Mr. Kroemer, where does the German healthcare system stand today in terms of digitalization?
At the beginning of an urgently needed implementation phase. The legal framework has been created, now we need to make rapid and significant progress. I believe there is no alternative. The term “skilled labor shortage” always suggests that these skilled workers are available somewhere. That is wrong.

In the next ten years, we will lose a third of our skilled workers per birth, the generation my age. We will only be able to cope with this without massive losses in quality if we make medical care extensively digital. Some people still don’t quite understand this.

Which legal changes do you expect the most from?
From a broader perspective, the electronic patient record in the opt-out version now planned is already a significant step forward. And the Health Data Use Act is particularly interesting from the perspective of university medicine, as it will make many things possible that were previously difficult or even impossible.

Which countries can or should we in Germany particularly orient ourselves towards?
On the one hand, there are the Scandinavian countries, which have achieved a lot of things very well, both in terms of digitally supported care structures and research using care data. The Netherlands and Israel also spring to mind, but also a country like Spain, which is less of a focus in political discussions. In Germany, we can actually learn something from almost everywhere when it comes to digitization.

What are the issues that will particularly concern us in this country in the coming years?
We have to think fundamentally about how medicine will work in the future. I have a watch on my wrist from which I can derive an ECG including a diagnosis. If sensor technology continues to develop at this speed, we can ask ourselves soberly what actually needs to be done in hospitals in the future – and what doesn’t.

What could the future look like?
I recently saw a presentation by a colleague from the Sheba Medical Center in Tel Aviv. Women with high-risk pregnancies are monitored at home, including home-based, AI-supported cardiac ultrasound. You can take this further in any direction. Then there is the whole area of ​​prevention: There is no incentive in the healthcare system to keep people healthy. This is not just a digitalization issue, but digitalization opens up new options here. Another important topic is diagnostic support, and then of course data-based research.

Keyword research: In cancer medicine and beyond, the generation of real-world evidence is becoming increasingly important. What importance does this type of research have at the Charité?
This is already very important today, and will become even more important in the future. The question is to what extent data generation in hospitals is already “real world”. Isn’t the combination of parameters collected digitally in everyday life with clinical care data much more realistic? We are trying to get closer to this at the Charité.

In what way, for example?
For example, at the beginning of 2023 we founded the German Heart Center of the Charité (DHZC) by merging the cardiac medicine facilities of the Charité and the German Heart Center Berlin (DHZB). A model clinic is being built there that can seamlessly combine data from the home with clinical data – for care and for research. The subsequent evaluation of real care data using artificial intelligence is also a topic that interests us – like many others.

The German Heart Center in Berlin

© Imago

What digital structures are necessary for this kind of research? It doesn’t happen automatically.
That’s not it at all, no. The interesting question is why we haven’t had this already. That has to do with the long-standing lack of a regulatory framework, which has only now been partially created by the Health Data Use Act. What we also urgently need is a sensible digital infrastructure – in the health care system, but also in the individual institutions.

If you look at the share of their revenue that hospitals have invested in digital infrastructure to date, it is far from what comparable American institutions have at their disposal. We need to work much more cloud-based, which is a given everywhere outside of Germany. All the work with AI applications that will ultimately get us through demographic change only works if there is an excellent digital infrastructure.

You have just put out a tender for a new hospital information system (HIS), the largest tender of its kind ever in Germany. What is the overall strategy?
We are currently in the process of fulfilling the requirements of the Hospital Future Act (KHZG) and combining this with the KIS tender. Under the title “We are rethinking health”, we have formulated a strategy for 2030 with the aim of providing better care and research. We are learning a lot from our exchanges with our national partners in the university medicine network. We have also set up a network with the ten largest European university hospitals. Ultimately, all university hospitals have similar problems.

Your most important individual project at the moment is the KIS tender mentioned above. What is the time horizon and which other projects have priority?
We are not completely free when it comes to implementing the HIS. The system we currently have is essentially due to be discontinued in 2027, which is a relatively short period of time for such large-scale projects. We will see. A second, very important topic is the shared data platform that we have set up together with the municipal clinics of Vivantes – despite different HIS systems. Around 3,300 beds from us and around 5,500 from Vivantes flow into it. That is a data set that you can work with. We are now expanding this to other hospitals, as far as Brandenburg.

Are such digitally integrated, regional platforms the long-term model of the future of healthcare in Germany?
I would delete the “permanently” part; I think it’s more of an interim solution. We need to think nationally in the long term; we can’t solve this regionally everywhere. I do believe that there is a need for local systems that link inpatient and outpatient care in a barrier-free way. But we still need an overall solution at the national level.

Where do you use AI solutions at the Charité or are you planning to do so?
There are various initiatives in the field of imaging, in pathology, neurology and in the emergency room. For example, we use a tool there that checks whether people who come in with COPD are being treated in accordance with guidelines. But I find the question of whether we can develop an integrated AI model that can be used for different purposes across the entire hospital – from admission to the operating room to administration – more interesting than such individual solutions.

We are thinking about this intensively in view of the challenge mentioned at the beginning of becoming demographically stable. Again: In my opinion, there is no other option than to digitize the system and back it up with AI, at all levels. We are working on this together with major providers and are trying to get it done somehow.