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XPOMET©: 360° Next Generation Healthcare
De Libreka GmbH
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Comece a lerDescrição
As modern healthcare becomes increasingly personalized and data-driven, traditional healthcare is being transformed into a dynamic, multi-layered and highly connected global ecosystem. New players, such as medical entrepreneurs and tech giants like Apple, Amazon, Google and IBM Watson are continuing to expose and challenge the current healthcare market by providing innovative digital products and know-how.
Digital health offers both—a suite of new capabilities and new approaches that unlock health(care) from constraints of time, place, distance and knowledge. It opens up entirely new ways to address and understand people and their health needs. This is how XPOMET© was born, and has been continuously growing as a platform, that is dedicated to innovative trends in medicine and care and at the same time creates a community that promotes cultural change in the healthcare industry.
In 2019, the XPOMET© Medicinale has become an international event to showcase best practice, highlight trends in global healthcare and forecast future developments in health and tech.
The book offers a broad collection of the extensive knowledge of contributors to the XPOMET© Medicinale 2019. International experts share their novel ideas, challenges and achievements in the global healthcare market. The reader is invited to join in the XPOMET© community’s vision and to be inspired by the latest discoveries and technological know-how in healthcare.
Digital health offers both—a suite of new capabilities and new approaches that unlock health(care) from constraints of time, place, distance and knowledge. It opens up entirely new ways to address and understand people and their health needs. This is how XPOMET© was born, and has been continuously growing as a platform, that is dedicated to innovative trends in medicine and care and at the same time creates a community that promotes cultural change in the healthcare industry.
In 2019, the XPOMET© Medicinale has become an international event to showcase best practice, highlight trends in global healthcare and forecast future developments in health and tech.
The book offers a broad collection of the extensive knowledge of contributors to the XPOMET© Medicinale 2019. International experts share their novel ideas, challenges and achievements in the global healthcare market. The reader is invited to join in the XPOMET© community’s vision and to be inspired by the latest discoveries and technological know-how in healthcare.
Ações de livro
Comece a lerDados do livro
XPOMET©: 360° Next Generation Healthcare
De Libreka GmbH
Descrição
As modern healthcare becomes increasingly personalized and data-driven, traditional healthcare is being transformed into a dynamic, multi-layered and highly connected global ecosystem. New players, such as medical entrepreneurs and tech giants like Apple, Amazon, Google and IBM Watson are continuing to expose and challenge the current healthcare market by providing innovative digital products and know-how.
Digital health offers both—a suite of new capabilities and new approaches that unlock health(care) from constraints of time, place, distance and knowledge. It opens up entirely new ways to address and understand people and their health needs. This is how XPOMET© was born, and has been continuously growing as a platform, that is dedicated to innovative trends in medicine and care and at the same time creates a community that promotes cultural change in the healthcare industry.
In 2019, the XPOMET© Medicinale has become an international event to showcase best practice, highlight trends in global healthcare and forecast future developments in health and tech.
The book offers a broad collection of the extensive knowledge of contributors to the XPOMET© Medicinale 2019. International experts share their novel ideas, challenges and achievements in the global healthcare market. The reader is invited to join in the XPOMET© community’s vision and to be inspired by the latest discoveries and technological know-how in healthcare.
Digital health offers both—a suite of new capabilities and new approaches that unlock health(care) from constraints of time, place, distance and knowledge. It opens up entirely new ways to address and understand people and their health needs. This is how XPOMET© was born, and has been continuously growing as a platform, that is dedicated to innovative trends in medicine and care and at the same time creates a community that promotes cultural change in the healthcare industry.
In 2019, the XPOMET© Medicinale has become an international event to showcase best practice, highlight trends in global healthcare and forecast future developments in health and tech.
The book offers a broad collection of the extensive knowledge of contributors to the XPOMET© Medicinale 2019. International experts share their novel ideas, challenges and achievements in the global healthcare market. The reader is invited to join in the XPOMET© community’s vision and to be inspired by the latest discoveries and technological know-how in healthcare.
Amostra do livro
XPOMET©
Kopp
1
The Future Health Insurance: Social Equality Is Neither Desirable nor Beneficial
Ulrich H. Pieper and Christopher Dickenscheid
The German health insurance market is characterized by a dual funding system that consists of a statutory health insurance market and a private health insurance market. The fundamental differences between these two markets result from differing interpretations of the word fairness
.
Within the private health insurance market, the situation is considered to be fair when, over the entire period ensured, the expected insurance premiums are equal to the expected insurance claims (principle of equivalence). Following this principle, people who entail greater costs should pay a higher insurance premium with no regard to the individual’s financial capabilities. Given that the insured must pay the costs that they entail, it is essential to the stability of this market that the insured possess above-average financial capabilities and income (Schradin and Wende 2006, p. 12).
In contrast, within the statutory health insurance market, individual healthcare costs have no impact on individual healthcare premiums. Here it is considered to be fair when the premiums are based on the individual’s financial capabilities and people with a higher income pay higher premiums. This guarantees that even people with no income have health insurance. Thus, solidarity is a cornerstone of the statutory health insurance market (Schradin and Wende 2006, p. 4).
Solidarity in itself is a social principle that violates basic economic principles. As a result, it brings forth a multitude of inefficiencies that in turn lead to the financial destabilization of the market. Over the past two decades, this effect has been visible within the German statutory health insurance market, as a 70 percent increase in public healthcare costs could only be mitigated by increasing the individual’s insurance premiums (Bundesministerium für Gesundheit [Federal Ministry of Health] 2018). With the ongoing demographic change resulting in an aging society, this trend is likely to continue and the German public healthcare system is in need of reform.
In political discussions, the answer to the first question is often the unification of the two health insurance markets. This would integrate the rather wealthy insured people of the private health insurance market into the statutory health insurance system and therefore increase solidarity. Furthermore, this would lighten the financial burden of insurance premiums for the working class that is currently put on the middle class. Overall, this would increase solidarity (at least temporarily), stabilize the market financially and, therefore, would be beneficial to society.
The answer to the second question is rather complex and has a great impact on the financial stability of the resulting system.
Fortunately, these problems are for the most part not unique to the German health insurance system. Some of our European neighbors have faced similar problems, therefore have had to answer similar questions in the past and it is worth taking a look at how they have chosen to handle them. Good examples are the Netherlands and Switzerland.
Both countries have chosen to reform their healthcare system in the past 25 years. They introduced a basic health insurance system that is mandatory for every citizen. This basic health insurance, in both cases, covers the inpatient and outpatient care as well as the prenatal care. Should an individual’s need or desire for health insurance exceed the coverage provided by the basic insurance, s/he may purchase private supplementary insurance. In effect, the Netherlands and Switzerland both introduced a dual health insurance system. However, they implemented vastly different financing structures for their basic health insurance.
Fig. 1 Financing structure in the Netherlands (based on Ginneken et al. 2006, p. 12)
Fig. 2 Financing structure in Switzerland (based on Spycher 2004, p. 23)
Fig. 3 Healthcare costs as a share of GDP (OECD 2019)
Both countries implemented a dual insurance system with mandatory basic health insurance and with similar insurance coverage but chose completely different financing structures, resulting in different levels of solidarity and healthcare expenses within the two systems. Even after factoring in the high costs in Switzerland and looking at healthcare expenditures as a share of the national GDP, the Swiss healthcare system still entails much greater costs than the Dutch system (see fig. 3).
Since this is a rather brief and shallow comparison, it is not possible to derive an unequivocal correlation between the level of solidarity and financial stability of a system, but it does indicate a positive correlation between them.
In a theoretical healthcare system without any financial solidarity, a large percentage of the population would not be able to afford any form of health insurance, so introducing any form of solidarity into the system would be beneficial to society overall. This coincides with the correlation found in the comparison of the Dutch and Swiss healthcare systems, however only for low levels of solidarity.
If this correlation remains unchanged for any level of solidarity, it would imply that it is beneficial to society and the financial stability of the system to continuously increase solidarity until absolute financial solidarity is achieved. In consequence, there wouldn’t be a correlation between the income or financial capabilities of an individual and the quality of healthcare s/he receives. This can only be achieved in one of two ways:
Either purchasing private supplementary insurance will be forbidden, thereby limiting every citizen to the insurance coverage provided by the statutory health insurance.
Or by broadening the insurance coverage of the statutory health insurance so that it includes every possible current and future treatment, making private supplementary insurance redundant.
Newly developed medical treatments are often more effective in treating a disease, but are also more expensive. Limiting every citizen to statutory health insurance would prevent such new treatments from being offered, lowering the overall quality of healthcare. Additionally, this reduces or destroys any incentives for further innovation or investment in the healthcare market. The German healthcare market, for example, is a multi-billion Euro industry. It cannot be in the interest of the German people or beneficial to society to reduce these incentives.
Broadening the insurance coverage of the statutory health insurance, on the other hand, would be ideal but it would increase the costs to such an extent that it is simply not financially feasible.
In conclusion, solidarity is an important, necessary and beneficial part of any healthcare system, but it should not be taken to extremes. The ideal level of solidarity is somewhere in the middle, where society provides health insurance for every citizen to cover the basic needs for medical care and where incentives for further innovation or investment in the healthcare market are existent. This means that a market for private supplementary insurance and the social inequalities that come with it need to be integrated into the health insurance system, one way or another. When it comes to health insurance, social equality is neither desirable nor beneficial.
References
Arentz C (2018) Die Krankenversicherung in den Niederlanden seit 2006—Analyse der Reform und ihrer Auswirkungen. WIP-Analyse 1/2018, Köln: Wissenschaftliches Institut der PKV (WIP). URL:http://www.wip-pkv.de/fileadmin/user_upload/WIP_Analyse_1_2018_Krankenversicherung_in_den_Niederlanden_seit_2006.pdf (accessed July 31, 2019)
Bundesministerium für Gesundheit [Federal Ministry of Health] (2018) Gesetzliche Krankenversicherung — Kennzahlen und Faustformeln 2018. URL:https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/3_Downloads/Statistiken/GKV/Kennzahlen_Daten/KF2018Bund_Juni-2018.pdf (accessed July 31, 2019)
Gerlinger T (2003) Das Schweizer Modell der Krankenversicherung: Zu den Auswirkungen der Reform von 1996. WZB Discussion Paper, Nr. SP I 2003–301. Wissenschaftszentrum Berlin für Sozialforschung (WZB). URL: https://bibliothek.wzb.eu/pdf/2003/i03-301.pdf (accessed July 31, 2019)
Ginneken et al. (2006) Erste Erfahrungen mit der Mischung aus Kopfpauschalen, Bürgerversicherung und einem zentralen Fonds. G&S Gesundheits- und Sozialpolitik 60(7–8), 10–18
Greß et al. (2006) Krankenversicherungsreform in den Niederlanden: Vorbild für einen Kompromiss zwischen Bürgerversicherung und Pauschalprämie in Deutschland?. Diskussionsbeiträge aus dem Fachbereich Wirtschaftswissenschaften der Universität Duisburg-Essen Nr. 150. URL: https://www.boeckler.de/pdf_fof/96722.pdf (accessed July 31, 2019)
OECD (2019) Health expenditure and financing: Health expenditure indicators. URL: https://www.oecd-ilibrary.org/social-issues-migration-health/data/oecd-health-statistics/system-of-health-accounts-health-expenditure-by-function_data-00349-en (accessed July 31, 2019)
Schradin HR, Wende S (2006) Krankenversicherung in Deutschland: Eine vergleichende Analyse gesetzlicher und privater Krankenversicherung. Mitteilungen, Institut für Versicherungswissenschaft an der Universität zu Köln, Nr. 1/2006. Köln: Universitat zu Köln. URL:https://www.ivk.uni-koeln.de/fileadmin/wiso_fak/versicherung_institut/documents/Mitteilungen/m1_2006.pdf (accessed July 31, 2019)
Spycher S (2004) Bürgerversicherung und Kopfpauschalen in der Krankenversicherung der Schweiz: Vorbild oder abschreckendes Beispiel. GG Wissenschaft 4(1), 19–27
2
The Future Patient Room
Meik Eusterholz, Melanie Alessandra Katterbach and Celina Sander
Introduction and Vision for 2025
Digital transformation is driving companies in the healthcare industry to redesign their entire organizational structure. It also provides patients and hospitals enormous benefits. The term Smart Hospital signifies an organizational shift towards patient-centered facilities in which the use of modern technologies is triggering new processes, automating non-value adding activities, thus improving the quality of outcomes and treatment (Eusterholz 2019).
The patient room alone offers numerous possibilities for value-added patient care in hospitals thanks to the integration of new technologies. From an objective point of view, however, the patient room is a functional room. The patient remains here between examinations, surgical interventions or various other treatments. This room may not be of great importance for medical staff in hospitals. It is a common room and in most cases does not even earn much money for the hospital. However, from the patient’s subjective point of view, the lounge-like area is a central place. This is where patients spend most of their time during their inpatient stay. Therefore, devices and amenities have much more influence on the patient than on the doctors, nurses, hospital management and other service providers.
The patient room of the future will be full of innovations and technical highlights. In addition to enabling optimum control in medical care, the furnishings provide the patient and guests with a certain feel-good factor. It is also patient-friendly thanks to its barrier-free design and the fact that it maintains the highest possible hygiene standards. The room is digitally networked with smartphones, laptops, notebooks and telemedical software. This allows for seamless and automated patient monitoring and documentation. Through networking solutions, the traditional exam room can be shifted to the patient’s room—where services are provided directly to the patient since patient data can be retrieved from any location. Lighting and acoustic concepts are also smart,
facilitating the control of these systems. The patient room of the future can be compared with the standards of an attractive and modern hotel. Service quality is increasingly coming to the forefront so that the focus is on the healing architecture of the room (Leydecker 2017). The patient’s emotional and physical well-being is promoted by an attractive design in the single room concept, thus contributing to the overall healing process.
Trends in Healthcare
The State of Technology
When it comes to digitalization on both international and national levels, the German healthcare system is at the bottom of the list. In comparison to other German industries, it is regarded as a digital beginner. In the future, however, it is a fair assumption that the degree of digitalization will increase. Nevertheless, at a mere 20 percent, highly digitalized processes in the healthcare sector are still rare. According to the DIGITAL 2018 economic index, around 32 percent of the companies surveyed stated that they use applications in the Internet of Things
(IOT) area, but only two percent use Big Data
applications (BMWi 2018).
In hospitals, innovative technologies are used primarily in the field of imaging and other specific, functional areas. Through individual initiatives, more and more innovative solutions are finding their way into the hospital where they provide significant, everyday working life support. These solutions are based on artificial intelligence (AI), clinical decision support systems or intelligently networked solutions such as smart mattresses (Bauer 2019).
Taking a glance at neighboring countries shows how this expansion can function better. Denmark is at the forefront. The state is investing € 5.6 billion to digitalize and network its healthcare system for the future use of state-of-the-art technology. By 2025, 18 ultra-modern super hospitals will be built. In addition, Denmark has been utilizing electronic health records (EHR) for the past 10 years and telemedicine is already a part of everyday life. Track & Trace has also helped to significantly optimize the use of resources through the set up an infrastructure based on the location of all people, objects and devices. This infrastructure enables medical devices such as mobile ultrasound devices to be localized and treatment planning can be adapted based on the availability and location of the device. A bed management system, for example, can be used to locate free beds via the infrastructure, organise the cleaning and disinfection, as well as the maintenance processes. Now Denmark is five to ten years ahead of other countries when it comes to innovative health solutions (Gonser 2015).
Future Developments in Healthcare and Technology
On average, the healthcare market for digital and innovative technology is growing faster than the overall economy (Sauer and Storz 2018). When new technologies are seamlessly integrated into a system landscape, significant benefits can be achieved for both the hospital and patient. Efficient processes effectively relieve staff and significantly improve the quality of care (Bauer 2019). In the future, five key technology areas will arise in healthcare:
The first is Artificial Intelligence (AI). About one-fourth of all patients believe that a more accurate medical diagnosis can be achieved using AI. The use of big data and AI plays an important role. Both can significantly support physicians in analyzing clinical data and interpreting data from imaging procedures or contribute to optimizing clinical research (vbw 2019).
Second, wearables can be used to monitor multiple parameters such as heart rate, sleep quality, training programs and much more.
The third technology area is virtual reality (VR) and augmented reality (AR). With AR-based apps, surgeons can practice every step of an operation in advance.
The IOT is the fourth area. Although it is not yet represented, networking and the integration of different medical devices in hospitals, databases and patient management software will provide a great deal of valuable data.
Last but not least, various breakthroughs have been made with 3D printing, such as in the treatment of burn victims, tracheal splints, and printing living tissue with blood vessels. Thanks to advancing digitalization, it is now possible to calculate exact 3D models in real time, which in turn simplifies the planning of an operation for the physician (BNP PARIBAS 2018).
Nevertheless, challenges for German hospital managers are, in particular, an additional burden on the organization and employees. Change management requires more attention and plays an important role for sustainable implementation. In addition, high investment costs, as well as the lack of digital expertise and data security by relevant stakeholders, are large obstacles (Berger 2018).
However, many digitalization projects are already failing due to the lack of infrastructure, complicated approval procedures, inadequate reimbursement regulations, and high regulatory requirements. Although responsible politicians and public authorities have an acknowledged willingness to take action, an enormous need to do so still remains (Reinhard 2018).
In addition, the issue of data protection has been raised repeatedly in the context of digitalization. Health data (patient-related or -referable) represent a special type of personal data and must be, therefore, protected. The handling of this data and, above all, its integration into IT systems is linked to high demands and is complex, which is why its usability has been restricted. However, there are already solutions that meet the data protection requirements from an IT perspective (Lux and Breil 2017).
Changes in the Patient Room
Benefits of the Patient Room
Although the multi-bed room concept is predominantly widespread in German hospitals, many clinics are now responding to the high demand for single rooms by offering ‘comfort wards’. The amenities in these rooms differ considerably in comparison to those in normal wards. Hospitals are orienting themselves towards hotel standards in terms of comfort and offering patients’ laundry and ironing services, internet, flat-screen TVs, and a wider selection in terms of meals. However, these luxuries only apply to patients who can pay accordingly. The price per night in a single room is between € 80 and € 150 unless a patient has additional insurance that covers this cost. Access to better rooms and healing is denied to all other patients, especially those with statutory health insurance who cannot afford the service for financial reasons. The standard room for those with statutory health insurance is a multi-bed room (Gurr and Stelter 2016).
It has been scientifically proven that single rooms ought to be used more frequently, especially from a hygienic point of view. Numerous advantages significantly increase patient satisfaction, avoid unnecessary bed blocks for isolated patients and shorten the overall length of stay. Some of these include separate sanitary areas, fewer medication errors, fewer bed transfers, lower risk of infection, greater privacy and data protection, better communication between staff and patient/relatives, less noise and disturbance from a roommate and better quality of sleep (Detsky and Etchells 2008). Years ago, the German Society for Hospital Hygiene argued that single rooms should be the focus of new construction projects. However, this is still not being practiced in Germany, while other countries are already implementing the increased use of single bedrooms. In England, a quota of 50 percent was agreed upon for the use of single rooms. Canada and the US are demanding that only single rooms should be built in new hospitals (Exner and Popp 2011). In Denmark, the advantages of having single rooms have been fully taken into account—their super hospitals are being built on the single room concept.
The Future Goals of Various Stakeholders
The patient room of the future has three main stakeholders:
the staff
the management
the patient and his or her relatives
From these three different perspectives, different requirements (see fig. 1) can be derived in order to fully exploit the potential of the future patient room and to provide maximum satisfaction to each stakeholder.
Fig. 1 Goals of the patient room of the future (UNITY AG, for more information: https://www.unity.de/de/leistungen/das-patientenzimmer-der-zukunft/ )
Care processes focus on the patient, who wants to recover fully. From the patient’s perspective, requirements are derived which, facilitate communication, improve hygiene standards and safety, increase comfort and well-being with a pleasant atmosphere as well as adequate service offerings. Ultimately, satisfaction should be improved through increased transparency and individualized treatment.
The primary importance for the staff is to be relieved of redundant documentation and administrative activities, as well as gaining a high level of occupational safety. With the help of efficient processes, they wish to eliminate possible sources of error and, for example, anticipate risks by using comprehensive sensor technology in order to have more time available to perform their main duties.
For management, there are requirements, such as the optimal use of resources, that aim to achieve both strategic and operative goals. In addition, maintaining high-quality results and processes is important for management to improve both patient and staff satisfaction. A pleasant working atmosphere and a high level of patient trust promote the recovery process and personnel error rates. In the long term, the following can be achieved through higher efficiency in capacity utilization: savings potentials, reduced lengths of stay and higher occupancy rates.
Fig. 2 Processes at the patient room of the future (UNITY AG, for more information: https://www.unity.de/de/leistungen/das-patientenzimmer-der-zukunft/ )
Future Processes
To ensure that stakeholder objectives can also be met in the patient room, there will be a shift in the provision of services from the traditional examination room to the patient room.
In the future, a large number of processes (see fig. 2) can be carried out directly on the patient’s bed from the time of admission. The room will be digitally networked with medical devices, medical software and the patient can control light, infotainment, door or bed settings directly via mobile devices. Clinical and administrative data acquisition, as well as medical documentation, is possible via mobile devices independent of location and thus takes place directly at the bedside. Point of Care Testing replaces the transport of samples to the laboratory and enables fast diagnostics of blood values etc., directly at the patient’s bedside. With the help of smart, mobile medical devices, smaller examination units such as ultrasound, EEG or X-rays and the discussion of findings can also be moved to the patient’s room.
Nursing care is facilitated by wearables, which automatically measure blood pressure, temperature, pulse, and intelligent wound care. The visit can take place via telemedicine communication, during which specialists can be called in at the same time, if required. The administration of medication and infusions can be controlled via various applications. Finally, there are also functions that can be fully automated, such as bed management for hygiene.
Outlook
Digital transformation is making its way into the patient’s room, opening up numerous opportunities to significantly improve the efficiency and effectiveness of a clinic and, in particular, to improve patient and staff satisfaction.
For this to happen, a new way of thinking must first and foremost be acknowledged in the political sphere so that fair financing solutions are created and two-tier medical system is avoided. The advantages of the single room clearly dominate and should be made available to every patient as a standard service. The incentive for hospitals to charge extra for this type of accommodation must cease, and instead be directed towards quality-oriented care with the use of new technologies.
References
Bauer M (2019) Auf dem Weg ins digitale Krankenhaus. URL: https://healthcare-startups.de/auf-dem-weg-ins-digitale-krankenhaus/ (accessed April 29, 2019)
Berger R (2018) Digitalsierung im Krankenhaus—Umfassende Digitalisierung befindet sich noch in den Anfängen. URL: https://www.rolandberger.com/de/Point-of-View/Digitalisierung-im-Krankenhaus.html (accessed April 29, 2019)
BMWi — Bundesministerium für Wirtschaft und Energie (2018) Monitoring-Report Wirtschaft DIGITAL 2018. wei-dner.media München
BNP PARIBAS (2018) Der Einfluss von Leasing auf das Gesundheitswesen URL: https://leasingsolutions.bnpparibas.de/wp-content/uploads/sites/6/2018/08/Whitepaper_Welchen-Einfluss-Leasing-auf-die-Gesundheitsbranche-hat.pdf (accessed April 29, 2019)
Detsky ME, Etchells E (2008) Single-patient rooms for safe patient-centered hospitals. JAMA 300, 954–956
Eusterholz M (2019) Smart Hospital—das Krankenhaus der Zukunft. In: Hellmann W (Ed.) SOS Krankenhaus-management. Kohlhammer Stuttgart
Exner M, Popp W, Deutsche Gesellschaft für Krankenhaushygiene (2011) Einbettzimmer im Krankenhaus. Hyg Med 36(10), 400–401
Gonser B (2015) Die Zukunft hat schon begonnen. URL: https://medizin-und-technik.industrie.de/allgemein/die-zukunft-hat-schon-begonnen/ (accessed April 29, 2019)
Gurr G, Stelter L (2016) Komfortstationen im Krankenhaus—Darf’s etwas mehr sein?. URL: https://www.tagesspiegel.de/berlin/komfortstationen-im-krankenhaus-darfs-etwas-mehr-sein/12962248.html (accessed April 29, 2019)
Leydecker, S (2017) Patientenzimmer der Zukunft. Birkhäuser Verlag GmbH Basel
Lux T, Breil B (2017) Digitalisierung im Gesundheitswesen: bessere Versorgungsqualität trotz Kosteneinsparun-gen. Wirtschaftsdienst 97, 10, 687–692
PwC—Pricewaterhouse Coopers (2014) European Hospital Survey: Benchmarking Devployment of eHealth Services (2012–2013), Final Report. European Union Joint Research Centre Luxembourg
Reinhardt P (2018) Medizin 4.0. Digitale Revolution in der Medizin: Stand der Technik und Ausblick. URL: https://www.devicemed.de/digitale-revolution-in-der-medizin-stand-der-technik-und-ausblick-a-758066/ (accessed April 29, 2019)
Sauer A, Storz F (2018) So hilft innovative Technik, die Digitalisierung im Gesundheitswesen voranzutrei-ben. URL: https://www.aktiv-online.de/news/so-hilft-innovative-technik-die-digitalisierung-im-gesundheitswesen-voranzutreiben-2701 (accessed April 29, 2019)
Vbw—Vereinigung der bayerischen Wirtschaft e.V. (2019) Neue Technologien im Gesundheitsbereich. URL: https://www.vbw-bayern.de/vbw/Aktionsfelder/Innovation-F-T/Forschung-und-Technologie/Neue-Technologien-im-Gesundheitsbereich.jsp (accessed April 29, 2019)
3
The Sky Is the Limit — E-Learning and the Future of Healthcare Education
Victoria Hancox
Thanks to the rapid-fire pace of technological innovations, the face of e-learning has changed considerably over the last two decades. We’ve come a long way from Encarta CD-ROMs.
It can be argued that e-learning is essential in supporting professional development in healthcare. After all, the skills required to confidently and competently engage with e-learning are the very attributes needed by professionals in dealing with technological innovations that arrive in the workplace (McDonald 2017). But how will this look in practice?
What seems likely is that the trend for self-directed learning will gain strength, taking learners away from the traditional, didactic environment. A future of increased autonomy has been envisioned, with people identifying their own knowledge-gaps and selecting the content they need in a format that works for them.
[The] backbone to this [self-directed learning] is more integrated, searchable, catalogued systems." (Greany 2018)
The providers of massive open, online courses (MOOCs) could take a crucial part of this backbone. Some medical schools already use exemplar courses from MOOCs in their curriculum (Doherty et al. 2015), which is a practical solution that reduces costs and time spent by educators in producing their own courses. In addition to allowing students a desired flexible access to the lessons, it also enables them to pursue topics outside the mandated curriculum. Such flexibility can boost enthusiasm, however, there is the thorny issue of accreditation, as institutes have an obligation to not only formally assess students but also provide empirical evidence of this and incorporating MOOCs may be problematic in that regard. There is also a high drop-out rate associated with MOOCs that may relate to student motivation. Are MOOCs victims of high, initial enthusiasm followed by a rapid decline, and if so, what can be done to prevent this and promote self-directed learning?
E-learning is an active process, requiring more interaction from the learner. This has many advantages—significantly, active learning has a greater impact on the acquisition of higher cognitive skills, as opposed to traditional, passive lectures (Freeman et al. 2014) and the deliberate practice facilitates the transition of information from short-term to long-term memory. It should be noted though, that active learning does not simply mean being physically active by clicking through a written text. It requires the student to be actively engaged in the content. Yet current e-learning is often a series of slides to be shown on a PC—text, diagrams, videos and multiple-choice questions, which does not reflect how people wish to learn. In order to grasp people’s attention and engagement, e-learning has to evolve.
Enhancing Content Engagement
One stand-out way to achieve this is to switch to game-based learning or gamification and although some may doubt the efficacy, gaming results in high levels of engagement, concentration and active participation. Throw online gaming into the mix and you’re also enhancing interactive team working skills (Walsh 2014).
It could consist of simple word games, such as hangman, to practice medical terminology or creating backstories and narratives for interactive case studies that allow each individual to make decisions that take them down a certain route (see fig. 1). It inevitably leads to long-term consequences that they have to face and can’t correct— just like in real life.
Phones and tablets continue to gain traction as the devices on which people access e-learning. The content needs to be modified to this aim. This doesn’t mean simply making it fit onto a smaller screen but rather, considering how people use their phones on a regular basis. Think about your daily commute—you see your fellow passengers:
reading books or articles,
watching films or videos,
playing games.
The trick is to use these activities in the delivery of educational packets and to illustrate this, just consider how difficult it is to click forward through a series of text-filled slides on your phone. However, scrolling is intuitive, so content could be rewritten in the form of an article or even a story.
Fig. 1 Virtual Reality by Relias Learning: A Day in the Life of Henry
allows people to empathise with the confusion and disorientation of patients living with dementia produced by certain actions of their carers
Micro learning is the buzzword here—the days of hour-long lectures are in the past— people want to access short and focused modules of learning which can fit conveniently into their daily routine. But how do you decide just what goes into these bite-sized courses?
One Size Does Not Fit All
Healthcare professionals need to address different components—theory and practical skills such as assessment, problem-solving and critical analysis. Therefore, e-learning providers need to present these in varying but appropriate formats.
The theoretical component— the related anatomy or disease pathology, for example—could be demonstrated through interactive diagrams that combine key facts with associated images.
Practical skills could be delivered via short videos, e.g. commentaries that complement the individual steps of the procedure, meaning that both visual and aural learning preferences are catered for. When learning any new practical skill, it’s commonplace to watch a more experienced colleague carry out the task, so a short video, which can be replayed again and again, supplements and reinforces this knowledge. Costs and technical skills used to be prohibitive, but as editing becomes cheaper, we can expect short video clips to be incorporated into most e-learning (Arshavskiy 2019).
Simulations give access to a safe practice that provides learners with the opportunity to make mistakes and see the consequences of those mistakes. In doing so, it bridges the gap between theory and practice, as the feedback secures the theoretical knowledge by underpinning the interactions and connections. Research has shown there is a direct correlation between retaining knowledge and quality of performance in a simulated exercise (Francis u. O’Brien 2019).
Depending on the skills required, the type of simulation can vary. For example, manikins are useful for hands-on practice in clinical skills such as cardiopulmonary resuscitation, venepuncture and urinary catheterisation. These simple tools have been a concrete part of healthcare training for decades now but the 21st-century versions have been taken to a whole new level. There are now products with palpable pulses, bowel sounds and varying pupillary responses; features which alter according to a variety of programmable scenarios and also provide real-time feedback on the efficacy of resuscitation attempts (Laerdal n.d.).
Broader skills relating to diagnosis and patient management can be developed by simulations using avatars as virtual patients, nurses or doctors—practicing in context allows for a more authentic experience and generates greater student satisfaction, motivation and engagement.
Virtual and augmented reality (VR/AR) is a breakthrough technology that, while it hasn’t quite enjoyed the anticipated take-up with the general public, looks set to consolidate its place in future e-learning (Arshavskiy 2017). Augmented reality involves the projection of an image onto a real environment. There are plenty of applications that use Smartphones as the viewing device. However, with improved resolution and location tracking in eyewear devices, AR is becoming a tour de force in medical imaging (Craig 2016). Cutting-edge HMD (head-mounted display) devices can transform the information from a patient’s CT or MRI scan into an immersive visualisation of their internal structures and currently, this is mostly being used in the diagnostic stages but it also segues perfectly into surgery planning and rehearsal. A further exciting opportunity arises from the ability to connect multiple HMD devices. Seeing the same scene from different angles opens up collaborative working and learning opportunities (Bergonzi 2019).
The total immersive environment provided by virtual reality, via headset and earphones, could have, among others, a role in a different aspect of learning: Sampling the patient experience and using that to inform future practice. Relias produced a course based upon a person living with dementia which allowed people to empathise with the confusion and disorientation produced by certain actions of their carers. It can be a powerful tool that has an impact on how healthcare professionals relate to and treat the people they care for (Craig u. Georgieva 2017).
Curating the Curriculum
However, making engaging content is not the end of the story when it comes to encouraging self-directed learning. A curriculum that relies solely on e-learning courses and activities might suffer due to the lack of collaboration between students or personalised support from a tutor, and ultimately, lead to reduced motivation (Warriner u. Morris 2018). Here’s where blended learning enters the equation.
The curriculum should have a topic-specific approach, which means curating the e-learning resources so that you have the best strategies for teaching the subjects and skills required. A scaffold approach should be adopted, incorporating levels of theory and practice opportunities that build on previous instruction and allow for reflection and evaluation (Power u. Cole 2017). Importantly, learners are able to review and repeat at their own direction, and have access to tutors whose main role is to provide support and feedback—a paradigm shift that educators themselves will need support in adjusting to (Back et al. 2015).
One More Trick Up the Sleeve
E-learning has a further significant part to play in healthcare education as the realm of learning analytics starts to find its feet. We can envisage a fluid system comprising of both curriculum and management system that gathers data about the learner and provides informed adjustments for their subsequent learning—personalised and adaptive learning instead of a generic curriculum for all (Doherty et al. 2015). It would provide tailored feedback, warnings and motivation, and customise the individual’s learning plans which, ultimately, enables them to take on responsibility for their own performance. Adaptive learning paths have been shown to be efficient and decrease the time taken to master a skill or acquire knowledge, which in turn, enhances learner satisfaction and motivation.
Taking this a step further, it seems inevitable that the evolution of analytically-driven adaptive learning will lead to Smart Learning Environments (SLEs) (Koper 2014). Learning can be supported by these interventions:
being asked a question,
working on tasks,
receiving information,
gaining feedback.
Usually, the educator manages these interventions, walking the learners through until they arrive at a pre-determined outcome. With SLEs, the selection and sequence of the interventions would come from a data-driven decision. For this to work effectively, the learners must have an interface with the environment. To achieve that, SLEs will make use of the Internet of Things (IoT) as a mechanism for providing input and monitoring output. Just as a SmartHome can make use of temperature sensors to control the thermostat, SLEs can analyse the data derived from portable EEGs, eye-trackers or prior learning activities. The hub can then send specific information or suggested educational tasks to the learner’s mobile device (Hwang 2014). It may sound like a futuristic way of delivering education but its core value is simply in providing the right information at the right time.
References
Arshavskiy M (2017) eLearning Evolution—The 3 Biggest Changes in 5 Years and How to Adapt to Them for Success. URL: https://www.shiftelearning.com/blog/elearning-evolution-the-biggest-changes
Arshavskiy M (2019) 6 eLearning Trends: What can we expect going into 2019 and beyond. URL: https://elearningindustry.com/6-elearning-trends-for-2019-beyond-what-expect (accessed August 2, 2019)
Bergonzi L, Colombo G, Redaelli D, Lorusso M (2019) An Augmented Reality Approach to Visualize Biomedical Images. Computer-Aided Design and Applications 16, 1195–1208
Craig E (2016) An augmented reality t-shirt—Virtuali-tee. URL: https://www.digitalbodies.net/augmented-reality/an-augmented-reality-t-shirt-virtuali-tee/ (accessed August 2, 2019)
Craig E, Georgieva M (2017) URL: https://er.educause.edu/blogs/2017/8/vr-and-ar-driving-a-revolution-in-medical-education-and-patient-care (accessed August 2, 2019)
Doherty I, Sharma N, Harbutt D (2015) Contemporary and future eLearning trends in medical education. Medical Teacher 37, 1–3
Francis G & O’Brien M (2019) Teaching clinical skills in pre-registration nurse education: value and methods British Journal of Nursing 28(7)
Freeman S, Eddy SL, McDonough M, Smith MK, Okoroafor N, Jordt H, Wenderoth MP (2014) Active learning boosts performance in STEM courses Proceedings of the National Academy of Sciences, 111(23), 8410–8415
Greany K (2018) 10 eLearning trends that research says you’ll see by 2020. URL: https://www.elucidat.com/blog/elearning-trends-2018/ (accessed August 2, 2019)
Hwang G-J (2014) Definition, framework and research
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