"Digital change is far more than just a technology-driven development: it is above all a social process that puts people at the center more than ever." This quote from the editor Christian Schuldt, makes the core aspect of digitization, especially in the field of care, clear. I chose the topic of digitization in nursing because in times of advancing mechanization the problems of this process, especially in nursing, become clear. Even with increasing mechanization, people remain the focus of nursing services. Both the carer and the person to be cared for are in focus.
The aim of this paper is not to answer a question, but to clarify the challenges of this process, to give an overview of the current state of digitization and to give practical examples of modern and current care. In the first part of this elaboration, the terms Care 4.0 and digitization are explained in the form of definitions. Further legal principles follow, which are intended to demonstrate that the establishment of technical possibilities has been a political issue for years. The main part of this paper relates to the current status of digitization in healthcare, especially the importance of home and inpatient care and the associated challenges. This second part is followed by practical examples that have already been integrated into ongoing care operations. Finally, there follows a summary of digitization in nursing and a brief outlook on further digitization measures in the nursing field.
When working on this topic, I used various literature studies, but also electronic publications and quotations. The state of research on this topic varies. There are numerous publications on the topic of digitization, but only a limited number of health economic publications and evaluations of employees in the nursing profession or people in need of care, which made research on this topic difficult.
I Table of contents
1 Introduction
2 Theoretical part
2.1 Definition Care 4.0
2.2 Definition of digitization
2.3 E-Health Act
3 Digitalization in Healthcare
3.1 Digitalization in Healthcare: Status quo and reasons
3.2 Digitalization in nursing: status quo
3.3 Challenges in the digitization of inpatient care
3.4 Importance of home care and new challenges
3.5 Increasing the attractiveness of the nursing profession through digitization?
4 Practice and acceptance of the technology
4.1 Definitions of terms Assistive Technologies
4.2 Private apartments with ambient assisted living systems
4.3 Acceptance of assistive technologies among seniors
4.4 Assistance robots: Robear
4.5 Assistance robot Paro
5 Conclusion
II List of abbreviations
EEL Ambient-Assisted-Living
LTD. public limited company
E-Health Electronic Health
E.V. Registered association
Gematik Society for Telematics Applications of the Gesundheitskarte mbh
IT information technology
1 Introduction
"The digital transformation is much more than just a technology-driven development: Above all, it is a social process that puts people at the centre more than ever."1 This quote from the editor Christian Schuldt makes the core aspect of digitization, especially in the field of care, clear. I decided on the topic of digitization in nursing, because in times of progressive mechanization, the problems of this process, especially in nursing, become clear. Even with increasing mechanization, the human being remains the center of a nursing service. Both the caregiver and the person to be cared for are in focus. The aim of this term paper is not to answer a question, but to clarify the challenges of this process, to give an overview of the state of current digitization and to reproduce practical examples of modern and current care. In the first part of this elaboration, the terms care 4.0 and digitization are explained in the form of definitions. This is followed by further legal bases, which are intended to show that the establishment of technical possibilities has been an issue in politics for years. The main part of this term paper relates to the current state of digitization in the healthcare sector, especially the importance of home and inpatient care and associated challenges. This second part is followed by practical examples, which are already integrated into the ongoing care operation. Finally, there is a conclusion about digitization in nursing and a small outlook on further digitization measures in the nursing sector. In the development of this topic, I used various literature studies, but also electronic publications and quotations. The state of research on this topic varies. There are numerous publications on the subject of digitization, but only a limited number of health economic publications and evaluations of employees of the nursing profession or persons in need of care, which made research on this topic more difficult.
2 Theoretical part
This part serves to explain the terms care 4.0 and digitization. Furthermore, the legal basis in the form of the E-Health Act is discussed.
2.1 Definition Care 4.0
The term Care 4.0 is derived from the term Industry 4.0. The integration of digital systems into the health and care sector, referred to by the term Care 4.0, is referred to the fourth industrial revolution. IT systems or robots in the areas of care, therapy or general service activities support human specialists in their daily work.2 Care 4.0 is an agile maintenance on a digital workflow. It contains three core components: Smart technologies, i.e. care expert software, lean and structured processes and technology competence. Care 4.0 is therefore the answer to the challenges and the constantly changing framework conditions of tomorrow's care.3 It should be noted, however, that there is no uniform definition of the term digitization. Digitization in the nursing professions is generally more advanced than commonly assumed. For example, a sample of the Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege from spring 2017 supports this thesis. In this figure, the four "focus technologies" of electronic documentation, telemedicine, technical assistance and robotics are graphically presented.
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Fig. 1: Use of the four "focus technologies" by work area
(Source: Merda/Schmidt/Kähler [2017], n.d.)
2.2 Definition of digitization
Digitization is generally understood as the transformation of analog information into digitally stored and used information. This ongoing process can be found in many sectors of industry, as well as in many others and areas and also in private life.4 There is also no uniform definition for this term.
2.3 E-Health Act
In order to improve patient care, the "Act on Secure Digital Communication and Applications in Healthcare and on the Amendment of Other Laws" was adopted on 29.12.2015 and entered into force on the aforementioned date, as well as on 01.01.2016 and 01.01.2017. It regulates the introduction of digital applications in the German healthcare system with the highest security standards and beneficial applications on the electronic health card.5 From the point of view of the time, medical practices, pharmacies and hospitals should be integrated nationwide into a digital network by mid-2018, i.e. a telematics infrastructure anchored in SGB V. Clear deadlines, incentives and sanctions have been set for these projects. Basically, the following applies: Those who participate will be rewarded, those who refuse to make progress must expect sanctions.6 The focus of the law is, among other things, the updating of the tasks of gematik, which among other things include modern master data management. This refers to the online examination and updating of insured master data and a medication plan that can be called up from the health card in order to prevent drug interactions. In addition, the way to the entry into the electronic patient record is paved. In order to enable comprehensive telemedicine, it must be ensured that appropriate IT systems can also communicate with each other, this is another task of gematik.7
Due to the innovation of the Internet and other technical factors, the digitization of society and industry continues to advance. The aim of this law is to exploit these opportunities and the potential of this technical progress for better medical and higher quality care for patients. Politicians are working on further legislative proposals to improve and expand this law even further, because mechanization in general, not only in the health care system, is progressing at a rapid pace.
3 Digitalization in Healthcare
This chapter discusses the status quo and the reasons for the current degree of digitization of healthcare, especially that of care. This is followed by the challenges of digitization in inpatient care and the importance of home care and the emerging challenges of this type of care. Finally, there is the question of whether the attractiveness of the nursing profession can be increased by digitization.
3.1 Digitalization in Healthcare: Status quo and reasons
"We have the opportunity for a digital economic miracle. The question is whether it will take place in Germany."8 This is how German Chancellor Angela Merkel commented on the advancing digitalization in the world at the IT summit in Hamburg in 2014. According to a study by Prognos AG on behalf of the Bavarian Business Association e. V. the proportion of digitization increased in the years 1991 to 2013 in all the industries depicted. Almost half of all industries achieved a digitization share of about 50%, the healthcare system was only 2.3% in 2013. In this period of about 22 years, the healthcare sector achieved an increase of only about 1%, the remaining industries managed to show an improvement of 25% to 30%.9
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Fig. 2: Digitalization share of the various economic sectors, 1991 and 2013 in %
(Source: Own presentation based on Pfannstiel/Da-Cruz/Mehlich [2017], p. 3ff)
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1 Schuldt [o. J.], P. 1.
2 cf. Die Schwester Der Pfleger [2018], o. S.
3 cf. Der Pflegefuchs [2018], o. s
4 cf. Bendel, Oliver [2017], o. s
5 cf. Federal Ministry of Health, [2018], o. s
6 cf. Riepe, [2016], o. s
7 cf. Federal Ministry of Health [2018], o. s
8 Wirtschaftsrat Deutschland [2015], o. S., quoted from Merkel [2015], o. s
9 cf. Pfannstiel/Da-Cruz/Mehlich [2017], p. 3ff.