Without context, everything is nothing

Dr. Matthias Naab
Dr. Marcus Trapp

Patients seeking medical assistance are usually required to answer several questions about their medical history. Physicians ask these questions to narrow the scope of possible diagnoses. This process, referred to as anamnesis, is an integral part of any medical diagnosis, and the contextual information it contains helps treating physicians or clinicians determine an appropriate treatment as a next step. Contextual information thus creates benefits for various areas of our lives. This idea also forms the guiding principle of the concept for a national health platform presented here.

In the field of medicine as well as everyday life, understanding contextual matters is incredibly useful when it comes to solving specific problems or providing advice to others.  When someone asks us for directions to a particular destination, we need to at least know their current location and the modes of transportation available to them. If someone asks us for relationship advice, it’s important for us to understand the current dynamics of their relationship and situation.

A look at the world of IT that surrounds us makes this point even more clear. When we interact with software systems that lack context, they often seem limited. For instance, basic versions of search engines, which lack context, provide vast amounts of results.  Searching for “restaurant” thus leads, among other things, to explanatory texts that define the term “restaurant.” While this might be the correct result for certain search intentions, most people query “restaurant” when they want to know which restaurants are nearby.

When the search engine automatically takes the user’s context into account, the results are suddenly much more meaningful: The user’s current location leads to suggested restaurants in the vicinity. If the software considers additional factors like the time of day or personal food preferences, the results become even more helpful, narrowing down the options to suitable restaurants that are currently open and align with individual preferences. Alternatively, there’s always the option to manually input contextual information, such as the location or the time of the visit.  While such user inputs would also yield good results, they would also increase the effort required.

Search engines are just one example; there are numerous other software applications that, by incorporating contextual information, provide improved results. Examples include navigation systems that continuously require a user’s current location for reliable guidance, fitness trackers that base recommendations on a full set of observed body metrics, or matchmaking platforms that can only offer promising suggestions when traits and preferences are shared.

The wide range of software applications operating with the aid of contextual information, and thus delivering value, has ensured that the overwhelming majority of users are fundamentally familiar with them. These users willingly share their contextual factors with the software systems in order to access individually tailored offerings.

Features that are perceived as intelligent and particularly helpful almost always depend on the utilization of contextual information and fuel the ongoing growth of user expectations. Those aiming to create new successful services thus focus on increasing automation and enhancing user experience by bringing together existing information and contextual data.

Context is the key to real patient benefits

A central objective of the national health platform is to provide patients with trustworthy health information and services that are selected and tailored to suit their current health situation.

The figure below depicts a streamlined image of the national health platform. The platform envisions a process by which information and service offerings are delivered to patients without explicitly incorporating external contextual information.

The national health platform aims to generate the highest possible benefit for patients by offering reliable health information and services that are as relevant as possible to their current health situation. Achieving this goal would require each patient to manually input the necessary contextual information. This solution is simply not feasible in today’s world, as it would create significant user burdens and thus fail to gain any noteworthy traction.  Nonetheless, patient contexts are essential to determining which information and services are appropriate for a specific individual.

The core concept of the platform proposed here is to harness contextual information that is already available in other IT systems (e.g., office management systems, electronic health records, or health trackers) for the selection of information and digital services on the national health platform. This would allow patients to determine which contextual information about themselves that originates with other IT sources can be integrated into their pathway and thus foster an improved user experience.  The resulting quality in outcomes could constitute a strong unique selling point for the platform.

How contextual information leads to specific patient benefits

Services and information that are provided automatically must be highly relevant to an individual’s situation if users are to embrace them. This is why the national health platform aims to embed information within a structured process of learning and interaction that results in a wide range of personalized patient information pathways (see Discover more, search less – prototype of a national health platform).

A patient information pathway refers to a tailored-to-the patient course of interaction in which the services and information offered are aligned with a patient’s unique situation. The customized assistance they receive is thus perceived as beneficial. Given the vast range of potential information pathways, it is not immediately clear, exactly, how this type of support can be generated automatically. Even for experts, making appropriate selections from an immense pool of information and service offerings can be challenging.

The solution lies in a newly created modeling language that enables experts to create pathway models as templates for the information needs that arise during the course of an illness. These pathway models take into account various aspects such as the course of treatment within a specific healthcare system, as well as different phases of disease management and (legal) issues related to benefits.

Pathway Model Creators

Developing such pathway models requires the presence of yet another role within the digital ecosystem: that of the pathway model creators. These creators are experts who draw on the typical trajectories of a condition, its treatment and its management to describe the anticipated information needs for a specific symptom. Employing a community approach here can help create an exhaustive and rapidly expanding knowledge base for the national health platform.

Processing contextual information is essential to the modeling process, as the envisioned trajectory is linked to information needs that can be expected over time. The situations in which patients find themselves, such as having to decide whether to have an operation or not, will determine which health information and services are presented to them. The expertise and experience of a broad range of actors from various scientific disciplines are thus integrated into the information pathways.

This involvement of an expert community is a cornerstone of quality assurance and generates modeled knowledge that can be verified and explained.  Based on information about a given situational context, the modeled templates are adjusted and expanded over time. The combination of human expertise with technology, rather than the implementation of purely AI-based solutions, should bolster confidence in a national health platform.

If implemented, the national health platform would generate and utilize millions of automatically personalized patient information pathways. These pathways, guided by the pathway models, incorporate concrete and patient-specific contextual information to select the health information and services offered at any given time. These pathway models, which are loaded with professional expertise and experiential knowledge, thus form the missing piece in the puzzle that makes it possible to provide customized information offerings to patients.

What is meant by “context,” exactly?

In this article, so far, we’ve used the term “contextual information” in an abstract manner. However, when it comes to using the term with reference to data and information, there is considerable potential for misunderstanding. On the one hand, the specific nature of the data and information under discussion is rarely specified and, on the other, too little is said about intended uses, emerging benefits and the resulting protection needs.  We therefore elaborate here upon the term “context,” offering clarification.

The concept of “context” is used in this article to refer to any information specific to a person’s situation that is available in IT systems and can be used to customize offerings to their needs. Contextual information can include, for example:

  • Basic personal variables: e.g., age, gender, weight
  • Patient preferences: e.g., preferences regarding information providers, preferences regarding information attributes (language, comprehensibility, etc.)
  • Health status information: e.g., symptoms, medication use, utilization of healthcare services.
  • Current information: e.g., on “events” such as a prescription for a new medication, being admitted to a hospital, situational moods and current well-being
  • Information about interaction with the national health platform: e.g., articles already read, feedback on articles

Other types of pertinent information that are not classified as contextual information include reliable health-related information, such as explanatory articles about specific medical conditions. These resources, made available by providers, lack any association with an individual’s personal details.

Contextual information, in the context of the national health platform outlined here, always serves the direct purpose of enhancing benefits for patients. This objective also informs all efforts to protect this data.

Contextual information in trusted hands

In principle, there are a variety of actors in the market that could establish a digital ecosystem and, with the consent of patients, aggregate and process their specific contextual information within a platform. However, each platform operator will certainly bring their own values to the design of their platform. While conceptualizing the national health platform proposed here, we thus emphasized the need to establish a trustworthy institutional structure that handles sensitive contextual information responsibly. (see Successfully establishing health ecosystems – models from abroad)

Contextual information should always be processed for the sole purpose of delivering better user experiences and improved information and service offerings. This is the core focus of the platform; these pieces of information are therefore not retained indefinitely or used for other purposes. Unless data use has been explicitly authorized for other purposes, the data is only stored for as long as necessary to fulfill its intended purpose.

Patients should retain full control over how their personal contextual information is used through a dedicated consent system. They should be able, at any point in time, to select or determine which providers and sources of contextual information are used.

As a whole, the platform aims to create valuable patient benefits and clearly communicate them to all actors in the healthcare sector. The decisive issue here is that the responsible and transparent use of health data can generate welfare effects and individual benefits. Of course, safeguarding personal data is always a priority.

Context matters

Context is a critical factor in making software solutions useful and enjoyable. This holds true for all sectors and, of course, the healthcare sector as well. While people have long been enjoying these advantages in many other areas, they often encounter fragmented systems in healthcare that either fail to consider contextual factors or do so insufficiently.

Offering personalized information tailored specifically to a patient’s needs, patient information pathways enhance the user experience by saving the patient considerable time in finding the information and services that serve them best.


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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    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. Depending on the search term entered by a user, Google and other search engines can generate hundreds of thousands, or even more, results, leaving it up to the user to determine which “hit” is accurate. Users often aren’t aware that their selection process is influenced not only by objective criteria but also by algorithmic systems that lack transparency, as well as their own emotions.

    The underlying logic of our product vision is different: rather than searching for information, patients discover it. The conventional “pull” principle of search engines gives way to the “push” principle of messenger services, where relevant information is offered at the right moment. Information and education in health care are no longer isolated events, they follow a structured process that considers individual preferences and the contextual conditions of each patient (cf. Understanding information transfer as a process)

    It starts with trust

    Unlike searches conducted with a search engine, the information pathway starts from within – not outside – the healthcare system, that is, in consultation and treatment rooms, and wherever else patients receive personalized support.  After all, trust in the platform isn’t fostered online; it’s built where people have face-to-face interactions. Therefore, our concept envisions that healthcare professionals can suggest or “prescribe” an information pathway through an SMS URL or even directly from a patient’s electronic health record.

    Personal information feed

    When it comes to user verification, our concept intends to utilize the digital health ID provided by health insurers to their policyholders. This approach eliminates the need for complicated registration processes and unnecessary access barriers. Once users log in to the platform, they’re greeted by a user interface resembling those found on major social networks. This has the advantage that users can navigate quickly and effortlessly.

    We’ve named our prototype “LIV,” which stands for the German concepts of “leicht” (easy), “individuell” (individual), and “vertrauenswürdig” (trustworthy). We’ve developed two versions: one optimized for mobile devices and the other for desktop use. Potential future additions include an auditory interface and voice control mechanisms for the information system.

    Similar to Facebook, LinkedIn, and other social networks, the focal point of the interface is a “feed” with tiled posts that accumulate content over time. However, this approach differs significantly from social networks in that it presents users with much less information. The platform’s objective is to reduce information overload while enhancing content quality. Content is thus highly personalized and relies on contextual information to determine the optimal time for delivery to the user.

    For instance, if a new medication is prescribed and the patient has opted in to data-sharing, this contextual information is transmitted to the platform via the electronic health record. Consequently, the information pathway automatically displays relevant information about the medication in real-time. Contextual cues can also come from various sources such as smartwatches, voice systems, or mobile sensors, offering prompts for situational information requirements.

    Integrated patient information

    The information pathways always refer to a specific medical condition, therefore they are created on a disease-specific basis. This tailored approach enables the system to potentially combine various medical conditions, delivering integrated and coherent offerings to patients dealing with multimorbidity.

    As part of our product vision, we’ve initiated an example pathway based on the diagnosis of “knee osteoarthritis.” A fictional user, Katharina Funke, receives an initial, tentative diagnosis, marking the start of a journey through different parts of the healthcare system. This journey encompasses specialized diagnostics, surgery decisions in a hospital, medical rehabilitation, and occupational reintegration. The information pathway starts by providing basic information about the condition, which is followed by details regarding the healthcare system, treatment alternatives and legal issues, as well as information on rehabilitation.

    Prevention pathways

    The concept of information pathways is illustrated in our product vision through the scenario of a knee osteoarthritis diagnosis. However, the basic principle of process-driven information management can easily be adapted to the domain of prevention and can even be tailored to specific target groups and cultural considerations. Applying the principle in this way, healthy behaviors could be practiced and strengthened over time. Particularly vulnerable groups could be reached precisely.

    In creating a personalized pathway, the system draws upon a wide array of information and services from various certified providers, thus offering users a comprehensive selection of suitable options. As a result, the system might encounter several different offerings for a specific information need. In such cases, the highest-rated offering within the user community is presented, and a drawer function allows users to view and select other options.

    Application of new knowledge

    In addition to the information provided, each pathway also presents relevant digital services based on the patient’s needs. For example, when learning about a newly prescribed medication, users can proceed to redeem a digital prescription. Similarly, users receiving information about treatment options are directed to a service for obtaining a second medical opinion. Additionally, information about healthy eating is followed by digital applications featuring cooking recipes and dietary plans. By integrating information and services in this manner, the system helps patients apply newfound knowledge to their lives and health-related decisions.


    Linking information with relevant services

    Each information pathway is unique, tailored to dynamic individual needs and encompasses medical, legal, and psychosocial considerations. The system also proactively offers information that users may not have even been looking for. For instance, it can provide information about a patient rights and responsibilities even before issues related to sickness pay arise.

    The system’s user interface and core service could undergo diverse modifications. Regardless of the final design, this product vision demonstrates that a national health platform could yield numerous benefits without having to generate editorial content itself. It showcases the feasibility of bundling valuable information and easing patients’ information management burden. By incorporating a quality verification process for providers, reversing the search engine principle, tailoring information to the user and applying process-driven principles to information provision, we can develop a new format that simplifies how health information is processed, facilitates informed decision-making, and fosters trust in digital solutions.


    Bol N, Smit ES, Lustria MLA (2020): Tailored health communication: Opportunities and challenges in the digital era. Digital Health, 6, 1-3. (Quelle)

    Kynoch K, Ramis MA, Crowe L, Cabilan CJ, McArdle A. (2019): Information needs and information seeking behaviors of patients and families in acute healthcare settings: a scoping review. JBI Database System Rev Implement Rep, 17(6): 1130-1153. (Quelle)

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