Fifteen years ago, Germany set out to build the world’s most comprehensive and secure network to exchange health information. Today, it features an eHealth card that stores the holder’s name, address, health insurance type and date of birth. That’s all. Will the Health Telematics Infrastructure (HTI) with the eCard ever be able to develop its full potential or is it facing the fate of another prestigious German technology project: The Transrapid.
The slow failure of the fast train
Transrapid – Germany’s high-speed monorail train with magnetic levitation – promised super-fast, noise-free, and luxurious travelling at a speed of 500 km p.h. (300 m.p.h.) The country’s industrial giants Thyssen, Siemens, AEG and others, together with the German government and the German railway operator Deutsche Bahn all stepped in to implement a new transport infrastructure of unprecedented dimension. From Hamburg to Berlin and from Lisbon to St. Petersburg, the Transrapid promised to reshape the whole identity of the European continent.
Feasibility studies were conducted for links between Dubai and Abu Dhabi, Las Vegas and Los Angeles, London and Glasgow. A test facility was built in Germany. China achieved the world’s first commercial implementation, from Shanghai airport to the city center.
But then “normal” trains became faster and more comfortable and flights became cheaper. The feasibility studies were cancelled. An accident with 23 casualties set a final nail in the coffin of what once was the pride of German engineering.
Why innovations fail
The Transrapid turned out to be a bridge to nowhere. Why? Because it lacked some key success factors to turn an idea into real-life innovation.
1. No sufficient added value
As modern high-speed trains were introduced, the benefits promised by the Transrapid melted away quickly and the technology no longer delivered any sufficient added value to justify the price tag.
When the HTI was planned, the iPhone was not even on the horizon yet – not to speak of Alexa, big data, AI, machine learning etc. What will happen to the HTI if emerging technologies will deliver greater value, require less investment and are easier to roll-out? At HIMSS18, Eric Schmidt, Executive Chairman and former CEO of Google, Inc. addressed this point by asking the health IT industry not to repeat Google’s infrastructure, but focus on innovation instead.
“Don’t repeat the infrastructure work that we’re building – focus on innovation”. Why? “Scale changes everything. Scale changes the rules” – @ericschmidt #HIMSS18 #thinkdigitalhealth pic.twitter.com/5iZBG8Uy1g
— Wayne Samuels (@waynemsamuels) March 6, 2018
2. Disruptive to functioning system
The Transrapid represented a disruptive technology that required investment in a whole new infrastructure. Why not improve the existing, conventional train system instead? This, in the end happened.
What if health investments focus on closing the gaps in the existing system where they occur – rather than introducing a whole new digital infrastructure for everyone? Germany’s largest public health insurance AOK together with the hospital groups Vivantes and Sana started pilot projects with their own EHR and IT infrastrucutre.
Martin Litsch, Chairman of the board of the AOK-Bundesverband said: “The AOK does not pursue a central approach in the implementation of their health network as with the HTI. Depending on the regional situation, we will implement different applications with different partners. All our solutions are connectable [to the HTI].”
3. Lack of customer insight
The industrial consortia and politics ignored the shift of paradigms in individual mobility that happened over the long period of development. “The Transrapid delivered answers to questions nobody raised anymore. The use case for which the system was designed in the 60s and 70s was no longer valid thirty years later.” (Prof. Reinhold Bauer, Stuttgart University, SZ online, 09/2014)
Claudia Dirks, one of Germany’s best known eHealth Journalists addressed the issue on Twitter: “Here’s my vision for 2025 – something like a health insurance card, but with information about allergies, drugs, blood type and my consent to organ donation – oh wait, I actually have this on my phone since two year.”
Ich hätte da ne Vision für 2025 – so ne Art Versichertenkarte, nur mit Informationen drauf wie Allergien, Medikamente, Blutgruppe und, ob ich meine Organe spenden möchte – ach, Stopp, hab‘ ich ja schon seit zwei Jahren auf meinem Handy… #noeGK #mhealth https://t.co/lRZbgnYl2o
— Claudia Dirks (@ehealthy_cd) March 5, 2018
Professional stakeholders show increasing signs of impatience about the country’s slow progress on eHealth. Recently introduced eHealth legislation has been countered by The National Association of Statutory Health Insurance Physicians (ASHIP) – @KBV4U – with a request to push back the deadlines.
Oliver Bruzek, CompuGroup’s CCO Political & Public Affairs, tweeted: “Have always said that it is irresponsible of @kbv4u to advise doctors to wait with connecting to #TI. Discount prices will not be given, technology is too costly. Now you ask for more money + more time & try to blame #technologyvendors for your own #failure.”
Haben immer gesagt, dass es unverantwortlich von @kbv4u ist, Ärzten bei Anbindung an #TI zum Abwarten zu raten. Spottpreise wird es nicht geben, dafür ist Technik zu aufwendig. Jetzt will man mehr Geld + mehr Zeit & versucht eigenes #Versagen wieder auf #Industrie zu schieben https://t.co/sz9eRQvSRe
— CompuGroupMedical SE (@CGMeHealth) March 3, 2018
Germans have a reputation for being forward-looking planners who like to identify success factors ahead of time, avoid foreseeable errors and execute efficiently. In complex innovations this can take a long time; time in which the world keeps moving – sometimes at a faster speed than even the best project planners were able to predict. It seems thought, that the country’s new government heard the alarm bells; eHealth now tops the policy agenda as you can read in my previous blog.