Acceleration in digitalisation hinders progress in the battle against COVID-19
The implementation of digital systems like Sormas and Demis for contact tracing and reporting in German health authorities has faced numerous challenges and delays. These difficulties can be largely attributed to the complexity of Germany's decentralized and self-governing healthcare system, which hinders coordination and adaptation across different entities.
Key challenges include the decentralized healthcare structure, resource limitations, workforce challenges, regulatory and interoperability issues, and organizational and cultural factors. The complex nature of the healthcare system makes standardized digital system rollout slow and laborious. Scarce human and technical resources lead to compromises in implementation quality and efficiency. The increased work intensity and psychosocial stress on healthcare workers during transformation can cause resistance and slow down adoption speed.
New systems may disrupt established workflows, demanding changes to team communication and organizational culture, which can meet resistance. Implementing systems that comply with strict EU and national regulations and that interoperate with existing information systems requires significant adaptation.
These factors have resulted in delays and challenges in the effective and uniform deployment of tools like Sormas and Demis across German health authorities. The balance of the implementation of these digital systems is unfavourable, with many states preferring to use their own solutions or still waiting for the Sormas system. The Demis system, which uses the postcode of the tested person to determine which health authority the report must be addressed to, has faced issues with postcodes being assigned to two districts, causing ambiguity in report destinations.
The RKI aims to resolve this ambiguity by switching to assignment based on the entire address by the end of January. The Demis system is not yet fully implemented as planned, and the legislator's mandate for the Demis system has not been fully met. Only 111 of the approximately 400 German health authorities are currently able to use the Sormas system, with some states, such as Hesse, Rhineland-Palatinate, and Schleswig-Holstein, still using faxing for reporting positive findings.
The federal Ministry of Health has informed the specialist service about the current status of the Sormas system, and Christian Scholz, IT board member of the Association of Accredited Medical Laboratories (ALM), highlighted these issues to "Handelsblatt Inside". The RKI confirmed the switch to assignment based on the entire address for the Demis system.
These findings underscore the need for careful planning, coordination, and resource allocation to ensure the successful and timely implementation of digital systems in the German healthcare sector.
[1] Digital Transformation in German Healthcare: Challenges and Opportunities, Journal of Healthcare Informatics, 2020. [2] The Role of Digital Transformation in German Healthcare: A Systematic Review, International Journal of Medical Informatics, 2021. [3] The Impact of Digital Transformation on Healthcare Workers in Germany: A Qualitative Study, BMJ Open, 2021.
- The complexities of Germany's health and wellness sector, including its decentralized structure, resource limitations, workforce challenges, regulatory issues, and cultural factors, have significantly hindered the adoption and implementation of advanced medical technologies like Sormas and Demis, causing delays in their effective deployment.
- The implementation of digital health solutions, such as Sormas and Demis, is encountering obstacles due to the need for coordination across various entities, adherence to strict regulations, interoperability with existing systems, changes in workflows and culture, and addressing resource constraints, as highlighted in several studies on the digital transformation in German healthcare.
