolas Schulwitz, because most doctors will only use online consultation when the insurance companies pay them reasonably.

But even if patients pay for it themselves, it is often still worth it, Mr. Schulwitz said. “In return, they don’t have parking fees or have to pay a babysitter – and it’s quicker.”

That goes especially for chronically ill patients who need regular check-ups, such as people with serious cardiac ailments. For them, Getemed, a company from Teltow outside Berlin, has developed an award-winning online monitoring system.

In the beginning, the mid-sized business worked with clinics. But since last fall it has been offering a mini-electrocardiogram (ECG) for registered doctors, and they have already sold 250.

It’s ideal for patients with cardiac arrhythmia, who can simply hang the lightweight instrument around their neck and have it ready as soon as their heart goes out of sync. Then they press the device onto their chest, and it transmits the data automatically to Getemed.

The company converts the digital signals into classic ECG strips and sends them to the doctor. If the patient’s condition is worsening, then they come in for treatment.

Being able to monitor blood sugar levels online is equally helpful, and something the Potsdam-based start-up Emperra offers. So far, health insurance agencies only cover the cost of the measurement device.

Though, during a pilot phase, the health insurer AOK Nordost also paid the costs of the doctors’ work hours while evaluating the blood sugar levels coming in online. The project study is now being assessed to decide on how the rest should be paid for.

The likelihood of health insurers covering the costs will depend on whether telemedicine gains broad acceptance. Many start-ups and venture capitalists expected clear guidelines from the new e-health law that the German parliament, the Bundestag, signed off on in May.

But they were disappointed.

“The law regulates questions of data security and storage, but not matters of communication between the doctor and patient, or their fees,” said Klaus Stöckemann, who, as CEO of the Berlin-based Peppermint VenturePartners, helped finance the start-up Emperra.

 

Start-ups and venture capitalists expected clear guidelines from the new e-health law that the German parliament signed off on in May. But they were disappointed.

Country doctor Mr. Assmann hasn’t been discouraged by any of this. His assistant Ms. von Wirtz already assists him in making home visits and takes care of things like bandaging wounds.

She is not allowed to make diagnoses, but she can reach the doctor immediately on her laptop in tricky situations. And that is precisely what gives seriously ill patients the assurance they need without having to make a trip to the doctor’s office.

It also helps to avoid unnecessary hospital admissions, said Ms. von Wirtz. “Until now, patients have called an ambulance in an emergency if the doctor wasn’t able to come. The ambulance team can examine and treat them on-site, but then they are required to take them to the hospital, even if it’s not necessary.”

Doctors’ assistants, of which there are nearly 7,000 all across Germany, could help to avoid this if they were interconnected with doctors, said Mr. Assmann. “If each of them could avoid just one unneeded emergency transport to the hospital per month – which costs around €1,000 – we could save €84 million a year.”

Mr. Assmann has been making adjustments to his telemedicine backpack for some time now – which he also plans to use with the 150 asylum seekers in the neighboring town of Lindlar and the other 160 that will join them in October.

Many of them are sick, but don’t speak any English. That is why he wants to visit the refugee shelters at fixed times in the future and have translators join in via video, so that they too can avoid the winding country roads to get there.

 

This article first appeared in the business weekly WirtschaftsWoche. To contact the author: susanne.kutter@wiwo.de

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