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Invest in benefits: Financing models for health ecosystems

Dr. Sebastian Krolop
Dr. Marko Queitsch

Realizing the vision of a national health platform as outlined in the Trusted Health Ecosystems project could generate financial benefits at many different points and help improve the overall economics of the healthcare system. However, this will require a sustainable and independent financing model that can provide the necessary flexibility for the initial development process, ongoing operations, and future updates and expansions. The solution most likely lies in a combination of different financing approaches.

Digital ecosystems can provide benefits in the healthcare sector in a variety of ways. For example, networking all relevant actors and using digital data creates transparency and facilitates personalized care offerings. Fully integrated healthcare offerings improve the user experience. Moreover, simplified procedures and digital support make the work of healthcare staff easier.

A recent McKinsey analysis shows just how great the financial benefits of a digitized healthcare system are likely to be, estimating the economic potential in Germany at around €42 billion per year (McKinsey & Company 2022). Digital ecosystems are not the only means by which to tap this enormous potential, but they could make an important contribution. For example, they could accelerate the digitalization process, while also linking disparate offerings and digital services together in a time- and cost-efficient way.

The OECD has also stated that facilitating access to high-quality health information, as an ecosystem modeled on the product vision outlined here would do, can have cost-saving effects. It estimates that between 3% and 5% of healthcare spending could be saved or used elsewhere through improved health literacy. For Germany alone, this would correspond to a sum of €9 billion to €15 billion per year.

However, depending on the project size, the investment needed to support the initial development, deployment and operation of such health ecosystems can in some cases be quite substantial. Ongoing operations also generate costs. This raises the question of what financing models are suitable for creating such an ecosystem and supporting ongoing platform operations, including future updates and expansions.

Requirements for national health platform financing models

A variety of financing models are conceivable for health ecosystems, each in turn entailing a number of advantages and disadvantages. In considering these options, it is important to keep in mind the core principles intended to guide the national health platform’s operations (see Objectives and conceptual premises):

  • Nonprofit model. The platform’s operation should not produce profits; any revenue generated will instead fund the platform’s further development. This has an effect on the potential legal form taken by the ecosystem (see Ownership: Public or private?). Of course, this stipulation applies only to the platform operator. Health information or service providers participating in the ecosystem can certainly function on a for-profit basis.
  • The ecosystem should act neutrally and independently of the particular interests of individual actors. This applies not only to healthcare providers and insurers, but also to private-sector companies with commercial interests. In practice, this rules out a number of funding options, such as advertising-supported operations.
  • The process of building and scaling an ecosystem requires time, and necessarily takes place in an environment of fast-moving technological change. Financing models should accordingly be designed for the long term.
  • Since the digital ecosystem will involve participation by private-sector and public-sector actors, and the ecosystem operator will presumably be acting on the basis of a statutory mandate, financing sources should be transparent and comprehensible to all. This will also increase users’ trust in the platform.
  • Open system. The national health platform should be developed as an open ecosystem that allows for links between disparate health providers. A number of features must be created to enable such functions, which in turn will generate ongoing costs – for example, for the development, deployment and maintenance of APIs and other core components.

Different financing models conceivable

In selecting suitable financing models, it is advisable to take a differentiated view of the platform’s initial development, ongoing operations, and future updates and expansions. Over this time, these separate phases will be associated with different financial requirements, for which different forms of financing are in turn available:

Initial development costs. Initial costs are incurred in setting up the basic infrastructure, for example for the IT platform’s technical development, for drafting legal and regulatory concepts, and for integrating the first healthcare providers into the ecosystem. Therefore, one-time basic funding is well-suited for this start-up phase – for instance in the form of grants or other funding from foundations, the government or the ecosystem’s stakeholders. One example of government support for digitalization can be seen in Israel’s National Digital Health Plan. There, the government has allocated a budget of around $300 million for this initiative, in part to build a big data platform containing anonymized health information relating to nearly all Israeli citizens.

Ongoing operating costs. Once the ecosystem has been established, its ongoing costs must also be covered. This relates to functions such as basic operations as well as maintenance, software licenses, marketing and personnel. These expenses can also be financed through public subsidies derived from taxes or social contributions. However, alternative funding models could also be considered as a means of complementing the independent basic financing. For example, in addition to traditional subscription models, co-op approaches or innovative models such as corporate profit sharing could prove useful.

  • Subscription models: Subscription models have been offered in the media and online retailing sectors for some time. For a regular fee, subscribers get access to news, streamed TV series or music, or other benefits. Membership fees could make a significant contribution to ongoing service improvements, but at the same time could constitute a financial barrier for users, thus increasing social inequality in access to health information. The consequent downward pressure on user numbers would also undermine the platform’s appeal to providers of health-related information and services.
  • Co-op model: Traditional cooperative financing, which is familiar from the banking, housing and agricultural sectors, is increasingly making its way into the healthcare sector in a modern form. The example of the French Welcoop Cooperative shows how a traditional pharmacists’ cooperative has developed into a digital ecosystem for patients, care facilities, hospitals and the pharmaceutical industry. A model of this kind could also create a sustainable and independent funding source for the national health platform outlined here.
  • Innovative financing models: In models such as brand licensing or corporate profit sharing, a portion of company profits are used to support healthcare initiatives. Options range from investing in research and development to funding programs that increase access to healthcare. In the context of the national health platform, participating companies could reinvest a portion of their profits into the ecosystem. No matter what legal form the platform ultimately takes, the operator and the company would determine together how these funds would be used, in order to avoid undue influence.

Update and expansion costs. Upgrading and expanding an ecosystem includes tasks such as the provision of additional services and interfaces in order to keep the platform appealing to existing users and attract new ones. Financing can be structured in a way similar to that of the initial development and ongoing operation phases (foundations, co-op models), but can also be supplemented by alternative models. The following variants have already been tested in the field:

  • Nonprofit business activities: The platform could pursue supplemental business models that are not primarily connected to its core business. For example, the platform could use its access to data to provide services to healthcare providers, and then use this revenue to fund its own further development.
  • Development on demand: Private healthcare providers that have been able to scale up their services through the ecosystem could also participate in funding platform updates. For example, on the Swiss healthcare platform, called Well, several physician networks are working with the operator to develop an appointment booking and check-in system through the Well app. In order to avoid competing with private-sector providers, the ecosystem operator’s development services could be limited to the platform infrastructure (e.g., interfaces).
  • Transaction fees: Alternatively, private healthcare providers could contribute to the funding stream via the use of their services. For example, they could pay a percentage-based fee to the ecosystem operator – as is done on travel and hotel booking portals – as soon as a service is used.

Another financing approach familiar from the e-commerce sector is the use of premium models, in which users pay for services that go beyond the basic offerings. However, these are less appropriate in the health setting, because (as noted above) they can limit general access to health information, and thus reinforce social inequality.

Creative solutions for sustainable financing

The vision of a national health platform, as is being developed in the Trusted Health Ecosystems project, promises many benefits. It has the potential to promote health literacy, create personalized care options and ultimately reduce healthcare costs. This great economic potential is offset by considerable financial challenges, because financing an ecosystem of this nature will require substantial investment not only to pay for its initial development, but also to cover the costs of ongoing operations and future updates.

The overall scope of these costs will depend on a variety of different factors. A more precise estimation will be possible only after a detailed planning process (see Initial thoughts on the technical structure of the national health platform). However, the financing of a national health platform with a strong civil society component will in any case require creative solutions that are shaped by the financial needs arising from the individual development phases, and which will provide the platform with sufficient financial flexibility.

Ultimately, the choice of funding model will depend on the national health platform’s specific requirements and goals. These include a focus on the common good, independence from special interests, sustainability, transparency and system openness. An integrative approach that combines different funding sources is likely to achieve the best results, while also supporting the ecosystem’s long-term development and ensuring its sustainability.

Bibliography

Eichler K, et al. (2009). The costs of limited health literacy: a systematic review. International Journal of Public Health 54. 313–324.

McKinsey & Company (2022). Digitalisierung im Gesundheitswesen. Die 42-Milliarden-Euro-Chance für Deutschland. URL: https://www.mckinsey.de/news/presse/2022-05-24-42-mrd-euro-chance

Ministry of Health, State of Israel (2018). The Government has approved a National Program for Promoting the Digital Health Field. URL: https://www.health.gov.il/English/News_and_Events/Spokespersons_Messages/Pages/25032018_2.aspx

World Health Organization (‎2019)‎. Interview with Jens Spahn, Federal Minister of Health, Germany. Public health panorama 5 (‎2)‎. 163–165. WHO. Regional Office for Europe. URL: https://apps.who.int/iris/handle/10665/327036

Authors

Sebastian Krolop, MD, PhD, MSc, is an expert with 25 years of professional experience as an emergency physician, and is additionally an economist, strategist and innovator. His areas of expertise include the transformation and financing of digital technologies in international health systems. He served as a board member of the Healthcare Information and Management Systems Society (HIMSS) in Chicago, IL, United States, where he oversaw areas including strategy, operations, startups and the company’s own digital ecosystem platform, called Accelerate. Previously, he was partner and industry lead for life sciences and healthcare at Deloitte. Krolop is the author of the annual Krankenhaus Rating Report, and has contributed as author and co-author to more than 40 books with a focus on the financing and digitalization of health ecosystems.

Dr. Marko Queitsch studied industrial engineering, and earned his doctorate in business management. He has conducted research as an economist on digital communication issues in healthcare, and has developed digital health solutions in the private sector. As head of business development for Weisse Liste gGmbH, a wholly owned subsidiary of the Bertelsmann Stiftung, he designs nonprofit business and financing models. In addition, he supports the Bertelsmann Stiftung’s Trusted Health Ecosystems project in the key areas of operating and financing models, as well in data and software architecture issues.

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    National health platform: Governance and legal framework

    Transcript

    Intro

    In principle, establishing and developing a national health platform on the basis of an existing legal framework is a feasible option. However, given the innovative nature of the platform and the diversity of its anticipated tasks, it seems advisable to create a new legal structure, or perhaps even multiple ones, for its operational framework.

    What factors should be weighed when selecting the appropriate legal structure?

    When determining the legal framework for the national health platform, it is important to consider what features the platform should have. This is because German corporate law specifically provides for a wide variety of legal forms, each carrying its own set of advantages and drawbacks. In any case, it’s important to ensure the platform’s operational capability. Whatever the chosen legal form, it should grant the platform a legal personality, thus enabling it to bear rights and responsibilities.

    It should also be aligned with the platform’s mission statement, which targets the common good, as opposed to purely profit-driven objectives. Here, too, the German legal context provides for legal structures that are more or less committed to this ethos.

    Finally, and perhaps most importantly, the chosen legal form should provide flexibility. The platform is expected to take on evolving roles and tasks, some of which may not be clearly defined at its inception. Furthermore, the selected legal framework should facilitate collaboration between both private and government organizations within the platform.

    Which organization could assume responsibility for the platform?

    In principle, establishing and developing a national health platform on the basis of an existing legal framework is a feasible option. However, given the innovative nature of the platform and the diversity of its anticipated tasks, it seems advisable to create a new legal structure, or perhaps even multiple ones, for its operational framework.

    What are the pros and cons of a private-law versus public-law form of governance?

    Publicly governed legal structures are typically accessible only to governmental entities. In other words, not everyone can opt for such a legal framework but, rather, only entities at the federal, state or municipal levels of government. While public legal structures do come with certain privileges, including advantages in financing and decision-making processes,

    these privileges also entail certain drawbacks. Most notably, these kinds of legal structures tend to be less adaptable and flexible. This means that when such projects take on new responsibilities, adjustments must be made to their legal basis. Furthermore, public and private actors cannot easily collaborate under the umbrella of a publicly governed legal structure.

    What recommendations can be derived from this for the organizational framework of a national healthcare platform?

    It’s important to choose a legal form for the national health platform that provides for operational viability, that is, a form that grants the platform a legal personality. Publicly governed legal forms seem to be less suitable for such a platform. Instead, privately held legal structures, which confer legal personality, seem preferable. Another option might be to allocate different platform responsibilities or business domains to distinct entities or businesses, each of which adopts the appropriate legal form. These companies can then, in turn, be brought together under the common umbrella of a holding company.

    Disclaimer

    The statements made in this interview are relevant exclusively to the German legal context. They offer a framework for guidance and should not be interpreted as providing legal counsel beyond the scope of the Trusted Health Ecosystems project.

    Content

    Expert

    While completing her doctoral studies, Prof. Dr. Laura Schulte gained experience in the field of constitutional law as a research assistant. Her doctoral thesis focused on data protection law, and she conducted further research on this subject at various institutions, including the Queen Mary School of Law in London. From 2020 to 2023, she was employed as an attorney at BRANDI Rechtsanwälte in Bielefeld, specializing in IT and data protection law. Since August 2023, she has held the position of professor of business law at the Hochschule Bielefeld.

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      National health platform: The state as a provider of information

      Transcript

      Intro

      If we view the national health platform as a central node of a network that involves government actors, it must adhere to the legal criteria governing state bodies.

      What constitutes government public service messaging, and how does it relate to the concept of a national health platform?

      Essentially any form of activity by which the state communicates information to the public can be regarded as a form of government public service messaging. This can include, for example, providing informing about specific topics such as certain medical conditions or endorsing behaviors like walking 10,000 steps a day. It also involves issuing warnings about certain products, like the use of specific medical devices. And it doesn’t necessarily matter which government agency is the source of this information. It could come from a federal ministry, a state or regional parliament, or a local government agency.

      Why is government public service messaging subject to specific legal requirements?

      The state’s activity in terms of providing information to the public is subject to distinct legal requirements because government entities typically have access to significantly different kinds of resources for their informational activities compared to privately owned businesses. Government agencies usually attract a great deal of public attention when issuing information and enjoy a certain degree of authority and trust, particularly among patients.

      This means that when, for instance, a federal ministry issues a warning about the use of a specific medical device, this effectively functions as a ban on that product. Citizens are much less likely to purchase the device if the government has officially cautioned against it. In practical terms, government public service messaging can significantly influence market dynamics. It can, for example, impact other providers of digital healthcare services’ fundamental right to occupational freedom.

      What guidance can be extrapolated from this for the governance of a national platform?

      If government actors are to participate in the national health platform, the platform will need to comply with the typically stringent legal requirements that are applicable to state entities. As a rule, this will involve establishing a legal framework. Even if product warnings are not the main focus of the project, the fundamental rights of providers of digital healthcare services could plausibly be affected by such an undertaking.

      This suggests that the national health platform should be run by a non-governmental organization such as a civil society organization that enjoys more flexibility. And this wouldn’t need to rule out public funds as a source of financing, as public financing doesn’t necessaeily dictate that the chosen governance or ownership model be based in public law.

      Disclaimer

      The statements made in this interview are relevant exclusively to the German legal context. They offer a framework for guidance and should not be interpreted as providing legal counsel beyond the scope of the Trusted Health Ecosystems project.

      Content

      Expert

      While completing her doctoral studies, Prof. Dr. Laura Schulte gained experience in the field of constitutional law as a research assistant. Her doctoral thesis focused on data protection law, and she conducted further research on this subject at various institutions, including the Queen Mary School of Law in London. From 2020 to 2023, she was employed as an attorney at BRANDI Rechtsanwälte in Bielefeld, specializing in IT and data protection law. Since August 2023, she has held the position of professor of business law at the Hochschule Bielefeld.

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      To contact our project team, please use our form. We look forward to your message and will get back to you as soon as possible.


        What can we learn from international platform solutions?

        Transcript

        Intro

        How do we create ecosystems that improve the public’s health literacy and promote prevention?

        How do we establish trust in a digital platform?

        In my opinion, it’s important to state how you go about establishing and building trust. This involves two things: For one, there’s clarity. What purpose does the ecosystem serve for citizens? And on the other, it’s important to establish transparency.

        Estonia stands as a notable example, in my opinion. They’ve legislated the specific purposes for which healthcare professionals can access health data, specifying when it’s permissible and when it’s not. They’ve also embraced transparency by allowing citizens to log in to their profile through the Estonian Central Health Information System and Patient Portal to track who has accessed their data.

        What additional elements are necessary to make a healthcare platform appealing?

        Utility is the key element. In the context of health platforms and health ecosystems, the focus is often on creating services that provide added value to both patients and citizens, as well as healthcare providers, such as nurses, caregivers, doctors and more.

        These services are often linked with each other, with a single service benefiting both citizens and healthcare providers.  It’s therefore crucial to develop these services with a user-centric approach and involve users and stakeholders from the outset. Ideally, this approach leads to the creation of a service that benefits multiple stakeholders and operates effectively and efficiently for those providing the service.

        Denmark serves as a compelling example in this context. They actively engage user panels, conduct user interviews and surveys, and collaborate with citizens and healthcare providers to co-create services. This leads to the development of services that not only deliver value but also, due to effective and efficient management, enhance user engagement.

        What objectives should a national healthcare platform strive for?

        The ambition could revolve around establishing ecosystems that boost the health literacy of the population, simplify preventive measures, empower individuals to manage chronic illnesses effectively, and ideally, free up healthcare providers to spend more time with patients and less on administrative tasks. An important concept to consider is the creation of open ecosystems, where third-party providers can offer their services within the ecosystem, insofar as they meet specific quality, transparency and security criteria.

        Israel has successfully implemented such an open ecosystem, with two noteworthy facets. First, health data exchange allows one doctor to access previous treatment information, which facilitates more informed decisions and improved patient care. Second, the involvement of third-party providers within the ecosystem, including startups and healthcare companies, fosters innovation on a national scale. This can prove to be a real boost to the country’s innovation advantage by bundling the innovative power of healthcare companies in creating a platform that makes innovative healthcare solutions more readily accessible to citizens.

        Content

        Expert

        Dr. Tobias Silberzahn holds a doctorate in biochemistry and is a Partner at the Berlin office of McKinsey & Company, Inc. His work focuses on healthcare innovation and the digital transformation of healthcare. Tobias also leads the global Health Tech Network, which brings together more than 1,800 health tech CEOs and founders, along with 250 investors and 300 corporations. He is co-publisher of the annual “eHealth Monitor,” a publication distributed by MWV publishing house that focuses on the digitalization of the German healthcare system. Within McKinsey, Tobias also co-manages a comprehensive health and well-being program that encompasses aspects such as sleep, nutrition, fitness, and stress management.

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          Disinformation in the healthcare sector: Using platforms to combat the infodemic

          Transcript

          Intro

          How can we better distinguish good information from the bad? There’s a whole range of things that platforms can do to take a bit of the work off people’s shoulders.

          Where does misinformation and disinformation on healthcare topics originate?

           Disinformation comes from many, many different sources. If we think back to the pandemic, WHO declared an infodemic in addition to the pandemic, in addition to the health crisis. That means that in addition to the coronavirus, we also had an information crisis.

          And we remember, for example, that some disinformation came to us directly from the White House, for instance when Donald Trump recommended at the time that we drink bleach to combat COVID-19. The same thing happened in Brazil with Jair Bolsonaro. So to some extent, it is governments that have spread disinformation.

          But that’s not the only source. It can come from social media, from people who are uninformed but still spread their opinions. It can come from family WhatsApp channels. And it can even come from journalistic sources, if maybe some newsrooms don’t have enough reporters with health expertise, or don’t have a science team that can work with clinical studies and present them in a comprehensible way.

          In this respect we’ve had a lot of uncertainty, especially during the pandemic, especially in Germany. We remember AstraZeneca and the debate around the vaccine, for example. This means that populations may be uncertain about things, and not well informed. You can easily look at that internationally, and see which countries were very well informed, and which didn’t have much disinformation at all, and where there might have been a particularly great amount of disinformation. You can look at what criteria allow communication spaces to be filled with disinformation, or ensure that trustworthy information travels from A to B.

          How can the healthcare system effectively combat disinformation?

          Ugh, where should I start? The hard thing about the topic of disinformation is that it’s a very holistic issue. What I mean is, you have to address many things all at once. I’ll give you an example. Take Facebook’s timeline. I’m on my Facebook timeline now. That means, two important factors determine whether I have a good information space or a bad information space. And these two factors are, on the one hand, the platform’s algorithm and the issue of how these algorithms work, what content is pushed to the top, what might be particularly strongly promoted, or just ranked lower.

          On the other hand it’s me, the user, who is sitting in front of the screen and has to decide what channels I’m going to follow. Both of these parameters are very important. We know that the platform’s algorithms aren’t particularly good, and that users’ information literacy isn’t very strong either. The whole thing can only work if we have more regulation, for example, by which I mean sensible provisions that regulate the conditions under which these algorithms are allowed to operate at all.

          This is ultimately a task for society as a whole, in which all elements of society really have to do their part to ensure we have a better and more resilient information ecosystem. This also applies to the healthcare sector, and to the actors who are communicating in it. And it raises the question as to whether they have enough training to be disseminating health information,  on social media, for example. And what actors in the sector might be playing a role in which they’re more likely to spread disinformation? What groups exist, maybe coming from alternative medicine communities, that are then playing a big role in spreading it there? In this regard, there are many things that have to happen at the same time for the information environment to improve.

          Content

          Expert

          Alexander Sängerlaub is the Director and Co-founder of futur eins. He takes a holistic approach to digital public spheres and explores how the utopia of an informed society can be achieved. Previously, he helped establish the “Strengthening Digital Public Sphere” department at the Berlin think tank Stiftung Neue Verantwortung, where he led projects on disinformation (“Fake News”), fact-checking, and digital news literacy. He studied journalism, psychology, and political communication at the Freie Universität in Berlin.

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            Unlocking success in digital ecosystems

            Transcript

            Intro

            The true appeal of an ecosystem lies in the extensive reach of its participant base.

            What factors contribute to the success of digital ecosystems?

            Creating value, incentives and motivation is particularly important in digital ecosystems because they operate differently from traditional business models and rely on multi-sided markets. A prime example of such a market is provided by Airbnb. Here we have Airbnb, the company itself, but there are also those who offer private accommodations, and then, on another side, there are the consumers, the travelers who use these accommodations.

            All participants interact on this ecosystem voluntarily; no one is coerced. And that’s why, of course, you have to create incentives to entice as many people or organizations as possible to participate in the ecosystem. The true appeal of an ecosystem lies in the extensive reach of its participant base.

            Could legal mandates compel actors to participate?

            Mandating certain actors to participate in a digital ecosystem is definitely not a good idea. In scenarios where participation is compulsory, as is the case with other business models, individuals often find ways to participate only superficially or, in a worst-case scenario, disrupt the operation of the digital ecosystem.

            Successful digital ecosystems have thrived by providing ample incentives to attract participants willingly. When participants engage of their own accord and see the value in their participation, that’s when the ecosystem truly flourishes.

            How can we harmonize the diverse interests of all participants?

            While the national health platform primarily serves patients, it also benefits from the involvement of other groups. Of course, conflicts of interest may arise from time to time. That’s why resolving such conflicts among all participant groups is absolutely critical to the holistic design of a digital ecosystem and thus of the national health platform. This ensures that patients’ goals are actually met while safeguarding the interests of other participant groups.

            What does a holistic design process entail?

            The holistic design of digital ecosystems involves assessing the consequences of every decision made during the design process on all participant groups. This assessment encompasses three viewpoints: the business implications, the technical implications and the legal implications.

            Success here depends on ensuring that representatives from all participant groups are involved in the process from the very beginning.  To ensure clear communication with these representatives, we use concrete scenarios, prototypes and real-world examples for illustration purposes. This helps us find the right language in our communication with each target group. The challenge lies in managing the design of the entire system across various levels of abstraction while preserving a comprehensive overview that can be aptly conveyed to all participant groups.

            Content

            Expert

            Dr. Marcus Trapp, co-founder of Full Flamingo, an eco-tech startup, aims to leverage the power of the platform economy for the greatest possible impact on sustainability. Before 2022, he held a senior executive position at Fraunhofer IESE, where he played a pivotal role in developing and overseeing the field of “Digital Ecosystems and the Platform Economy.”

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              Digital ecosystems: an opportunity for healthcare

              Transcript

              Intro

              While there are risks of international players dominating the German and European markets, for the healthcare sector, it’s particularly important that we establish a digital ecosystem rooted in European values.

              What opportunities does a national healthcare platform present?

              I firmly believe that we should embrace the concept of a national health platform because anyone who has ever sought reliable health information online knows that it’s no simple task.

              Likewise, those who have ventured into the realm of digital healthcare services are well aware of the challenges – it’s not a straightforward, simple, direct or swift process. We are resolute in our belief that a digital ecosystem capable of enhancing information dissemination and expediting transactions can be successfully applied to the healthcare sector.

              The reality is that such a digital ecosystem does not currently exist. We therefore have a unique opportunity to lead the way, not only in Germany but also far beyond its borders. And we also have the chance to set a positive precedent for a government-led digital ecosystem, breaking new ground in the process.

              What if our healthcare systems fail to take action?

              If our national healthcare systems fail to take action, we will undoubtedly have missed a significant opportunity. In the healthcare sector, the established players have not yet achieved dominance, leaving us an opportunity to shape the entire system based on European values. However, it is highly likely that tech giants will enter this field simply because it is so highly lucrative and intriguing for them.

              Merely establishing a digital ecosystem with basic functionality will not  prove sufficient. To be competitive, we must create a digital ecosystem that is user-friendly, genuinely valuable, and is quick and convenient to use.  Thsi is the only way we can be competitive and hold our own against the international tech giants.

              How did you envision a competitive platform?

              We used our proven ecosystem approach to design the national health platform. Together with a team from the Bertelsmann Stiftung, we focused on identifying the core element of the ecosystem we are developing here: communicating reliable health information.

              We played out this communication of reliable health information through a concrete, comprehensible scenario and continuously evaluated it with participants from various groups. We adapted and refined it as needed, presenting it in formats conducive to productive discussions with these groups. In doing so, we sidestepped a common pitfall observed in other contexts, where abstract, feel-good visions with seemingly boundless possibilities fail to account for challenges.

              Why did you choose to illustrate these specific scenarios using toys?

              Yes, we actually used Playmobil cars and Playmobil figures. We applied the Tangible Ecosystem Design (TED) method developed at Fraunhofer IESE.

              This involves using the ecosystem method, specifically the TED method, to model the entire ecosystem. This allows us to delineate roles within the ecosystem, identify interactions and define relationships.

              What makes designing a health platform special?

              Yes, while designing the national health platform, we things that distinguish it from other ecosystems we have observed across various sectors. First of all, of course, the intended target audience – patients – is an exceedingly large group. Health is vital for everyone. And the number of participant groups is significantly higher than what we have observed in other ecosystems.

              Then, of course, we have the unique situation in the healthcare sector, where significantly more regulations are in place compared to other domains. Naturally, this also has an impact on the design of the digital ecosystem within the national healthcare platform. Finally, we should highlight a key distinction, namely that with a national healthcare platform, we have a governing body that is primarily oriented toward avoiding an undue emphasis on financial interests.

              Content

              Experts

              Dr. Matthias Naab and Dr. Marcus Trapp, co-founders of Full Flamingo, an eco-tech startup, aim to leverage the power of the platform economy for the greatest possible impact on sustainability. Before 2022, they held senior executive positions at Fraunhofer IESE, where they played a pivotal role in developing and overseeing the field of “Digital Ecosystems and the Platform Economy.”

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              To contact our project team, please use our form. We look forward to your message and will get back to you as soon as possible.


                National health platform: Editorial content creation

                Transcript

                Intro

                The national health platform’s purpose should be to enhance, not replace, existing information services.

                Who bears responsibility for the content on a national healthcare platform?

                When it comes to the question of who bears responsibility for the content provided on a national health platform, it comes down to the nature of the content in question. The platform operator is initially accountable for their own content. However, if the platform operator assumes responsibility for third-party content –  by evaluating it before making it public or by expressing a willingness to take on such responsibility – then the platform operator may be held accountable.

                If an entity other than the platform operator assumes responsibility for assessing content before it is published, this might require a different legal assessment. In such cases, it’s possible that the platform operator could be held liable or share the responsibility for external content. This means that the platform operator must establish a mechanism for users to report false or unlawful information.

                How should the creation of original content be assessed from a competition law perspective?

                Evaluating the creation of original content for a national health platform in terms of competition law is complex, especially when government actors are involved. In principle, government initiatives should only be introduced when a form of market failure is evident. This means either insufficient information is being communicated or information in the healthcare sector is not being adequately transparent.

                Past experience has shown that digital healthcare service providers are quite capable of meeting this demand. The national health platform’s purpose should be to enhance, not replace, existing information services. This should benefit not only users but also providers of digital information services in the health sector.

                What insights can we gain from this for the platform’s content strategy?

                When it comes to shaping the national health platform’s content strategy, it’s important to bear in mind that creating or asserting ownership of content and disseminating it can be, in terms of competition law, challenging to justify, especially when government bodies are involved in the project. In this context, it seems preferable to prioritize the distribution of third-party content, meaning content generated by civil society or private-sector organizations. The providers of such information should be given fair and transparent access to the platform.

                Disclaimer

                The statements made in this interview are relevant exclusively to the German legal context. They offer a framework for guidance and should not be interpreted as providing legal counsel beyond the scope of the Trusted Health Ecosystems project.

                Content

                Expert

                While completing her doctoral studies, Prof. Dr. Laura Schulte gained experience in the field of constitutional law as a research assistant. Her doctoral thesis focused on data protection law, and she conducted further research on this subject at various institutions, including the Queen Mary School of Law in London. From 2020 to 2023, she was employed as an attorney at BRANDI Rechtsanwälte in Bielefeld, specializing in IT and data protection law. Since August 2023, she has held the position of professor of business law at the Hochschule Bielefeld.

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                  Initial thoughts on the technical structure of the national health platform

                  Dr. Matthias Koch

                  The software architecture of a digital platform illustrates its structure, but also offers information regarding expected costs and the technical feasibility of certain requirements. In the case of the national health platform outlined here, the architecture will follow the basic pattern of other intermediary platforms, but can be elaborated in detail only once all requirements necessary for implementation have been defined and all open questions conclusively answered. During the concept development stage, some questions were deliberately left unanswered so as to provide flexibility and avoid building any premature decisions into the process. However, the conceptual decisions already made, along with the determination of roles and tasks of the platform in the digital ecosystem, make possible an initial overview of the required components and their interactions.

                  Based on the preliminary conceptual considerations (see Conceptual considerations: an overview), system boundaries can be identified that clarify what lies within the scope of the national health platform, as well as which directly neighboring systems are to be connected via interfaces. However, the considerations described here do not represent an implementation-ready software architecture that already encompasses all relevant architecture drivers and technological aspects. Their identification and refinement will be the subject of further conceptual work.

                  Participating ecosystem actors

                  The focus here is on the national health platform as a technical backbone brokering context-specific digital health information and services. The platform has the task of providing the essential functions needed to manage users and content. It also constitutes the technical link between the various ecosystem actors. Apart from the platform operator, these actors include:

                  • Providers of health information – for instance, information on diseases, prevention, health care structures and so on, in various formats.
                  • Providers of health-related services – for instance, online appointment scheduling, hospital search tools, pain diaries, etc.
                  • Providers of contextual information – personal information that provides clues regarding patients’ situational information needs.
                  • Developers of pathway models – indication-specific templates describing the expected trajectory of informational needs, along which specific health information is presented to individual patients as it becomes relevant.
                  • Patients

                  The platform and its interfaces

                  The core task of the national health platform is to relay health information and health-related services to the right people at the right time. This will usually be triggered by events, for instance a visit to the doctor or the expiration of a time period such as “six weeks after taking sick leave.” Such events will in turn be derived from incoming contextual information, which triggers the national health platform to deliver the appropriate information and services to patients along one or more currently relevant pathway models (see Conceptual considerations: an overview). This core functionality of brokering health information and services requires a number of interfaces, which are presented below:

                  • Interface for the inclusion of health information: This interface makes it possible to store health information on the platform so that it can be associated with patients’ situational informational needs based on certain characteristics and made available in a personalized feed (see Discover more, search less – prototype of a national health platform). In addition, this information can be retrieved via a semantic search.
                  • Interface for the inclusion of services: The inclusion of services is analogous to the inclusion of health information. Services are also made available to patients on a situational basis.
                  • Interface for the inclusion of individual contextual information: The transmission of individual contextual information about patients requires interfaces that allow for automated communication between systems. The exchange of data via these interfaces takes place exclusively on the basis of patients’ differentiated consent, as given to the provider of this contextual information; this could include the electronic health record (ePA) or various providers of fitness and health data. At the interfaces for the transfer of contextual information, the platform can check whether user consent has been given before allowing the transfer to take place. Different contextual information from different providers may require customized interfaces in each case, with the national health platform subsequently harmonizing the incoming data.
                  • Interface for managing pathway models: The templates are created via a graphical user interface and stored on the platform. The same interface can be used to manage, revise and improve pathway models. Likewise, it facilitates collaborative modeling involving multiple creators.
                  • Interface for patients: Patients access the functionalities of the national health platform via a graphical user interface – for example, in the form of a website or app for mobile devices – most typically to obtain health information or access health-related services. Additional access methods other than this traditional interface can be used, especially voice-based user interfaces. Patients are authenticated via the healthcare-sector digital identity planned for inclusion in the Telematics Infrastructure 2.0, which ensures that all data can be associated reliably with specific patients, and accessed only by them.

                   

                  Interface for the inclusion of health information

                  Health information is made available by certified providers by means of a dialogue-based process. This helps the various providers submit their information to the platform in such a way that it can be linked to pathway models and displayed to patients or found by them via a search. The actual content – such as an informational text or a video – is not transferred to the platform in this process, but remains with the provider. Instead, a link is created and enriched with metadata such as the date of creation or the sources used.

                  The health information is transmitted to the national health platform through the previously mentioned interface. This interface can be implemented in two forms. On the one hand, the platform itself can provide a graphical user interface. This website or application would be usable by health information providers, and would support them in submitting their information and entering all the necessary details.

                  On the other hand, this interface can also be designed to accept data from other systems without any active intervention by users. This requires supplementary interfaces on the part of the health information providers, specifically in the content management systems within which the information is originally prepared. These systems transmit authorized information to the platform. This has the advantage that providers do not have to engage with an additional system, and can remain in their familiar working environments.

                  Interface for the inclusion of health-related services

                  Health-related services are handled similarly to health information. This means that certified providers will be given support in linking their services to the national health platform. As with the health information, the services are not transferred completely to the platform. Rather, a linking strategy is used: The platform receives a reference to a service, including descriptive metadata, in order to display this to patients along a pathway model.

                  Interface for the inclusion of individual contextual information

                  Throughout the healthcare system, various actors accumulate contextual information that sheds light on patients’ situational information needs. Capturing this in a uniform format aligned with existing standards is critical to the success of the national health platform. I will discuss one such possible standard below. The basis for this uniformity is the interface specified by the platform, through which third-party systems transmit data. Currently, the most important data provider is Gematik, the state digital agency, which bundles all the data that doctors’ practices, pharmacies and clinics pass on via their various administrative systems in the form of the electronic health record.

                  The interface should allow the integration of other sources of contextual information in addition to the electronic health record. This could include health insurance companies or health data platforms such as Google Health or Fitbit, for example. Assuming that patient consent has been secured, the various actors would transmit this data to the national health platform. Since the exact formats of the data from the different providers are not yet known, it is likely that different types of interfaces will be offered for various groups of providers. As a result, the data may subsequently be harmonized on the national health platform.

                  The interface outlined here is utilized by a number of systems. It is not used by patients themselves, and does not provide a graphical user interface, since individual contextual information is automatically generated and transmitted by the information providers. In the absence of automation, it would not be feasible to keep such a large quantity of data sufficiently up to date. Nevertheless, this interface must also contain authentication mechanisms, thus ensuring that only authorized systems can transmit their data to the national health platform.

                  Interface for pathway model management

                  Creating models for patient information pathways requires expertise regarding the trajectory of patient informational needs and knowledge of the typical stages of a disease. For this reason, the templates are created exclusively by certified actors (see Conceptual considerations: an overview). At the same time, pathway models are expected to be complex, making it useful to have a visualization. The graphical user interface for interacting with pathway models will be accessible on the national health platform to appropriately certified stakeholders or their institutions.

                   

                  Interface for patients

                  Finally, we consider the perspective of the patients, who are presented with relevant health information and services based on their individual contextual information. They use the platform’s user interface to access the digital ecosystem in order to obtain information and services relevant to them along pathway models or – based on their individual needs – to search for information and services of verified quality. In addition, to ensure respect for data privacy, patients are given the ability to control how their data is used. This can be done via a privacy dashboard, such as the one being developed and tested in the D’accord research project (https://daccord-projekt.de).

                  Patients are authenticated via the digital identity provided for in the Telematics Infrastructure 2.0. This authentication facilitates the link to personal data from the electronic health record, which could serve as a primary source of contextual information, especially at the outset. In addition to this avenue of access, other mechanisms can be created to engage patients in the digital ecosystem. For example, authorized service providers might send SMS text messages that allow for direct links to the national health platform’s user interface.

                  Further conceptual steps

                  The final selection of suitable frameworks and technologies should be based on a requirements analysis and a detailed architectural design that expands upon and refines the broadly sketched requirements identified thus far. Non-functional requirements must be given special consideration in this regard. The topic of IT security was addressed in the previous section. Performance and scalability are also extremely important, as high user numbers can be expected, given that the platform is to be available to all patients in Germany. The large number of users means in turn that there will be a very large inflow of data to be processed by the platform. Given such loads, the technologies selected for implementation and the underlying infrastructure must allow for scaling.

                  Another essential non-functional requirement to be considered is the user experience (UX). Since the national health platform is open to all patients, and should be easy to use for everyone, consideration must be given to the special needs and preferences of different user groups, some of which are particularly vulnerable. These include elderly people or patients with a cognitive impairment, for example. Special attention should be paid to these groups during the design process.

                  The requirements analysis also determines the platform’s additional functionalities, including user and authorization management, pathway model management, and the instantiation of pathway models for patients. This refers to the assignment of specific health information and services to certain individuals, and their display via the platform, based on those individuals’ contextual information.

                  Framework for deployment and hosting

                  The core of the national health platform is the software itself, which must be made functional via distribution to one or more servers. This process is called “deployment.” In addition, it is required to operate the runtime environment for the software, which is referred to as “hosting.” Moreover, the platform will process or convey large quantities of data, ranging from user data and identifiers to links to health information and services to contextual information. Some of this must be present on the platform itself in order to be processed appropriately. All this data must also be stored, or hosted, on one or more servers.

                  The hosting of the platform and all stored data must of course be carried out in a technologically state-of-the-art way. This means that data handling must comply with the requirements of the General Data Protection Regulation (GDPR), and in the case of health-related data, with the requirements of the special protective measures defined by the GDPR. As the platform’s IT architecture is further refined, a number of decisions must be made regarding deployment. For example, a number of issues must be resolved, including which parts of the overall system are to be deployed where, and how this is to be done; and which organizational units are to be responsible for hosting them in each case. For example, the software hosting can be separated from the data hosting, with security measures put into place on both sides. Monitoring data flows on both the software and database sides and physically separating the servers will make it more difficult to compromise the system as a whole. Measures of this kind would help achieve a higher level of security and data-handing reliability

                  Specific analyses of potential attack scenarios are additionally needed in order to protect the national health platform. These must be carried out as the software architecture is designed. In principle, one goal should be for the hosting, including the storage of backups, to take place in Europe. Moreover, this should be handled by an entity recognized within the healthcare sector as being trustworthy.

                  Event-driven architecture

                  Health information and services are largely provided using the push principle – that is, patients receive the information relevant to them along the pathway models without having to take action themselves. Regardless, patients can also use a traditional search function. When matching search hits to queries, the platform can use all available contextual information to display matching results. This information can be used to create an individually tailored ranking of search results analogous to that provided by established search engines. In contrast to these, however, the national health platform can as needed report transparently on what specific contextual information, with which weighting, has led to a particular ranking of search results. This helps to gain the trust of both patients and the providers of health information and services.

                  A system like the national health platform outlined here can be technically represented using what is called an “event-driven architecture.” An architecture of this kind focuses on the communication between different components in the overall system that takes place as events occur. Each event is triggered by an event producer, and is then processed by an “event handler.” This technical subsystem determines the subsequent actions based on the producer, timing, type and content of the event – for example, it may determine the appropriate health information to display to a patient.

                  Event-driven architectures are an established concept in software engineering, with a number of technical frameworks already in existence that can facilitate implementation. The Apache Kafka message broker (https://kafka.apache.org) offers one such example of a possible implementation strategy. Apache Kafka is a versatile technology that does not incorporate domain-specific features. In contrast, frameworks also exist that incorporate or define specific standards and functionalities for handling health-related data. Stanford University provides an open source framework for building healthcare-sector ecosystems called Spezi (https://github.com/StanfordSpezi). This framework defines an architecture that facilitates the exchange of health-related data with other systems by implementing the HL7®-defined FHIR® standard for the exchange of health-related data (https://www.hl7.org/fhir/). It would be conceivable – after an in-depth analysis of the requirements and the framework – to build selected parts of the platform on Spezi.

                  Feasible and open to new ideas

                  The considerations presented here regarding the technical implementation of a national health platform outline the basic functionality and establish the technical feasibility of the concept. At the same time, we show that the “brokering” model – that is, the provision of health information and services based on patients’ individual contextual information – is feasible. This is especially true if the platform can build on standards and open-source frameworks such as Stanford’s Spezi, as this can reduce effort and costs while decreasing dependence on proprietary solutions.

                  In addition, according to the concept, the national health platform is limited at its core to serving as an intermediary for the brokering of relevant information and digital services. This means the platform itself does not engage in the editorial creation of health information, the development of services or the acquisition of individuals’ contextual information. This constellation, which is typical of digital ecosystems, makes it possible to distribute responsibilities, and thus focus resources on quality assurance and the automated presentation of relevant information and offerings to patients.

                  The remarks in this paper deliberately do not specify a specific system architecture, and do not offer any preliminary technical definitions. The final determination of the appropriate architecture and technologies to realize the platform and its interfaces will be made after the functional and non-functional requirements have been worked out in detail and documented.

                  Author

                  Dr. Matthias Koch is a software engineer at Fraunhofer IESE, where he heads the Digital Innovation Design department. He has been designing innovative software solutions since 2012, with clients from the business community and in research projects. He has focused in particular on the areas of requirements and user experience engineering, as well as on the implementation of innovation workshops. Koch’s work involves the design of methods and tools for building digital platforms, especially in the area of digital ecosystems.

                  Recommendations

                  Discover more, search less – prototype of a national health platform

                  The core service of the national health platform outlined here is to provide personalized information pathways that adapt to changing information needs and have the capacity to facilitate the handling of health-related information. To illustrate our concept, we have developed a prototypical design that shows what this platform might look like one day. Increasingly, patients are using the internet to gather information from sources beyond the traditional healthcare system. Currently, they rely primarily on major search engines for this task.

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                    Conceptual considerations: an overview

                    Our vision of a national health platform foresees a trustworthy information architecture within the healthcare sector that aims to streamline the management of health-related information and render top-tier information and data more readily available.  This contribution offers a bird’s eye view of the digital ecosystem we’ve envisioned and outlines the key stakeholders, roles and processes involved.

                    The core service provided by this ecosystem is a customized compilation of quality-assured information and services that are tailored to individual information needs over time (see Discover more, search less). This service helps ensure that patients receive information that is pertinent to their needs when they need it. By consolidating a variety of content from accredited providers, the platform curates trustworthy information and services. Tailored to users’ individual contextual factors, the curated information and services are further refined to cater to specific situational support requirements (see Without context, everything is nothing).

                    This process-driven guidance, coupled with tailored-to-the user information and service offerings, not only fosters well-informed decision-making but also advances health literacy, thereby making a substantial contribution to personal health management (see Health literacy and infodemics). However, making this product vision a reality requires more than simply providing a technical platform equipped with algorithmic systems. Above all, it requires the constructive, collaborative engagement of the full array of relevant actors and players. Collectively, they constitute the digital ecosystem in which the national health platform operates. They target shared objectives and benefit from the rewards of their collective engagement (refer to Benefit model for a national health platform).

                     

                    Brokering trustworthy health information and services

                    A key element of the platform centers on the curation of information and service providers, as well as the brokering of trustworthy health-related information and service offerings. The platform is not designed for the creation of original content. The platform does not engage in generating original content; rather, it excels at cultivating an ecosystem wherein the platform’s initiator and operator do not shoulder the sole responsibility for developing all functions and services. Instead, their focus lies in establishing the framework that empowers partners to seamlessly integrate their services and applications into this ecosystem. Thus, the platform does not autonomously produce content and offerings; rather, it functions as a broker for context-specific health information and services.

                    This “brokering principle” revolves around the role of an intermediary that bridges supply and demand. The “broker” provides the infrastructure and delivers a user-friendly interface, thus facilitating interaction between the two sides. Such platforms often include rating systems, offer recommendations, or contribute to personalized offerings. We’ve applied this approach in our blueprint for a national health platform. The platform thus acts as a broker, connecting providers of health information and digital services on one end with patients on the other. By tailoring the presentation of available options to align with a patient’s specific requirements, the platform enhances its brokering service.

                    Platform operator

                    As a central figure within the digital ecosystem, the platform operator shoulders a range of responsibilities to ensure the seamless operation of the platform. This encompasses the provision of essential technological infrastructure, including software, servers, databases, networks, interfaces, and an array of technical resources. The tasks of a platform operator further encompass delineating platform regulations, fostering connections among participating entities, promoting interactive engagement, establishing a trustworthy space of interactions, and ultimately, expanding and scaling both the platform and the encompassing ecosystem.

                    Given this diversity of tasks and the anticipated scope of the digital ecosystem, the platform operator faces substantial demands. It is imperative that the governing body maintains independence and secures the acceptance of all participating entities. Moreover, it’s crucial to recognize that governmental institutions have limitations, as information activities administered by the state are bound by specific legal prerequisites (see ). Thus, to ensure legal clarity, it is advisable to establish a platform that is rooted in civil society and which is not administered by the state.

                    In the case of the national health platform, it seems advisable to delegate specific tasks within the ecosystem to distinct entities or bodies, conceptualizing the ecosystem as an overarching organization. Effectively managing the governance and operations of this digital ecosystem could involve distributing responsibilities across various organizational units to accommodate the complexity and diversity of roles, functions and tasks. All participating organizations could then be brought together under a non-profit and independently funded holding structure (see Ownership: Public or private?).

                     

                     

                    Information and service providers

                    To consolidate a diverse array of offerings on the platform and harness the innovative capabilities of various stakeholders, the ecosystem should remain open to state-run, civil society and commercial information and service providers, whose role involves contributing their offerings and thus breathing life into the platform. Relevant offerings include not only conventional information portals but also digital services, such as those that allow patients to schedule doctor appointments or locate specialists.

                    A prerequisite for participation in the ecosystem is meeting clearly defined quality requirements that must be demonstrated at the provider level. Our concept thus envisions a certification procedure that focuses on both structural and process quality (see ).  All providers with a valid certificate can add their information and services to the ecosystem. The result is a trustworthy pool of information and services that have been sourced exclusively from verified providers.

                    Pathway Model Creators

                    Searching for trustworthy health information is often no less difficult than looking for a needle in a haystack. The challenge for patients lies in filtering out the information that is truly relevant to their specific situation. The national health platform can provide assistance in this regard by providing personalized information with exceptional precision that is embedded within a structured learning and interaction framework known as a Patient Information Pathway (see ).

                    Within these information pathways, platform users receive customized information and service offerings that are tailored to their specific phase of illness, coping and care (see ). These pathways follow condition-specific patterns or pathway models.  While basic condition-related information is provided with the initial diagnosis, subsequent stages frequently entail assessing specific treatment options. Particularly in the case of chronic conditions, managing the illness often becomes the focal point of attention.

                    By following such patterns, the anticipated trajectories of information needs can be modelled for a variety of conditions. These models can be used to automatically structure information in chronological order, which allows patients access to information they might not have actively sought. This could include pointing them toward legal and social matters relevant to their specific treatment phase.

                    In addition to providers, the ecosystem also needs pathway model creators to design pathway models. This role requires having the expertise to define templates for information and support needs and could be taken up by various decentralized actors, such as professional societies or patient advocacy groups.  These actors can help create a large number of pathway models in a very short period of time.

                    Providers of contextual information

                    While templates structure information, they do not account for where patients stand along their timelines, potential supplementary information needs, or decisions to be made during a course of treatment. Information needs can vary substantially and depend on factors like whether a patient has opted for surgery or a more conservative treatment.

                    In order to provide a truly tailored-to-needs set of offerings and create customized information pathways, pathway models must be adaptable to changing contexts. This could involve using periodic self-reported input from users. However, extensive data collection of such inputs is inconvenient for users, often impractical, and raises the spectre of the search engine problematic. But how can the platform “know” what information its users need in a given moment?

                    The key to delivering a personalized offering lies in factoring in a wide spectrum of contextual information that can be easily and automatically obtained with the individuals’ consent (see ).  Providers of contextual information thus form the third relevant group of actors within the digital ecosystem.

                    Potential sources of pertinent contextual information include electronic health records, which, within an advanced Telematics Infrastructure 2.0, could provide vital insights into the situational information needs of patients. Similarly, the management systems used by hospitals and physicians’ offices, as well as digital health applications or fitness trackers, could serve as sources in this regard.

                    Contextual information is already present in digital systems and would no longer need to be captured through a separate process. Leveraging these resources within the digital ecosystem to personalize health information and services creates a clear benefit for patients by mitigating information overload while improving the quality of information provided.  Contextual information can also be used to proactively inform patients, remind them of tasks, or tailor how information is presented to align with individual preferences.

                    High-quality collaboration

                    A truly user-centered offering can only come to fruition through the collaborative interaction of different types of participants. Providers of information and services, creators of pathway models, and providers of contextual information each bring a crucial element to the functionality of the ecosystem. Just like the pieces of a puzzle, their contributions fit together, creating added value as a whole.

                    In order to instill user trust, the platform must adhere to stringent quality standards. However, given the platform’s openness to a vast number of participating entities, meeting these standards is far from straightforward. A key aspect of quality management is rooted in the aforementioned certification of information and service providers (). Yet, this alone falls short, as ensuring quality must extend across all processes within the ecosystem. Pathway model creators and contextual information providers must also meet clear quality or qualification standards that align with their respective roles.

                    LIV – An easy to use, personalized and trustworthy user interface

                    The synergies created by the variety of actors participating in the national health platform are expected to create significant and tangible added value for patients. Regarding products, there are likely numerous pathways through which these synergies can materialize. To facilitate a shared understanding of what our product vision entails, we have articulated in detail one such pathway and developed a prototypical design that showcases what the national health platform might look like from the patient viewpoint (see Discover more, search less – prototype of a national health platform).

                    Our concept envisions a platform with a user interface that is tailored specifically to the patient’s needs and is available as an app as well as a website. We’ve named the interface “LIV,” which stands for the German concepts of “leicht” (easy), “individuell” (individual), and “vertrauenswürdig” (trustworthy). LIV is designed to provide optimal support to patients, both proactively and during targeted searches. It’s primary design principle is to mitigate information overload while offering only high-quality information and services. The content provided through LIV is thus highly personalized, and the timing of its delivery is driven by contextual information.

                    If implemented, LIV would be available to millions of people and thus the national health platform’s most visible component. However, the platform would require additional components in order to facilitate seamless interaction among the various groups of actors. For example, the platform would need more user interfaces for ecosystem participants that would allow them to register new health information and services or to create templates for patient information pathways. Integration interfaces would also be needed to connect other IT systems, such as those used by context providers (cf. Initial thoughts on the technical structure of the national health platform).

                    Find, understand, appraise and apply

                    The twin goals of our product concept for the national health platform are to streamline health information management and promote health literacy. Health literacy involves having the skills to find, understand, evaluate and apply health-related information. Research suggests that digital information overload poses a challenge to nearly half of the European population. The core service of the national heath platform we’ve conceived addresses this concern and operates across all four levels of health literacy.

                    Find: Users no longer have to actively seek out pertinent information. Instead, relevant content and services are proactively presented to them. This shift from a “push” to a “pull” communication model offering personalized information streamlines search efforts, preventing users from becoming lost in the sea of information.

                    Understand: The ecosystem defines minimum standards for content clarity and digital application usability. In addition, the complexity of texts can be determined automatically. Users can then select information that is suited to their (self-reported) level of health literacy.

                    Appraise: A cornerstone of the ecosystem is the quality-centric selection of providers of information and digital services. As part of the proposed national-level certification process, providers would be audited at regular intervals. This helps create a trusted space for patients in which the risk of misinformation and data misuse is mitigated.

                    Apply: Information gains practical relevance when it leads to actionable decisions. The personalized compilation of information and digital services makes it easier for users to modify their behavior, make informed choices, and translate knowledge into practice.

                    Additional benefits of the national health platform

                    In addition to its core service, the concept of a national health platform harbors several opportunities to create additional benefits and engage more actors in the digital ecosystem:

                    • Distribution partners: The quality-assured health information and services available on the national health platform could be distributed through alternative channels. These distribution partners might encompass other platforms that specialize in delivering health-related content and services. Other candidates include digital health applications that require curated information and directly integrate it into their solutions.
                    • White-label solutions: In principle, LIV could potentially be provided as a white-label patient interface. Interested partners could incorporate this application into their own offerings and infuse it with their branding. Such a move would further amplify the reach of LIV.
                    • Anonymized data for research: The national health platform processes data that not only benefits patients directly but could generate additional value. By means of aggregated analysis, the provision of fully anonymized data or creation of synthetic data sets, the platform could make a valuable contribution to health services research.
                    • Internationalization: Although conceived for a national setting, the envisaged health platform has the potential for international scalability. Despite differences in healthcare systems, the platform’s principles, roles, and even software could be adapted to suit other national contexts. Over time, an international network of nationally anchored platforms might materialize in which each network adheres to shared standards, exchanges insights and data, and thereby contributes to establishing a global infrastructure of trust.

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                    To contact our project team, please use our form. We look forward to your message and will get back to you as soon as possible.