[{"data":1,"prerenderedAt":398},["ShallowReactive",2],{"slug-diga-how-germany-channeled-digital-health-apps-into-its-healthcare-system":3},{"post":4,"relatedPosts":168,"relatedBooks":308},{"id":5,"date":6,"date_gmt":7,"guid":8,"modified":10,"modified_gmt":11,"slug":12,"status":13,"type":14,"link":15,"title":16,"content":18,"excerpt":21,"author":23,"featured_media":24,"comment_status":25,"ping_status":25,"sticky":26,"template":27,"format":28,"meta":29,"categories":30,"tags":34,"project_category":42,"contact_email_category":45,"yst_prominent_words":46,"class_list":51,"better_featured_image":70,"acf":103,"yoast_meta":113,"_links":115},47437,"2022-10-04T10:00:00","2022-10-04T08:00:00",{"rendered":9},"https:\u002F\u002Fmedicalfuturist.com\u002F?post_id=47437&_wpnonce=80e8e9dcab&status=auto-draft&type=post","2022-10-04T09:43:40","2022-10-04T07:43:40","diga-how-germany-channeled-digital-health-apps-into-its-healthcare-system","publish","post","https:\u002F\u002Fmedicalfuturist.com\u002Fdiga-how-germany-channeled-digital-health-apps-into-its-healthcare-system",{"rendered":17},"DiGA: How Germany Channeled Digital Health Apps Into Its Healthcare System",{"rendered":19,"protected":20},"\n\u003Cp>Digital health applications and solutions are increasingly becoming part of our healthcare experience. Partially because they offer fast and convenient solutions for problems arising from capacity shortages of the traditional medical systems (like skin checking apps), or because they enhance the capabilities of doctors, medical personnel, or hospitals (like sepsis watch algorithms or A.I. diagnostics models).\u003C\u002Fp>\n\n\n\n\u003Cp>While these apps are available in a large number of medical specialities, channelling them into state-run healthcare systems to harness the benefits on population-wide scales is challenging. \u003C\u002Fp>\n\n\n\n\u003Cp>Germany’s DiGA system tackles this issue with a model that is worth a detailed analysis. DiGA stands for \u003Cstrong>Di\u003C\u002Fstrong>gitale \u003Cstrong>G\u003C\u002Fstrong>esundheits\u003Cstrong>a\u003C\u002Fstrong>nwendung or Digital Health Applications in English. We dived deep into this model with the valuable help of: \u003C\u002Fp>\n\n\n\n\u003Cul class=\"wp-block-list\">\u003Cli>Dr. Anne Sophie Geier – Managing Director of the \u003Ca href=\"https:\u002F\u002Fdigitalversorgt.de\u002F?lang=en\">German Digital Healthcare Association\u003C\u002Fa>\u003C\u002Fli>\u003Cli>Inga Bergen – Healthcare Innovation Facilitator & Podcast Host “\u003Ca href=\"https:\u002F\u002Fvisionaere-gesundheit.de\u002F\">Visionäre der Gesundheit\u003C\u002Fa>“\u003C\u002Fli>\u003Cli>Hauke Rienhoff – Chief Commercial Officer –\u003Ca href=\"https:\u002F\u002Fwww.orthopy.de\u002F\"> Orthopy Health GmbH\u003C\u002Fa>\u003C\u002Fli>\u003Cli>Lennart Dörwald – CEO & Co-Founder – \u003Ca href=\"https:\u002F\u002Fwww.orthopy.de\u002F\">Orthopy Health GmbH\u003C\u002Fa>\u003C\u002Fli>\u003C\u002Ful>\n\n\n\n\u003Ch2 class=\"wp-block-heading\">How does the DiGA system work?\u003C\u002Fh2>\n\n\n\n\u003Cp>For DiGAs the German lawmakers have developed an innovative and new legal foundation: the Digital Healthcare Act, passed in December 2019. Based on the new law, 73 million Germans covered by statutory health insurance (approximately 90% of the total population) are now entitled to use DiGAs, provided they have a prescription or an attested diagnosis. In a nutshell, this essentially means that digital healthcare has made it into primary care and is here to stay. \u003C\u002Fp>\n\n\n\n\u003Col class=\"wp-block-list\">\u003Cli>\u003Cstrong>Apps on prescription, costs reimbursed by all statutory health insurers\u003C\u002Fstrong>\u003C\u002Fli>\u003C\u002Fol>\n\n\n\n\u003Cp>Simply speaking, DiGAs are “apps on prescription”. DiGAs are digital health applications that can be prescribed by doctors for patient use for a variety of diagnoses. The introduction of DiGAs is quite revolutionary, and Germany has officially introduced a legal framework to include digital health care innovation into primary care. Not only it is possible to use the approved apps with a prescription, but all statutory health insurers reimburse the associated DiGA costs in Germany, with prices negotiated in advance with the umbrella association of German health insurance companies (as opposed to with each individual insurance company) – explains Dr Anna Sophie Geiger, Managing Director of the \u003Ca href=\"https:\u002F\u002Fdigitalversorgt.de\u002F?lang=en\">German Digital Healthcare Association\u003C\u002Fa>.\u003C\u002Fp>\n\n\n\n\u003Cp>Existing DiGAs range from the treatment of mental health issues to the rehabilitation of orthopaedic injuries and the guiding of cancer treatments.\u003C\u002Fp>\n\n\n\n\u003Col class=\"wp-block-list\" start=\"2\">\u003Cli>\u003Cstrong>Treated as medical devices\u003C\u002Fstrong>\u003C\u002Fli>\u003C\u002Fol>\n\n\n\n\u003Cp>As opposed to conventional “lifestyle and well-being apps”, DiGAs are treated as medical devices for use for risk categories I and IIa and undergo a rigorous certification process to enter the market. Steps for certification are overseen by the German Federal Institute for Drugs and Medical Devices (or BfArM in short). Prerequisites include medical device CE certification as well as additional requirements including proven medical evidence, quality management systems, and data protection. \u003C\u002Fp>\n\n\n\n\u003Col class=\"wp-block-list\" start=\"3\">\u003Cli>\u003Cstrong>A clear framework for reimbursements\u003C\u002Fstrong>\u003C\u002Fli>\u003C\u002Fol>\n\n\n\n\u003Cp>Once a health application is granted an official DiGA certification from the regulatory body, practitioners can prescribe them to their patients. DiGA prescriptions work very much like prescriptions for drugs or therapeutic appliances, in the sense that a prescription form is completed and handed to the patient, who can then submit the form to his or her health insurer. The health insurance company in turn provides an access code to the app for the patient. Statutory health insurers reimburse the associated DiGA costs in Germany, with prices negotiated in advance with the umbrella association of German health insurance companies.\u003C\u002Fp>\n\n\n\n\u003Col class=\"wp-block-list\" start=\"4\">\u003Cli>\u003Cstrong>Preliminary and permanent certificates\u003C\u002Fstrong>\u003C\u002Fli>\u003C\u002Fol>\n\n\n\n\u003Cp>It is important to highlight that there are two levels of DiGA approval: preliminary and permanent, and app developers can choose which approval level to aim for. The preliminary approval, valid for one year only, is slightly easier to obtain and requires pre-data but not excessive clinical study data – Dr Geiger says. \u003C\u002Fp>\n\n\n\n\u003Cp>During this temporary listing phase, market entry is allowed. Within the one-year period covered by the temporary approval, developers can build their case for a permanent listing provided they can collate the medical evidence for permanent level approval. If sufficient data cannot be shown, the listing is then revoked. The preliminary approval path is often chosen by startups. If sufficient data is already available, e.g., from previous clinical trials, the developer can also apply directly for permanent listing approval. This path is often chosen by more established companies with more available resources.\u003C\u002Fp>\n\n\n\n\u003Cfigure class=\"wp-block-image size-large is-style-default\">\u003Cimg loading=\"lazy\" decoding=\"async\" width=\"768\" height=\"764\" src=\"https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2022\u002F09\u002FDIGA-Germany-768x764.jpg\" alt=\"Germany DIGA system for digital health apps\" class=\"wp-image-47441\" srcset=\"https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2022\u002F09\u002FDIGA-Germany-768x764.jpg 768w, https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2022\u002F09\u002FDIGA-Germany-150x150.jpg 150w, https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2022\u002F09\u002FDIGA-Germany.jpg 987w\" sizes=\"auto, (max-width: 768px) 100vw, 768px\" \u002F>\u003C\u002Ffigure>\n\n\n\n\u003Cp>Currently, there are 33 DiGAs listed on the official BfArM registry: 13 are permanent and 20 are preliminarily listed. All applications that receive DiGA approval are subject to an initial peer review by BfArM, which evaluates aspects such as randomisation methods, patient recruitment, selected endpoints, and any quantitative analysis. Others can subsequently review the data and clinical studies once published by the developer. \u003C\u002Fp>\n\n\n\n\u003Cp>\u003Ca href=\"https:\u002F\u002Fhellobetter.de\u002Fen\u002F\">HelloBetter\u003C\u002Fa> for example, a Hamburg\u002FBerlin-based “grown-up”, holds approvals for DiGAs covering a variety of mental health indications (diabetes, depression, panic attacks, etc.), and their peer-reviewed clinical studies are available to the general public through their website.\u003C\u002Fp>\n\n\n\n\u003Ch2 class=\"wp-block-heading\">A unique process to pave the way\u003C\u002Fh2>\n\n\n\n\u003Cp>The DiGA concept is quite unique in many ways: \u003C\u002Fp>\n\n\n\n\u003Col class=\"wp-block-list\">\u003Cli>\u003Cstrong>The Certification process: faster and cheaper without compromising safety\u003C\u002Fstrong>\u003C\u002Fli>\u003C\u002Fol>\n\n\n\n\u003Cp>The BfArM (the German Federal Institute for Drugs and Medical Devices) outlines clear and very transparent guidelines on how to obtain DiGA certification. The whole process is divided into several small steps. The certification process is far from easy, but becomes more manageable and predictable, especially for startups. The DiGA fast-track reduces the time to market significantly, without compromising any safety aspects for patients.  \u003C\u002Fp>\n\n\n\n\u003Col class=\"wp-block-list\" start=\"2\">\u003Cli>\u003Cstrong>The Reimbursement: one deal covers all \u003C\u002Fstrong>\u003C\u002Fli>\u003C\u002Fol>\n\n\n\n\u003Cp>All statutory health insurance companies reimburse DiGA costs so there is no cost to the practitioner or patient, thereby allowing for less complexity and bureaucracy and stronger predictability in insurance coverage for DiGA developers. As a result, this replaces the past practice of negotiating selective contracts with up to 50+ different health insurance companies just to gain market entry or apply for reimbursement. The only hurdle as of now is the approval from BfArM. \u003C\u002Fp>\n\n\n\n\u003Col class=\"wp-block-list\" start=\"3\">\u003Cli>\u003Cstrong>Central registry: one easy-to-use central reference database\u003C\u002Fstrong>\u003C\u002Fli>\u003C\u002Fol>\n\n\n\n\u003Cp>There are thousands of “health apps” available in today’s app stores. As a practitioner or patient, how do I know which app provides actual medical benefits? How do I know which app protects sensitive data? The official DiGA registry of BfArM provides this guidance. The registry is regularly updated and represents a single source of information for all parties involved: practitioners, patients, and insurers alike. \u003C\u002Fp>\n\n\n\n\u003Col class=\"wp-block-list\" start=\"4\">\u003Cli>\u003Cstrong>Process speed: fast track process for the preliminary listing \u003C\u002Fstrong>\u003C\u002Fli>\u003C\u002Fol>\n\n\n\n\u003Cp>Bringing a medical device or a drug to market often takes years if not decades. While clinical trials occupy a portion of this time, efficiencies can be made elsewhere in other aspects of the certification process. The DiGA ‘fast-track’ attempts to address this without compromising safety and quality standards. While DiGAs are treated as having lower risk relative to drugs and other medical devices, the requirements to become a DiGA are nonetheless strict and becoming even more so.\u003C\u002Fp>\n\n\n\n\u003Ch2 class=\"wp-block-heading\">Germany is the guinea pig for digital health regulations\u003C\u002Fh2>\n\n\n\n\u003Cp>Germany’s DiGA framework has raised a lot of interest in other European countries and even further abroad. It is incredibly difficult to change legislation in healthcare, with regulatory processes often hampering any legislative change. Despite the surging interest, it will likely take years for uniform legislation to be implemented. In addition, the cost factor is a significant reason for slow adoption. As of now, Germany is essentially the “guinea pig”, and other countries are observing closely how the DiGA evolution will take place in the short term.\u003C\u002Fp>\n\n\n\n\u003Cfigure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\">\u003Cdiv class=\"wp-block-embed__wrapper\">\n\u003Ciframe loading=\"lazy\" title=\"DiGA Fast Track - explained by Dr. Henrik Matthies, hih\" width=\"640\" height=\"360\" src=\"https:\u002F\u002Fwww.youtube.com\u002Fembed\u002FO7Hkc6jMa9E?start=93&feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen>\u003C\u002Fiframe>\n\u003C\u002Fdiv>\u003Cfigcaption>If you are interested in the detailed working of the DiGA system, click over to this video\u003C\u002Ffigcaption>\u003C\u002Ffigure>\n\n\n\n\u003Cp>There are, however, some fast followers. France for example will publish a DiGA-like framework by the end of this year. On a European level, a new task force was also recently founded with the goal of pursuing and harmonising evaluation procedures for patient-centred digital medical devices (DMDs) within the European Union.\u003C\u002Fp>\n\n\n\n\u003Ch2 class=\"wp-block-heading\">Startups benefit from the fast-track model\u003C\u002Fh2>\n\n\n\n\u003Cp>Sometimes innovation needs a little push. The country had a previous system (pre-DiGA), which, with its tedious processes wasn’t really startup-friendly. Only larger MedTech or Pharma companies had the resources to pursue years of clinical trials and navigate the bureaucracy behind the certification processes. To be honest, large-size corporates are not known for fast innovation. Startups can be more penetrative, agile, and fast-moving particularly in the context of seeking and obtaining their listing status. \u003C\u002Fp>\n\n\n\n\u003Cp>“The advantage of the fast-track model, therefore, provides the attraction and opportunity for new entrants to establish themselves in the market without being slowed by financial difficulty, data, health regulatory restrictions, and other obstacles. Ultimately, it allows startups to focus directly on the testing of their hypotheses for their products and services without external interruption” – Hauke Rienhoff, the Chief Commercial Officer of \u003Ca href=\"https:\u002F\u002Fwww.orthopy.de\u002F\">Orthopy Health GmbH\u003C\u002Fa> explains.\u003C\u002Fp>\n\n\n\n\u003Cp>“We, as Orthopy Health, would have not tried to enter the German health care market if it wasn’t for the DiGA fast-track model. We are currently at the end of our first clinical trials and will likely apply for preliminary approval early next year. The fast-track process gave us structure.”- added Lennart Dörwald, CEO & Co-Founder of Orthopy. \u003C\u002Fp>\n\n\n\n\u003Cp>“What makes us believe in DiGA and the fast-track model? Our own founding story: \u003C\u002Fp>\n\n\n\n\u003Cp>Lenny, one of our co-founders, has torn his cruciate ligament in his knee twice in his life. A torn ACL (anterior cruciate ligament) is a common sports injury, which in most cases gets fixed through surgery, followed up by 9-12 months of rehabilitation. Lenny experienced the care breaches, if not gaps, in the current standard of care firsthand. He was missing guidance when transitioning from the stationary to the ambulant setting. \u003C\u002Fp>\n\n\n\n\u003Cfigure class=\"wp-block-image size-large is-style-default\">\u003Cimg loading=\"lazy\" decoding=\"async\" width=\"768\" height=\"432\" src=\"https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2022\u002F08\u002Ftmf_article_eliminating-waiting-times-hospital-768x432.png\" alt=\"\" class=\"wp-image-47078\" srcset=\"https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2022\u002F08\u002Ftmf_article_eliminating-waiting-times-hospital-768x432.png 768w, https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2022\u002F08\u002Ftmf_article_eliminating-waiting-times-hospital-370x208.png 370w, https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2022\u002F08\u002Ftmf_article_eliminating-waiting-times-hospital.png 1280w\" sizes=\"auto, (max-width: 768px) 100vw, 768px\" \u002F>\u003C\u002Ffigure>\n\n\n\n\u003Cp>Physiotherapy before the surgery wasn’t an option and post-surgery came with waiting times. Often, he felt insecure and left alone during his treatment path. That’s where the idea came for a digital therapy companion.\u003C\u002Fp>\n\n\n\n\u003Cp>Luckily, his friend Torben, also Co-Founder, knew all about the DiGA fast-track model and convinced Lenny to give it a shot. You could go as far as to say Lenny and Torben did patient-driven innovation. Quickly they brought Max on board and the founding team was complete.\u003C\u002Fp>\n\n\n\n\u003Cp>Today, patients use our digital health app, Orthopy, during their therapy. They inform themselves about their injury and treatment path through our patient education section. They use our quality-approved training plans pre- and post-surgery with guided exercises, and they keep track of their progress through our embedded analytics. We firmly believe this type of innovation would have not been possible without the introduction of DiGAs and the complementary fast-track.” \u003C\u002Fp>\n\n\n\n\u003Ch2 class=\"wp-block-heading\">40,000 access codes by three insurers in the first half of 2022\u003C\u002Fh2>\n\n\n\n\u003Cp>With the influence of apps in our daily lives, the emergence of apps focusing on medical health is increasingly inevitable, and this extends to the DiGA ecosystem. \u003C\u002Fp>\n\n\n\n\u003Cp>In the first half of 2022, the three largest health insurance companies (Techniker Krankenkasse, Barmer, and AOK) \u003Ca href=\"https:\u002F\u002F12ft.io\u002Fproxy?q=https%3A%2F%2Fwww.handelsblatt.com%2Finside%2Fdigital_health%2Fdigitale-gesundheitsanwendungen-diga-markt-waechst-im-ersten-halbjahr-2022%2F28496184.html\">handed out around 40,000 DiGA access codes to their customers\u003C\u002Fa>.\u003C\u002Fp>\n\n\n\n\u003Cp>This indicates that while DiGAs are in their early stages and relatively new to the medical industry, public awareness, patient interest and trust continue to grow and the potential is strong. Not surprisingly, some DiGA startups have already joined forces and built joint marketing campaigns to raise awareness for DiGAs in the wider public. \u003C\u002Fp>\n\n\n\n\u003Cp>The simple idea that the future patient can have relevant treatments conducted and safely monitored in a paperless fashion is entirely a possibility, provided some existing barriers can be broken. A simple example is, why would you need a paper-based prescription just to access an entirely digital health product or service? Hopefully, e-prescriptions could be a future solution.\u003C\u002Fp>\n\n\n\n\u003Ch2 class=\"wp-block-heading\">Mental health and orthopaedic apps lead the way \u003C\u002Fh2>\n\n\n\n\u003Cp>The majority of current DiGAs, are in the “mental health” category for diagnoses such as depression, burnout, and anxiety. This is particularly so due to therapeutic care gaps within the mental health area. Access to personal psychotherapeutic treatment resources is limited and waiting times can be extremely long to the detriment of the patient. \u003C\u002Fp>\n\n\n\n\u003Cp>DiGAs offer an excellent interim solution to bridge this time gap for milder cases. Also, orthopaedic DiGAs for acute injuries or chronic pain, are popular. The build-up of the training plans and exercise execution in such orthopaedic DiGAs is in essence quite like that of conventional fitness app programs that people are already familiar with. There are plenty of other therapeutic areas where patients can use DiGAs and hopefully even more will follow soon. \u003C\u002Fp>\n\n\n\n\u003Cfigure class=\"wp-block-image size-large is-style-default\">\u003Cimg loading=\"lazy\" decoding=\"async\" width=\"768\" height=\"432\" src=\"https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2021\u002F07\u002Ftmf_article_279-01-768x432.png\" alt=\"\" class=\"wp-image-35099\" srcset=\"https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2021\u002F07\u002Ftmf_article_279-01-768x432.png 768w, https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2021\u002F07\u002Ftmf_article_279-01-370x208.png 370w, https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2021\u002F07\u002Ftmf_article_279-01-1536x864.png 1536w, https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2021\u002F07\u002Ftmf_article_279-01.png 1920w\" sizes=\"auto, (max-width: 768px) 100vw, 768px\" \u002F>\u003C\u002Ffigure>\n\n\n\n\u003Cp>The number of listed DiGAs and their usage is steadily increasing. Most DiGA developers are young companies and have focused on passing the regulatory demands. The biggest challenge they currently face is access to the patient. We observe DiGA providers testing different market access models here – from building up a sales force to partnering with pharmaceutical companies for distribution.\u003C\u002Fp>\n\n\n\n\u003Cp>Applications can lose their DiGA status if they cannot prove positive care effects. There are many reasons why clinical studies can fail, such as a difficult study design or problems with recruiting enough patients. In addition, BfArM standards for approval have changed over time, and this can affect the ability of startups to meet the appropriate approval criteria. \u003C\u002Fp>\n\n\n\n\u003Ch2 class=\"wp-block-heading\">Positive care effects are the focus, and financial savings will come\u003C\u002Fh2>\n\n\n\n\u003Cp>“The DiGA system focuses on providing “positive care effects” rather than financial savings. Positive care effects are defined either as a medical benefit or a patient-relevant improvement of structure and processes in healthcare. Ultimately, we believe that by providing such positive care effects, long-term costs will decrease” – says Inga Bergen, Healthcare Innovation Facilitator & Host of “\u003Ca href=\"https:\u002F\u002Fvisionaere-gesundheit.de\u002F\">Visionäre der Gesundheit\u003C\u002Fa>“ (~ Health Visionaries) podcast. \u003C\u002Fp>\n\n\n\n\u003Cp>“As an example, if patient usage of a particular DiGA results in recovery or symptom reduction at a rate faster than existing methods, then the expectation is that the associated costs (e.g., statutory sick pay) will in turn also fall.” – she added.\u003C\u002Fp>\n\n\n\n\u003Cp>Generally, FDA leads the way in regulating digital health and the regulatory bodies of other countries are just trying to follow their lead. It’s now great to see a European country showing a framework that can be used in practice and that might be a better fit for the European healthcare systems.\u003C\u002Fp>\n",false,{"rendered":22,"protected":20},"\u003Cp>Channelling digital health apps into state-run healthcare systems to harness the benefits on population-wide scales is challenging. This is how Germany tackled the issue. \u003C\u002Fp>\n",6,27443,"closed",true,"","standard",{"_acf_changed":20,"footnotes":27},[31,32,33],7079,798,800,[35,36,37,38,39,40,41],275,3465,548,764,7657,7659,207,[43,44],950,952,[],[47,48,49,50],1571,1617,2987,2989,[52,14,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69],"post-47437","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-tmf","category-digital-health-research","category-healthcare-policy","tag-healthcare","tag-germany","tag-healthcare-policy","tag-healthcare-system","tag-digital-health-apps","tag-diga","tag-digital-health","project_category-medical-professionals","project_category-policy-makers",{"id":24,"alt_text":71,"caption":27,"description":27,"media_type":72,"media_details":73,"post":101,"source_url":102},"Germany and 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health apps into state-run healthcare systems to harness the benefits on population-wide scales is challenging. Germany tackled the issue.",{"self":116,"collection":122,"about":125,"author":128,"replies":131,"version-history":134,"predecessor-version":138,"wp:featuredmedia":142,"wp:attachment":145,"wp:term":148,"curies":164},[117],{"href":118,"targetHints":119},"https:\u002F\u002Fapi.medicalfuturist.com\u002Fwp-json\u002Fwp\u002Fv2\u002Fposts\u002F47437",{"allow":120},[121],"GET",[123],{"href":124},"https:\u002F\u002Fapi.medicalfuturist.com\u002Fwp-json\u002Fwp\u002Fv2\u002Fposts",[126],{"href":127},"https:\u002F\u002Fapi.medicalfuturist.com\u002Fwp-json\u002Fwp\u002Fv2\u002Ftypes\u002Fpost",[129],{"embeddable":26,"href":130},"https:\u002F\u002Fapi.medicalfuturist.com\u002Fwp-json\u002Fwp\u002Fv2\u002Fusers\u002F6",[132],{"embeddable":26,"href":133},"https:\u002F\u002Fapi.medicalfuturist.com\u002Fwp-json\u002Fwp\u002Fv2\u002Fcomments?post=47437",[135],{"count":136,"href":137},9,"https:\u002F\u002Fapi.medicalfuturist.com\u002Fwp-json\u002Fwp\u002Fv2\u002Fposts\u002F47437\u002Frevisions",[139],{"id":140,"href":141},47467,"https:\u002F\u002Fapi.medicalfuturist.com\u002Fwp-json\u002Fwp\u002Fv2\u002Fposts\u002F47437\u002Frevisions\u002F47467",[143],{"embeddable":26,"href":144},"https:\u002F\u002Fapi.medicalfuturist.com\u002Fwp-json\u002Fwp\u002Fv2\u002Fmedia\u002F27443",[146],{"href":147},"https:\u002F\u002Fapi.medicalfuturist.com\u002Fwp-json\u002Fwp\u002Fv2\u002Fmedia?parent=47437",[149,152,155,158,161],{"taxonomy":150,"embeddable":26,"href":151},"category","https:\u002F\u002Fapi.medicalfuturist.com\u002Fwp-json\u002Fwp\u002Fv2\u002Fcategories?post=47437",{"taxonomy":153,"embeddable":26,"href":154},"post_tag","https:\u002F\u002Fapi.medicalfuturist.com\u002Fwp-json\u002Fwp\u002Fv2\u002Ftags?post=47437",{"taxonomy":156,"embeddable":26,"href":157},"project_category","https:\u002F\u002Fapi.medicalfuturist.com\u002Fwp-json\u002Fwp\u002Fv2\u002Fproject_category?post=47437",{"taxonomy":159,"embeddable":26,"href":160},"contact_email_category","https:\u002F\u002Fapi.medicalfuturist.com\u002Fwp-json\u002Fwp\u002Fv2\u002Fcontact_email_category?post=47437",{"taxonomy":162,"embeddable":26,"href":163},"yst_prominent_words","https:\u002F\u002Fapi.medicalfuturist.com\u002Fwp-json\u002Fwp\u002Fv2\u002Fyst_prominent_words?post=47437",[165],{"name":166,"href":167,"templated":26},"wp","https:\u002F\u002Fapi.w.org\u002F{rel}",[169],{"id":112,"date":170,"date_gmt":171,"guid":172,"modified":174,"modified_gmt":175,"slug":176,"status":13,"type":14,"link":177,"title":178,"content":180,"excerpt":182,"author":23,"featured_media":184,"comment_status":25,"ping_status":25,"sticky":26,"template":27,"format":28,"meta":185,"categories":186,"tags":189,"project_category":199,"contact_email_category":201,"yst_prominent_words":202,"class_list":208,"better_featured_image":222,"acf":255,"yoast_meta":264,"_links":266},"2022-09-20T10:00:00","2022-09-20T08:00:00",{"rendered":173},"https:\u002F\u002Fmedicalfuturist.com\u002F?post_id=47267&_wpnonce=b16deadc42&status=auto-draft&type=post","2022-09-19T23:20:29","2022-09-19T21:20:29","6-examples-of-how-the-hippocratic-oath-should-be-upgraded","https:\u002F\u002Fmedicalfuturist.com\u002F6-examples-of-how-the-hippocratic-oath-should-be-upgraded",{"rendered":179},"6 Examples Of How The Hippocratic Oath Should Be Upgraded",{"rendered":181,"protected":20},"\n\u003Cp>Physicians have been taking the Hippocratic Oath for centuries. Originally written in 400 BC, it is one of the oldest known codes of ethics, attributed to Hippocrates, the ancient Greek philosopher and physician. In the “\u003Ca href=\"https:\u002F\u002Fwww.jmir.org\u002F2022\u002F9\u002Fe39177\" target=\"_blank\" rel=\"noreferrer noopener\">A Revised Hippocratic Oath for the Era of Digital Health\u003C\u002Fa>” paper published in the Journal of Medical Internet Research by Brennan Spiegel and Bertalan Mesko (The Medical Futurist), we advocated how we should upgrade the millennia-old principles to reflect the 21st-century realities of medicine.\u003C\u002Fp>\n\n\n\n\u003Cp>Amazingly modern for its age and timeless in its core principles, the Oath describes ideals that are timely and relevant even in the 21st century: to treat patients to the best of one’s ability; preserve a patient’s privacy and faithfully teach the art of medicine to the next generation.\u003C\u002Fp>\n\n\n\n\u003Cp>Most physicians believe the Oath still has relevance today, although there are few empirical studies that have formally evaluated the sentiment about it. In a non–peer-reviewed survey, only 39% of physicians and medical students under the age of 34 years said the Oath was still meaningful, whereas 70% of respondents aged 65 years and older positively endorsed the pledge. Despite these varying views, most medical schools still ask their students to recite either the classic or modified form of the Oath.\u003C\u002Fp>\n\n\n\n\u003Cfigure class=\"wp-block-image size-large is-style-default\">\u003Cimg loading=\"lazy\" decoding=\"async\" width=\"768\" height=\"432\" src=\"https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2018\u002F07\u002Fcreation_of_adam-768x432.png\" alt=\"Hippocratic Oath 2.0.\" class=\"wp-image-21635\" srcset=\"https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2018\u002F07\u002Fcreation_of_adam-768x432.png 768w, https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2018\u002F07\u002Fcreation_of_adam-370x208.png 370w, https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2018\u002F07\u002Fcreation_of_adam-512x288.png 512w, https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2018\u002F07\u002Fcreation_of_adam.png 870w\" sizes=\"auto, (max-width: 768px) 100vw, 768px\" \u002F>\u003C\u002Ffigure>\n\n\n\n\u003Cp>Although the Oath has gone through several revisions, (most notably in 1948 by the World Medical Association) it does not reflect the dramatic changes in 21st-century healthcare. \u003C\u002Fp>\n\n\n\n\u003Cp>It is now justified to modify the Hippocratic Oath—even if modestly—to adapt the text to the digital health revolution, advances in patient empowerment, and the evolving role of technology in the everyday practice of medicine.\u003C\u002Fp>\n\n\n\n\u003Cp>Let’s take a look at some of the 21st-century principles that should be included in a modernised version. \u003C\u002Fp>\n\n\n\n\u003Ch3 class=\"wp-block-heading\">1. Recognise a broader origin of scientific gains in medicine\u003C\u002Fh3>\n\n\n\n\u003Cp>The Hippocratic Oath entreats physicians to “respect the hard-won scientific gains of those physicians on whose steps I walk.” In the era of digital health and democratized care, research arises not only from physicians and nonclinical researchers but also from patients who both contribute their own data and meaningfully participate in research through patient-centered and patient-created models such as those supported by the Patient-Centered Outcomes Research Institute.\u003C\u002Fp>\n\n\n\n\u003Cp>We suggest the following edits: \u003C\u002Fp>\n\n\n\n\u003Cp>“I will respect the hard-won scientific gains of those physicians, \u003Cstrong>\u003Cem>researchers, and patients\u003C\u002Fem>\u003C\u002Fstrong> in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.”\u003C\u002Fp>\n\n\n\n\u003Ch3 class=\"wp-block-heading\">2. Acknowledge both “Sick Care” and preventive “Health Care”\u003C\u002Fh3>\n\n\n\n\u003Cp>The Oath focuses on treating the sick but is silent on the role of preventive medicine for the well, yet modern medicine emphasises the importance of preventive care across physical, mental, and social realms of health, not just reactive “sick care” for the ill. Advances in digital health place an emphasis on predictive analytics using remotely collected data, while precision medicine aims to identify early signs of disease to inform timely preventive care.\u003C\u002Fp>\n\n\n\n\u003Cp>This is our suggested version: \u003C\u002Fp>\n\n\n\n\u003Cp>“I will apply, for the benefit of \u003Cstrong>\u003Cem>the healthy\u003C\u002Fem>\u003C\u002Fstrong> and the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.”\u003C\u002Fp>\n\n\n\n\u003Ch3 class=\"wp-block-heading\">3. Treatments don’t only include medication and surgeries but algorithms as well\u003C\u002Fh3>\n\n\n\n\u003Cp>As advances in AI, robotics, virtual reality, mobile health apps, wearable biosensors, and portable diagnostic devices continue to expand, we believe the Oath should acknowledge the growing and permanent impact these technologies now exert on care delivery. In the 21st century, the Hippocratic Oath should reflect the foundational role of digital health in patient care. \u003C\u002Fp>\n\n\n\n\u003Cp>This is how we would include this principle: \u003C\u002Fp>\n\n\n\n\u003Cp>“I will remember that there is an art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife, the chemist’s drug, \u003Cstrong>\u003Cem>or the programmer’s algorithm\u003C\u002Fem>\u003C\u002Fstrong>.”\u003C\u002Fp>\n\n\n\n\u003Ch3 class=\"wp-block-heading\">4. Embrace an equal-level partnership between patients and physicians\u003C\u002Fh3>\n\n\n\n\u003Cp>The Hippocratic Oath encourages physicians to say, “I know not” when they are unsure how to treat a patient, and to “call in my colleagues when the skills of another are needed for a patient’s recovery.” These are laudable sentiments, however, the Oath should ideally acknowledge that patients, too, can help with diagnosis and treatment.\u003C\u002Fp>\n\n\n\n\u003Cfigure class=\"wp-block-image size-large is-style-default\">\u003Cimg loading=\"lazy\" decoding=\"async\" width=\"768\" height=\"432\" src=\"https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2022\u002F03\u002Fdecarbonizing-patient-pathways-1-768x432.png\" alt=\"decarbonizing patient pathways\" class=\"wp-image-40715\" srcset=\"https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2022\u002F03\u002Fdecarbonizing-patient-pathways-1-768x432.png 768w, https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2022\u002F03\u002Fdecarbonizing-patient-pathways-1-370x208.png 370w, https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2022\u002F03\u002Fdecarbonizing-patient-pathways-1-1536x864.png 1536w, https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2022\u002F03\u002Fdecarbonizing-patient-pathways-1-2048x1152.png 2048w\" sizes=\"auto, (max-width: 768px) 100vw, 768px\" \u002F>\u003C\u002Ffigure>\n\n\n\n\u003Cp>Patients now have expansive access to credible information about biomedical sciences, increasingly generate their own biometric health data through wearable biosensors, and monitor their own psychometric scores through apps; these data sources are now part of clinical practice. While physicians have experience prescribing treatments and monitoring a wide range of diseases, the Oath should recognise that patients are the experts of their personal illness experiences. When engaged collaboratively by their physicians, patients can deliver meaningful insights that shape diagnostic and care plans. \u003C\u002Fp>\n\n\n\n\u003Cp>In light of this paradigm shift, we suggest the following additions to the Oath: \u003C\u002Fp>\n\n\n\n\u003Cp>“\u003Cstrong>\u003Cem>I will treat my patients in an equal-level partnership, and \u003C\u002Fem>\u003C\u002Fstrong>I will not be ashamed to say ‘I know not,’ nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.”\u003C\u002Fp>\n\n\n\n\u003Ch3 class=\"wp-block-heading\">5. Address the importance of physicians protecting patients’ data as well\u003C\u002Fh3>\n\n\n\n\u003Cp>Respecting patients’ privacy is a primary passage in the Oath. However, the concept of privacy now extends beyond safekeeping conversations to guarding the “big data” generated in the care of every patient in modern health care. \u003C\u002Fp>\n\n\n\n\u003Cp>We suggest the following addition: \u003C\u002Fp>\n\n\n\n\u003Cp>“I will respect the privacy of my patients \u003Cstrong>\u003Cem>and their data\u003C\u002Fem>\u003C\u002Fstrong>, for their problems are not disclosed to me that the world may know.”\u003C\u002Fp>\n\n\n\n\u003Ch3 class=\"wp-block-heading\">6. Therapies reflect on vital signs, data and algorithms\u003C\u002Fh3>\n\n\n\n\u003Cp>The explosion in big data surrounding healthcare is transforming how doctors care for and interact with their patients. A.I. in particular has a vast potential to automate processes and potentially overtake certain roles and responsibilities normally filled by clinicians. \u003C\u002Fp>\n\n\n\n\u003Cp>Nonetheless, physicians must always remain focused on their patients, including their personal stories and their biopsychosocial well-being beyond their digital fingerprints and big data analytics. A.I. will never replace medical professionals, although physicians who embrace A.I. may eventually replace those who do not. \u003C\u002Fp>\n\n\n\n\u003Cp>We propose the following additions to the Oath to reflect these considerations: \u003C\u002Fp>\n\n\n\n\u003Cp>“I will remember that I do not treat a fever chart, a cancerous growth, \u003Cstrong>\u003Cem>a data point, or an algorithm’s suggestion, \u003C\u002Fem>\u003C\u002Fstrong>but a human being.”\u003C\u002Fp>\n\n\n\n\u003Ch3 class=\"wp-block-heading\">Not a definitive set of final recommendations\u003C\u002Fh3>\n\n\n\n\u003Cp>We offer these modest suggestions to help prompt discussion and contemplation about the current Oath and its relevance to our changing times. These are not meant to be a definitive set of final recommendations. Rather, we propose a new text that bodies such as the World Medical Association might consider integrating into an updated Oath, just as previous changes were adopted to ensure the Oath remains relevant and impactful for all physicians and their patients.\u003C\u002Fp>\n\n\n\n\u003Cp>The Medical Futurist Institute is happy to give support or cooperate with healthcare institutions and universities open to introducing a revised version of the Oath. If you are in a position to facilitate the process, feel free to reach out! \u003C\u002Fp>\n",{"rendered":183,"protected":20},"\u003Cp>While timeless in its core principles, the Hippocratic Oath should be revised to reflect the 21st-centrury digital-health reality. Six suggestion on how to modernize it. \u003C\u002Fp>\n",21238,{"_acf_changed":20,"footnotes":27},[31,187,33,188],521,516,[190,191,192,193,194,195,196,197,198],7649,7651,308,313,7641,7643,7645,981,7647,[200,43],949,[],[48,203,204,205,206,207],1631,2001,2003,2015,2613,[209,14,53,54,55,56,57,58,210,60,211,212,213,214,215,216,217,218,219,220,221,68],"post-47267","category-future-medicine","category-medical-education","tag-revised-hippocatic-oath","tag-21st-century-hippocratic-oath","tag-medical-education","tag-medicine","tag-medical-oath","tag-doctors-oath","tag-upgrade","tag-hippocratic-oath","tag-modernized-hippocratic-oath","project_category-educators",{"id":184,"alt_text":223,"caption":27,"description":224,"media_type":72,"media_details":225,"post":253,"source_url":254},"TMF, New hippocratic oath tmf","TMF",{"width":226,"height":227,"file":228,"sizes":229,"image_meta":251},870,489,"2018\u002F07\u002Fnew-hippocratic-oath.png",{"medium":230,"large":236,"thumbnail":241,"medium_large":245,"large_old_512x288":246},{"file":231,"width":232,"height":233,"mime-type":234,"source_url":235},"new-hippocratic-oath-370x208.png",370,208,"image\u002Fpng","https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2018\u002F07\u002Fnew-hippocratic-oath-370x208.png",{"file":237,"width":238,"height":239,"mime-type":234,"source_url":240},"new-hippocratic-oath-768x432.png",768,432,"https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2018\u002F07\u002Fnew-hippocratic-oath-768x432.png",{"file":242,"width":243,"height":243,"mime-type":234,"source_url":244},"new-hippocratic-oath-150x150.png",150,"https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2018\u002F07\u002Fnew-hippocratic-oath-150x150.png",{"file":237,"width":238,"height":239,"mime-type":234,"source_url":240},{"file":247,"width":248,"height":249,"mime-type":234,"source_url":250},"new-hippocratic-oath-512x288.png",512,288,"https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2018\u002F07\u002Fnew-hippocratic-oath-512x288.png",{"aperture":100,"credit":27,"camera":27,"caption":27,"created_timestamp":100,"copyright":27,"focal_length":100,"iso":100,"shutter_speed":100,"title":27,"orientation":100,"keywords":252},[],21234,"https:\u002F\u002Fcdn.medicalfuturist.com\u002Fwp-content\u002Fuploads\u002F2018\u002F07\u002Fnew-hippocratic-oath.png",{"cta_type":104,"cta_color":27,"related_books":256,"related_posts_footer":260,"related_posts":20,"subtitle":27},[257,258,259],24765,24762,34151,[261,262,263],14229,11980,47157,{"yoast_wpseo_title":179,"yoast_wpseo_metadesc":265,"yoast_wpseo_canonical":177},"While timeless in core principles, the Hippocratic Oath should be revised to reflect the 21st-centrury digital-health reality. Here are six suggestions.",{"self":267,"collection":272,"about":274,"author":276,"replies":278,"version-history":281,"predecessor-version":285,"wp:featuredmedia":289,"wp:attachment":292,"wp:term":295,"curies":306},[268],{"href":269,"targetHints":270},"https:\u002F\u002Fapi.medicalfuturist.com\u002Fwp-json\u002Fwp\u002Fv2\u002Fposts\u002F47267",{"allow":271},[121],[273],{"href":124},[275],{"href":127},[277],{"embeddable":26,"href":130},[279],{"embeddable":26,"href":280},"https:\u002F\u002Fapi.medicalfuturist.com\u002Fwp-json\u002Fwp\u002Fv2\u002Fcomments?post=47267",[282],{"count":283,"href":284},16,"https:\u002F\u002Fapi.medicalfuturist.com\u002Fwp-json\u002Fwp\u002Fv2\u002Fposts\u002F47267\u002Frevisions",[286],{"id":287,"href":288},47327,"https:\u002F\u002Fapi.medicalfuturist.com\u002Fwp-json\u002Fwp\u002Fv2\u002Fposts\u002F47267\u002Frevisions\u002F47327",[290],{"embeddable":26,"href":291},"https:\u002F\u002Fapi.medicalfuturist.com\u002Fwp-json\u002Fwp\u002Fv2\u002Fmedia\u002F21238",[293],{"href":294},"https:\u002F\u002Fapi.medicalfuturist.com\u002Fwp-json\u002Fwp\u002Fv2\u002Fmedia?parent=47267",[296,298,300,302,304],{"taxonomy":150,"embeddable":26,"href":297},"https:\u002F\u002Fapi.medicalfuturist.com\u002Fwp-json\u002Fwp\u002Fv2\u002Fcategories?post=47267",{"taxonomy":153,"embeddable":26,"href":299},"https:\u002F\u002Fapi.medicalfuturist.com\u002Fwp-json\u002Fwp\u002Fv2\u002Ftags?post=47267",{"taxonomy":156,"embeddable":26,"href":301},"https:\u002F\u002Fapi.medicalfuturist.com\u002Fwp-json\u002Fwp\u002Fv2\u002Fproject_category?post=47267",{"taxonomy":159,"embeddable":26,"href":303},"https:\u002F\u002Fapi.medicalfuturist.com\u002Fwp-json\u002Fwp\u002Fv2\u002Fcontact_email_category?post=47267",{"taxonomy":162,"embeddable":26,"href":305},"https:\u002F\u002Fapi.medicalfuturist.com\u002Fwp-json\u002Fwp\u002Fv2\u002Fyst_prominent_words?post=47267",[307],{"name":166,"href":167,"templated":26},[309],{"id":108,"date":310,"date_gmt":311,"guid":312,"modified":314,"modified_gmt":315,"slug":316,"status":13,"type":317,"link":318,"title":319,"content":321,"excerpt":323,"author":23,"featured_media":325,"comment_status":25,"ping_status":25,"template":27,"yst_prominent_words":326,"class_list":328,"better_featured_image":331,"acf":349,"yoast_meta":367,"_links":370},"2020-12-02T08:54:13","2020-12-02T07:54:13",{"rendered":313},"https:\u002F\u002Fapi.medicalfuturist.com\u002F?post_type=book&p=31417","2023-03-12T18:17:41","2023-03-12T17:17:41","invest-in-digital-health","book","https:\u002F\u002Fapi.medicalfuturist.com\u002Fbooks\u002Finvest-in-digital-health\u002F",{"rendered":320},"Invest In Digital Health – The Medical Futurist’s Guide",{"rendered":322,"protected":20},"\n\u003Cp>Artificial Intelligence and Digital Health are booming. In this book, we explain why now it’s a good time to invest in Digital Health and give recommendations on where to invest by looking at the top 24 technological trends we find the most promising.\u003C\u002Fp>\n",{"rendered":324,"protected":20},"\u003Cp>Artificial Intelligence and Digital Health are booming. 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