KHZG in Germany: How to achieve digitization in hospitals?

One topic is currently on the minds of hospital administrators like no other: the digitization of systems and work processes. Legal requirements and subsidies are intended to define the framework and possibilities for hospitals. In Germany, the Hospital Futures Act (KHZG) was created for this purpose.

However, implementation is difficult: many hospitals do not have a clear digital strategy. In the end, it’s not just tablets in staff lockers that must be used, but process improvements and standardizations that should lead to more efficient hospitals with lean administration.

In the webinar "Digitalization in Hospitals," Dr. Benedict Gross, Senior Manager at PWC Germany, talks about the challenges and opportunities of digitizing hospitals in Germany. What do you need to know, what do doctors and staff think about digitalization and what solutions are available?

What is the Hospital Futures Act and what is it supposed to achieve?

The German federal and state governments have been providing a total of 4.3 billion euros under the Hospital Future Fund since January 2021. Applications for funding must be submitted to the Federal Social Security Office by the end of 2021.

The funding covers investments in modern emergency facilities and measures to improve the digital infrastructure. These include, for example, electronic patient portals, digital documentation, medication management, telemedical network structures and IT security measures. The latter must account for at least 15 percent of the approved funding. Associated personnel measures are also covered by the .

The aim is to improve patient care and the security of systems in hospitals.

What challenges do German hospitals face in implementing the KHZG?

The need for modernization at hospitals is enormous. "Over the last few decades, an investment backlog in German hospitals has meant that hospital data centers are anything but up-to-date and modern," says Gross. "There simply hasn't been money to invest in modern infrastructure or build IT teams."

That's why funding is being made available through programs such as the Hospital Future Act. The funding amount of 4.3 billion euros means an average of two million euros per hospital in Germany. Per bed, around 8,000 euros could be distributed arithmetically. "Depending on the size of the hospital, that can be a lot," Gross comments, "or very little, for example, if it's a university hospital that actually needs ten times that amount of funding."

The federal allocation of funds by the states complicates the funding process. "In the fall, the Hospital Future Actwill celebrate its first birthday - without one cent having gone to a hospital," Gross notes.

The specialist: Dr. Benedict Gross

Dr. Benedict Gross is a senior manager at PWC, where he is part of an international network of experts working on digitalization and optimization of processes, risk management, forensics and cyber security. His focus is on working with organizations that operate in unpredictable and challenging situations, such as hospitals.

According to Dr. Gross, the first cash receipts are expected in late 2021 or early 2022. Theoretically, hospitals have been able to spend money on digitizing their facilities since the fall of 2020. However, hardly anyone wants to take the risk of spending grant money that has not yet been approved.

"There will be a flood of tenders on the German market around the coming turn of the year," predicts Dr. Gross. Competition for providers to help hospitals digitize will be fierce as result.

Digitization and security must go hand in hand

Cybersecurity is an Achilles' heel for any company, especially in the healthcare sector: healthcare systems are popular targets for cyberattacks. The topic area also has tremendous momentum, says Benedict Gross: "The technical and procedural evolution of cybersecurity is changing even faster than, say, a research-driven discipline like medicine."

Legal regulations and hospital budget planners can't keep up with the pace of change in digitization. "No matter how much money we're pumping into the market right now, as long as we're running at the current speed, we're not going to win the cybersecurity competition," Dr. Gross says.

New forms of organization are needed, for example collaborative structures between different hospital operators, to tackle IT security and digitization together. "Security is an imperative for medical service delivery," says Bendict Gross, emphasizing the importance of cybersecurity. This applies to technical security as well as data and information security; after all, a patient record must not fall into the wrong hands.

Hospitals therefore have to operate in a triangle between requirements, available resources and contractual penalties due to poor implementation of the specifications. The: If digital services for patients are not implemented by the end of 2024, this can lead to severe deductions in hospital financing. How is a hospital with few full-time IT staff already tied up in day-to-day operations supposed to meet this challenge in such a short time?

Business case digitization: what are the benefits of digitization for the hospital?

Before we turn to a possible solution, it's important to ask what digitization brings to a hospital aside from meeting regulatory requirements. Digital processes significantly improve everyday work. Hospital employees also see it that way, as surveys show.

More than two-thirds of physicians, for example, believe that digital technologies reduce hospital costs. Doctors, for example, spend almost half their time on documentation. Here, standardization and digital process improvements enable significantly more treatment time.

Likewise, more than two-thirds of physicians are convinced that digital technologies improve prevention. One third of the respondents even expect an increase in the life expectancy of patients. Studies on digital decision support systems show clear effects on the length of hospital stays, patient safety and many quality indicators.

Patients in particular benefit from the digitized hospital: half of those surveyed would like to make doctor's appointments online, and more than two-thirds would like to renew or receive prescriptions digitally. Most patients see more time for treatment as a significant improvement in quality.

Currently rarely in focus, but a significant future feature, will be employee satisfaction: "What applies to the market for IT professionals has long applied to the market for nurses and doctors," Gross explains. "If you have several hospitals to choose from in a metropolitan area, which one do you choose? Of course, salary plays a role, but when in doubt, go where the atmosphere is better and where you have a work environment that meets their expectations. In the future, that will be a digital environment free of mindless paper documentation tasks."

In addition to improving in-house organization, there are other long-term, sustainable reasons for hospitals to invest in digitization. Their future treatment offerings will depend heavily on technological capabilities. For example, AI systems that can detect certain diseases as reliably as doctors now exist. In the future, it is likely that patients will choose a particular hospital primarily on the basis of its technological capabilities.

In addition, telemedicine applications are becoming increasingly important. Not every hospital can employ all specialists. However, through new technologies, specialists can easily join the conversation from anywhere in the world and assist with both diagnosis and surgery. Digital work sharing and telepresence between hospitals will become an important issue in the future.

Healthcare Ecosystem by Netcetera and the i-engineers: Digitizing the Hospital Quickly & Securely

The wave of digitization unleashed by the KHZG will empty the market for healthcare IT professionals. Hospitals will increasingly have to turn to consulting firms or service providers to meet the legal requirements on time.

This also presents an opportunity. After all, why should a hospital go to the trouble of acquiring the expertise for digitization itself, with all its rapid dynamics and the sometimes expensive requirements for IT security, when there are experts available to do the job? Digitalization strategists in the healthcare sector are familiar with the IT requirements for hospitals and, thanks to their experience, can implement them quickly and reliably. The hospital, on the other hand, can concentrate on its core competence: the successful treatment of patients.

The Healthcare Ecosystem by Netcetera and the i-engineers offers a comprehensive service for digitizing hospitals. Many of the modules of the Healthcare Ecosystem are eligible for funding according to the Futures Act. In the Clinic Cockpit, the hospital manages orders and patient:inpatient data centrally. Using individually configurable dashboards, physicians and staff can conveniently create individual digital work environments. Whether appointments, laboratory and radiology results,  a patient:inside archive, or digital forms, an intuitive, modern order entry system will increase efficiency and enable significant time savings on the wards.

The underlying health engine server monitors redundant data storage, rights and role management, and legal requirements. 150 different interfaces to peripheral and third-party systems integrate all important standards in German-speaking countries, including proprietary primary systems such as HIS, RIS, LIS or PDMS.

Data exchange with internal and external partners as well as with a patient and physician portal is possible, as well as with outpatient facilities, the IHE and the telematics infrastructure for EPA or EFA. An interface to telemedicine is also available. Most importantly, cybersecurity and data protection are top priorities for all elements of the healthcare ecosystem. 

An example of a successful digitalization with the Healthcare Ecosystem is the Unispital Basel.

We are always happy to assist you with a free consultation. Contact us now and together we will find out how your hospital can become digitally future-proof within the framework of the Hospital Futures Act. You can reach us by email, phone or LinkedIn.

Here you can find the complete webinar on digitization in hospitals:

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