"The informed patient" creates new challenges

During the summer months, Swiss television broadcast an entertainment programme entitled "Doctors vs. the Internet". In each case, a team of doctors and a team of laypeople competed in making the correct diagnosis based on real descriptions of symptoms. While the doctors "only" had access to their specialist knowledge, the laymen were able to get their information from the Internet. Even though in the end it was mostly the doctors who came out on top, it was amazing how often the "Internet teams" came up with the right diagnosis based on their research on the Internet - and this was not always the case with trivial clinical pictures such as Crohn's disease, ulcerative colitis, secondary lymphedema, psoriasis, and many more. Even the doctors had to admit from time to time that in practice they only came up with the right diagnoses and therapies through Internet research by the patients themselves.

Appointment with "Dr. Google"
The phenomenon of the "informed patient" is more than ever a challenge for doctors and hospitals in the healthcare sector. Health information is now accessible to almost everyone; "Dr. Google" is increasingly the first consultation before a visit to the doctor. Surprisingly, according to a study by the Bertelsmann Foundation, private-sector Internet platforms such as Wikipedia, apotheken-umschau.de or netdoktor.de rank well ahead of the offerings of public institutions in terms of awareness and credibility (e.g. in Germany, the patienten-information.de website of the German Medical Association and the National Association of Statutory Health Insurance Physicians). Regardless of which platform on the Internet someone uses for health information: The patient's journey begins with the symptom, i.e. even before the first contact with a doctor.

Doctors fight back against ratings
As a rule, the patient's journey should be over after successful treatment and therapy or complete healing. But far from it: the journey goes even further. Because on relevant portals on the Internet, patients increasingly have the possibility to evaluate the quality of doctors, practices or hospitals. The result: the nimbus of the "demigods in white" is fading, and doctors are exposed to the hard-hitting mechanisms of online platforms. In spring 2018, the case of a dermatologist caused a stir in Germany when she tried to have her profile removed from jameda.de, which she claims is the most comprehensive online doctor directory. Although the doctor won her case before the German Federal Court of Justice in the last instance, the platform has since made adjustments that rendered the original cause of action - that the platform was not neutral - invalid. However: It remains to be seen how the new General Data Protection Regulation, which includes a "right to be forgotten" for personal data, will affect this and similar platforms.

Increase the quality of the relationship between doctor and patient
With increasingly well-informed patients, a paradigm shift is taking place for healthcare institutions, as Bernhard Geist, Head of Product Management at CompuGroup Medical SE, explained at a consultant conference at the Swiss headquarters of this eHealth company. "The doctor knows better" is increasingly being called into question. Patients' expectations are changing: they want to be informed in a comprehensible way and they want to remain involved in the entire process by using the available information in a meaningful way so that treatment is carried out in the best possible way in terms of quality, planning, coordination, etc., according to Bernhard Geist. Ultimately, it is about improving the quality of the relationship between patient and doctor. As a result, next generations of clinical information systems must be based on process-oriented platforms as the "core of the solution" and take even greater account of the interaction between patients, doctors and nursing staff.

What a modern HIS should do
The new challenges for a HIS can be summarized as follows:

• What a modern HIS should do The new challenges for a HIS can be summarized as follows: The work situation of the respective actor (doctor, therapist, nursing staff, etc.). Furthermore, it incorporates data contributed by the patient himself. Treatment plans are coordinated and information is provided about appointments and measures. The entire patient journey within an organization, such as a hospital, can be coordinated via the HIS.
• There is a consistent electronic patient file. This is interprofessional and interdisciplinary and ensures permeable documentation between outpatient and inpatient treatment. A modern HIS functions as a cross-system continuous information system.
• Multi-resource planning with the aim of achieving maximum treatment quality while maintaining efficiency: To achieve this, a HIS must be able to provide optimal support for all workflows. For example, it must be possible to monitor the length of stay or complex treatments via a management or treatment cockpit. The HIS must also be able to network hospital staff along the entire patient journey. This also enables more dimensional planning in order to make the best possible use of the available resources.
• Today, there is often a lack of knowledge within the institutions regarding user interfaces for a HIS. At the same time, the administrative requirements in medicine are constantly increasing. And many HIS do not offer mobile support. Accordingly, a customizable design of the user interface is necessary, independent of the device. A mobile application and the ability to process data at the point of use are further requirements for a modern HIS. Because a perfect user experience can also save a lot of time.
• A modern HIS must not only be able to map treatment plans, but also offer support in decision-making. To do this, it draws on existing knowledge, such as tried-and-tested plans and processes. Structured documentation also automates the recording of services. Stored data is monitored, and the HIS can also aggregate data for overall insights. Machine learning can also be used to continuously optimise the planning of stays and treatment - especially in view of the fact that more and more processes are being carried out on an outpatient basis, this can be a decisive feature.
• And last but not least, a modern HIS must be interoperable and service-oriented. "Communication with minimal effort" must be the motto. Ultimately, it serves as the central communication platform for the entire patient journey and forms the basis for the collaboration of all players in all processes.

Electronic patient dossier not expected until 2020
An "egg-laying pillow", then? Indeed, the objection could be made that such an IT system is too complex. A HIS must be simple, lean and interoperable, i.e. not overloaded with too many features, as one hears from hospitals. The digitalization of the health care system through modern HIS should have the goal of accelerating processes, making them more transparent (by avoiding duplications) and thus reducing costs. A prerequisite for this is the electronic patient file, which will be introduced in Switzerland in 2020 according to the Federal Office of Public Health (FOPH). Its complexity and decentralised organisation across the cantons are proving to be major challenges. In addition, patient data is extremely sensitive information that requires appropriate protection. And here it seems that the philosopher's stone has not yet been definitively found. Nevertheless, the canton of Basel-Stadt has recently introduced the EPD. With this system, called "myEPD", patients can determine their access rights online in detail. The creation of such an EPD is (still) voluntary; the service providers themselves, i.e. doctors, pharmacists or chiropractors, are also not obliged to do so. These still have concerns about data security.

How far the EPD is an advantage or not under these conditions remains to be seen. Many questions, including those of cost, are still open. Irrespective of this, patients are likely to continue to make "self-diagnoses" on the internet. Whether or not such "informed patients" will increase the number of careless medical consultations remains to be seen. This would hardly reduce costs - all the more important are processes that help to avoid expensive incorrect treatment. Information technology is a means to an end.