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Topic of the Month June: Communication in Medicine
”Interoperability is still not developed“
Patients measurering their own
body functions, take their health
in their own hands;© panther-
Everything can be digitally stored and retrieved and not just on the go and from home, but also at the doctor’s office or the hospital.
Since digital technology and medicine continue to merge through “mobile computing”, MEDICA.de highlights exactly these two topics. Two experts take a look at the subject of health apps, each of them from their respective point of view: Professor Petra Knaup-Gregori of the Institute for Medical Biometry and Informatics,University of Heidelberg represents the medical perspective while Doctor Pablo Mentzinis, Divisional Director of the Public Sector, BITKOM – German Federal Association for Information Technology, Telecommunications and New Media (“Bundesverband Informationswirtschaft, Telekommunikation und neue Medien e.V.”) takes on the technical point of view .
MEDICA.de: Health apps permit patients with chronic diseases, such as cardio-vascular diseases for instance, comprehensive monitoring of their body functions. How reliable are these apps?
Paoblo Mentzinis: It is hard to make general statements. What is important is that especially those apps that make clinical findings possible, for example pulse rate measurements via Smartphone, are medical devices. Medical devices have to be certified based on EU Medical Device Regulations and have to obtain the so-called CE marking.
Petra Knaup-Gregori: This question is less about the reliability of the application than about the safety and protection of personal data and the reliability of the user to record and store this data on a regular basis. Technically speaking, the reliability of the app should not be a problem. Generally, ‘apps’ should only serve to store data and not to generate active medical recommendations. To do this, a thorough validation and where necessary also a certification would be required. For a mere supply of knowledge through applications, the quality of content should be checked and be HONCode certified for example.
MEDICA.de: At this point, there are no certifications for these types of applications. Which quality indicators should physicians and patients pay attention to?
Knaup-Gregori: As long as there is no seal of quality or at least a recommendation from the respective medical association, physicians will not recommend the use of apps. For storage and presentation of measured data, a medical seal of approval may not be required, but rather the technical reliability of providers has to be ensured. In terms of quality of medical content, new indicators should not primarily be created, but established procedures should be used instead and expanded if necessary — for instance ’Health on the Net‘ Foundation, http://www.hon.ch/HONcode/German/'.
Mentzinis: Just like with other apps, you can trust in the collective intelligence of users when it comes to health apps. If there is only negative feedback from other users of these apps, it is a pretty reliable reference point. However, this only applies of course if there are more than three reviews available.
MEDICA.de: What impact could this technical development, the “tracking” of vital parameters on your own via apps, have on doctor-patient communication?
Mentzinis: Apps work on several levels. By having the patient measure his own body functions, he takes his health in his own hands and in many instances develops more personal responsibility. Especially for diseases such as Type 2 Diabetes, this is an important step in the right direction. For the physician, ongoing, consecutive, closely timed measurements by the patient provide a better picture about his patient’s state of health than a few exams at the doctor’s office. Finally, it is far more convenient for the patient to measure at home.
Knaup-Gregori:The continuous storage of vital parameters could lead to consultations becoming less frequently necessary and to providing data online to the doctor that you trust. The patient could then feel the need to receive feedback on their state of health more often. This could possibly lead to additional workload for physicians.
Applications that merely serve to inform the patient result in the patient having an allegedly better level of knowledge at the time of their office visit. Physicians however, had to respond to informed patients since the jumpstarting of the Internet for private households.
Despite the potential of the measured data, in the personal doctor-patient relationship, the interpersonal communication has to continue to be the main focus; © panthermedia.net / Detlef Krieger
MEDICA.de: What should medical facilities, hospitals and medical practices generally keep in mind with regard to using this technology to ensure smooth communication among each other?
Knaup-Gregori: The continuous storage of vital parameters can cause physicians to no longer rely on the verbal account of patients after the event, but instead base decisions on regularly measured and thus objective values. What is crucial for a good quality treatment however is for the patient to be educated about the importance of regular measurements and –given the measured parameters- to know in which situations a visit to the doctor is urgently advised. In addition to and despite the potential of the measured data, in the personal doctor-patient relationship, the interpersonal communication has to continue to be the main focus.
Mentzinis: The magic and buzz words are interoperability and standards. Interoperability, meaning the intertwining of this technology at the physician office, outpatient care and in the hospital is still not developed to the point that you would actually like in the interest of patients and doctors. That is why it is all the more important that the German Federal Ministry of Health now tackles this major problem of health care. BITKOM actively collaborates, because lack of interoperability oftentimes is a market obstacle for our member companies.
MEDICA.de: Which developments in the medical field are foreseeable not just in Germany but also on an international level in the future?
Mentzinis: The focus on developments will probably be on so-called civilization diseases. Those who suffer from Diabetes, high blood pressure, heart disease or chronic diseases for instance, oftentimes have to regularly track vital parameters such as blood pressure, pulse rate or blood sugar levels and strictly adhere to a medical treatment plan. The Smartphone can help with this: special apps remind the patient when he/she has to take which drug in what dosage. The times of alarm clocks and confusing bits of paper are now over.
It is similar for recording vital parameters: especially diabetics and people with high blood pressure often have to keep a diary on their values. Apps can also help in this case to organize the necessary bookkeeping in a simple and clearly arranged way: values are directly entered into the application. The app then stores and graphs them. Each measurement result can be commented. This helps to give reasons for fluctuating blood pressure and counteract it accordingly.
Knaup-Gregori:The availability of medical applications on mobile phones makes it possible for patients to interlink actions that serve the monitoring and improvement of their health more closely to activities in their daily lives. Hopefully, this will lead to them being more informed about their disease and more competent to make decisions about their health. Nowadays, mobile phones are also already widespread in emerging markets. The availability of data via mobile devices enables global access and thus increases the mobility of people who are sick.
From a more technical point of view, the applications can only be efficiently utilized by health personnel if the data that is collected during the daily life of patients, is also integrated into the local hospital or doctor’s office information systems. It is essential to harmonize technical standards and communication standards in medicine and to ensure semantic interoperability in particular.
The interview was conducted by Diana Posth and translated by Elena O'Meara.