Germany seeks telehealth solutions in
By Andy Shaw
Demographic differences more than
daunting distances are what’s driving remote healthcare in Germany. In
Canada, the 1,000 kilometre or more distance between an injured or ill
patient in an Inuit community in the sub-Arctic wilds of Northern
Ontario, and specialist help in Toronto is no doubt what pushed Ontario
to build the world’s largest telemedicine network.
Yet in Germany, a much more compact country with nearly three times our
population and consequently with far less need to make seven-league
video conferencing and other digital leaps as we do, there is a
burgeoning telemedicine industry, which Canadian caregivers, patients,
and entrepreneurs could well profit from.
That came clear recently during a visit to Canada made by several
innovative German telemedicine companies and their supporting agencies.
“Even though we don’t have the same distances to cover, we have very
much the same problem as you do. We have trouble attracting doctors to
serve in our rural areas,” explains Ywes Israel, the managing director
of Germany’s National Association for eHealth and Telemedicine - NEST,
for short, based in the German capital of Berlin.
“Most of our young people, for both professional and personal reasons,
gravitate towards our major cities, leaving behind an aging population
that requires more care as they age, but have fewer and fewer caregivers
close at hand to look after them.”
Like Canada, the hope that Israel and his fellow NEST innovators have is
that telemedicine will support the caregivers in rural regions, and even
encourage more doctors to practice there.
They found encouragement from no less than Ontario’s province-girding
Ontario Telemedicine Network (OTN).
“From the point of view of both our patients and our caregivers, our
satisfaction rates run almost embarrassingly high, usually over 95%, and
we consistently lead satisfaction surveys done for all other healthcare
sectors in Ontario,” OTN vice president Ron Riesenbach told the German
visitors at a breakfast briefing arranged for them in a downtown Toronto
“We’ve also tracked travel savings from not having to fly patients into
places like Toronto. Last year, we saved the healthcare system about $15
million dollars in travel costs and expect it to rise to $20 million
dollars this year. Also, we know that more doctors are now setting up
practices in some of our remote locations, because they know they can
have specialist help at their beck and call via OTN.”
“We’ve learned a lot already about telemedicine in Canada,” said Markus
Schroeder, CEO of Tembit Software GmbH, a maker of remote patient
monitoring software, based in Berlin.
Schroeder and his fellow travellers to Canada found other OTN statistics
cited by VP Riesenbach similarly impressive and encouraging, including
OTN’s: connections to all of Ontario’s 175 hospitals, 2,000
videoconferencing outlets, 3,000 clinical users, and last year some
100,000 remote clinical consultations along with 20,000 administrative
and educational sessions conducted over the network.
Building a similar network in Germany is problematic, says Israel. “We
have very strong physician and pharmaceutical lobbies in Germany that,
at least at the outset, might oppose it. Also, like Canada, our
healthcare is controlled to a great extent by our individual states, the
equivalent to your provinces.
“We are really in a land of small kingdoms in healthcare, each with its
own king. What’s more there’s no overriding federal agency, such as your
Canada Health Infoway, providing financial and other support for network
development. So we have to work harder at convincing hospitals and other
partners to finance pilots we undertake.”
And yet medical device development, including telemedicine technologies,
are thriving in Germany. In the Berlin area alone, some 250 companies
fall into that bracket. And despite a recession that hit Germany
particularly hard, the sector continued to grow right through it. And
now, buoyed by a resurgent German economy, the sky seems to be the
“It’s a very fruitful environment now in Germany for medical
technology,” Dr. Tilo Mandry PhD, the senior manager for healthcare at
Germany Trade & Investment, told the breakfast briefing. “Generally we
expect growth of the German economy to be 3.4% this year, the highest in
the European Union (EU) and our unemployment is at its lowest since
1987. Also, we have an aging population that makes Germany even more
attractive for those serving that market. At an estimated 23 billion
euros (over $30 billion Canadian), it is the largest healthcare market
in the EU.”
Speaking to the interests of Canadian medical device exporters to
Germany, Dr. Mandry, a former pharmaceutical industry lawyer, added:
“It’s a relatively easy market to enter. We do have one or two big
companies like Bayer, but the great majority are small to medium sized.
Nor do we have large chains like Walgreens like they do in the United
States. So it’s no big battle to get your products listed with
As an added incentive, to help overcome high wage costs for a very
skilled workforce in the medical device field, Mandry pointed out that
Germany has recently reduced its high business taxes to around the
lowest in Europe.
Nonetheless, there are strong incentives for German telemed makers to
come to Canada. Take Ywes Israel’s own company, TimeKontor AG, based in
Berlin, for example.
TimeKontor is working with one of Germany’s largest health insurance
companies on an internet-based, smoking cessation program, with an eye
to exporting it with an English-only name: Smoke, Quit, Win! – or SQUIN
“We developed it, in part, with the prestigious Brandenburg Research
Institute and it takes you through several levels of smoking reduction
and then through three levels of actual cessation. It’s on the internet,
so you can take it with you wherever you go and it makes you part of a
therapy group, as well,” explains Herr Israel. “We would be interested
in sharing this application with Canada, especially if there is a
smoking cessation problem in any of its remote territories. We would
also be open to Canadian firms or organizations bringing their
experiences to our network in Germany.”
A German experience that Canadian telemedicine care-givers might well
want to share is the remote monitoring, indeed, even remote diagnosing
projects that Herr Schroeder and his Tembit firm have undertaken.
Schroeder, who is also a NEST board member, founded his company with a
partner 18 years ago. Today some 33 Tembit employees produce customized
ISO 9000 certified financial services, marketing, and healthcare quality
management, tracking, and record keeping software.
“Our expertise lies really in coding systems that we used initially for
tracking things like contributions to bio-banks. But now we’ve evolved
and focus mainly on development of patient record-keeping for chronic
diseases,” says Schroeder. “And we’ve worked hard at developing
interfaces with other software such as the clinical pathways
software used in Germany and with portable devices such as smartphones.
We naturally have been working in German at first, but we expect
certification for our English version by the end of the year.”
In the meantime, Tembit has launched a universally accessible
record-keeping project for one of the most devastating chronic diseases,
multiple sclerosis (MS).
“It’s a sad fact that MS patients are often struck by relapses. If they
are travelling or otherwise away from home, they must often go to a
strange hospital that has no access to their medical records. So in
co-operation with another German company, we developed a completely
secure USB stick complete with its own browser that the MS patient can
give to the attending doctor. So no matter where in the world the
patient is, the patient can give the doctor both access to his or her
records, but also, from a privacy point of view, by virtue of handing
over the stick also giving informed consent to access the complete
In addition, Tembit makes monitoring software packages for homecare
including one that comes bundled with a new device that performs
overnight blood cleansing via the stomach membrane – used by dialysis
patients not at the hospital where dialysis is traditionally done – but
Perhaps just as remarkably, Dr. Ronald Weiss, a lecturer at the
University of Applied Sciences for Social Pedagogy in Berlin, has
developed a new remote monitoring diagnostic tool – for one of the
world’s most misdiagnosed afflictions: attention deficit hyperactivity
disorder (ADHD) in children.
“We’ve done studies in Germany and I know in the rest of the world on
just how much medication is being given inappropriately to children,
often just to keep them quiet, and who often do not have the disease,”
says Herr Weiss. “Of course, it’s also a very difficult disease to
diagnose in the first place.”
But in one telling pilot, a school child who had been accurately
diagnosed with ADHD and one who was clearly not afflicted at all were
both wired up with a remote monitoring belt and wristband and monitored
around the clock for two weeks.
“We were measuring and collecting data on their body functions and vital
signs such as body temperature, blood pressure, skin conductivity,
muscle tone, and muscle contractions,” explains Weiss. “And we found at
school, for instance, when the teacher told her students to do
something, you could see big and consistent differences in these
measurements between the ADHD and the normal child.”
This promise of solving one of the world’s most perplexing diagnostic
challenges, is one that Weiss, NEST, and indeed Germany would like to
explore to their mutual benefit with Canadian counterparts.
At the wrap-up Question-and-Answer to the breakfast briefing, a Toronto
attendee, Veronika Litinski, hung out another carrot for German telemed
developers to bring their innovations to this side of the Atlantic. Said
Litinsky, who co-ordinates the venture services programs delivered to
entrepreneurs, investors and high-growth companies at Ontario’s MaRS
medical innovation centre, “One of the advantages we have in Ontario is
that there are a number of system integrators that can put your products
into a pilot for Canadian testing without the same difficulty you may be
finding in Germany. Also we have a centre for innovation and complex
care co-funded by hospitals and a provincial government that is also
very approachable for such joint projects.”
A common breeding ground, in other words, for both the long and the
short and the best of telemedicine.
Posted October 21, 2010