Technology is already an integral part of the caring system in most European countries. And it will become systemically important in no time at all. The reasons are manyfold. Most families live in a state of geographical separation. The situation on a remote and more and more depopulated island like Lastovo is also in this regard on one hand extreme as well as symptomatic on the other.
By consequence communication between people in need of care and their relatives is only possible by means of technology. And the care work has to be done by professional and informal carers instead of relatives.
Furthermore, aging people and people suffering from disabilities are statistically much more often inflicted by chronic diseases and in need for regular therapeutical interventions. All these proceedings have to be managed and organised. In rural areas this has to happen more and more remotely.
Remote monitoring of mental and physical condition becomes a crucial prerequisite when people in need of care shall stay at their home instead of being transferred to a stationary care centre. In Germany stationary care for elderly could be provided for a maximum of 25% of those who are in need of care. This figure will not rise with the increasing amount of people in need in an ageing society.
Under these circumstances not only the interaction and the communication of the human members of an individual care arrangement – the clients themselves, their mostly abroad living relatives, informal and professional caregivers, legal guardians, physicians etc. – have to be managed thoroughly. A lot of therapeutical devices and technical aids for assisted living, all the innovative solutions that have been evaluated in Innoclusion and much more yet to be developed, have to be integrated into the daily proceedings and seamless workflows.
In countries where remuneration of care services is in place you have to document delivered services, the use of technology, and even consumables. Let alone the documentation needed to avoid a/o mitigate liability risks.
At the end of the day this is a seriously complex set-up. Without a seamless integration of all elements, data, work and information flows this complexity turns out to become excessively complicated – so complicated that the whole system will not work at affordable costs (and predictably not at all at the end).
Remember one of our key learnings in Lastovo: Any innovation, any device, any technical system, any procedure has to be lean, easy to use, and affordable (what means available to low or better no costs) that it can be used under the conditions prevailing there. What we are talking about here is reducing the enormous complexity of the whole system into easy to use applications and devices for the users.
With this in mind it should be no question that seamless interoperability is the very first constraint to enable humane, dignified care for our fellow citizens now and in the near future.
Against this background here is some advice to policy makers:
On the EU level:
Force the EU interoperability act into action – not only with regard to certain technical systems for public administration and law enforcement, but to the administrative and operative part of the social and the health system as well. For any systems and devices subject to the MDA regulation this can be easily obtained by making interoperability as 1st regulative constraint – retrospectively as it has been done before in other cases.
As health and care management systems contain relevant data to be used in the context of the European Health Data Space, interoperability is a necessary prerequisite for the intended exchange and use of that data. Hence, interoperability has to become part of the data space regulation.
This applies not only to health data from hospitals, and registered physicians, and therapists but also to the long-time care and support (LTC) area where data relevant for the development of better medical treatment and – at least equally important – to measure the effects of (no) prevention in our aging societies could be collected.
Intelligence on the basis of this real world data is not only important in the genuine medical – in the preventive and curative context. It is utterly important on a (macro-) economic basis for the further development, indeed the further existence of our European health and care systems.
On the national level in Germany:
Transposing European directives into national law without creating new national peculiarities is mandatory. As the development of the European MDR shows European member states are great in transforming one European directive into some 20 different national regulations. What has been started as a „common market“ enabling endeavour ended up as means to create and separate national markets. So, also in the health sector beyond the common myth, there will be no such thing as a common market.
Ceterum censeo: Integrate the long-time care (LTC) and support for disabled sector (SGB IX, XI, etc.) with the interoperability regulation of the health sector stated in SGB V.
But: Do not alone address hospitals, care providers, and such with the regulatory pliers, but first and foremost the providers of HIS, NIS, and the upcoming clinical data warehouses. Keep in mind: No regulation will take any effect without penalisation. And: What has been started in terms of interoperability in Germany is just at the very, very beginning…
