Digital Transformation in Healthcare: How the Potential of Digital Health Is Tackled to Transform the Care Process of Intensive Care Patients Across All Healthcare Sectors

Abstract

• (a) Situation faced: The digitalization case reports from the care process of the fictitious mechanically ventilated patient, Mr. Müller. After inpatient treatment in the ICU of the Charité, Mr. Müller is awaiting his discharge to the outpatient nursing care facility of LRD that is an outpatient care provider for long-term mechanically ventilated patients. The current care process of long-term mechanically ventilated patients is determined by insufficiently coordinated care processes between the inpatient and outpatient care providers and missing standards and tools for information exchange and communication between the care providers, as well as between the care providers and the patients. Motivated by the unsatisfactory patient data management across all healthcare sectors, Mr. Müllers takes part in the feasibility study of the scientifically supported innovation project Bea@Home. The aim of the project is to develop, test, and evaluate an innovative, integrated, and digitally supported care model for mechanically ventilated patients.

• (b) Action taken: This section focuses on the digital transformation of the care process introduced by the innovation project Bea@Home and describes the implemented inter-organizational, technological, and organizational changes in detail. As digital innovations in German healthcare typically face the challenges of idiosyncratic and often non-interoperable IT infrastructures and applications as well as non-coordinated processes, the development and implementation of coordinated organizational processes across the relevant healthcare sectors is an essential basis for any intersectoral change process before technological aspects, such as the implementation of digital health solutions, can be addressed. The inter-organizational changes refer to collaboratively developed process and quality standards that integrate the relevant healthcare sectors. The technological changes refer to the digital solutions implemented in the feasibility study, including an inter-sectoral EHR, a video conference tool, and AAL services. The organizational changes refer to the change processes within each organization that are triggered by the aforementioned inter-organizational and technological changes. These are the adjustment of firm internal process standards and their documentation, HR training on the use of the digital solutions, the creation of new organizational positions, as well as the specific customization of the digital solutions.

• (c) Results achieved: The qualitative evaluation of the feasibility study from the perspectives of the care providers and the patients shows a distinct amelioration of the quality of life for the mechanically ventilated patient, Mr. Müller. Furthermore, an increase in the quality of care, especially in outpatient care, as well as during the discharge and re-admission process, is indicated. The quantitative evaluation of the new care model from an economic perspective, being a process cost analysis of digitally supported care processes, shows an unbalanced allocation of benefits and costs between the inpatient and outpatient healthcare sector. Due to the higher commitment of the hospitals’ physicians during the outpatient care process, the new care model causes a distinct increase of the personnel related process costs for the hospital. At the same time, the personnel related process costs decrease for the outpatient care providers due to the reduction of patients’ re-hospitalization.

• (d) Lessons learned: This digitalization case highlights five key lessons learned: (1) the necessity of changing governance structures for successful digital transformation processes, (2) the necessity of adequate business models for the different actors involved, (3) the meaning of a strategic fit between digital solutions, and market regulations and standards, (4) for the special case of German healthcare—the necessity of changing reimbursement models for innovative digital care models, and (5) the reciprocal relation between digitalization and inter-organizational collaboration.