DiGA: Health apps on prescription

The demand for digital solutions in the health sector is increasing and many medical device manufacturers are already following up with different strategies. The offer ranges from the provision of medically verified information, and preventive measures such as the monitoring of bodily functions (e.g. heart rate) to automated medication reminders or self-management for chronic diseases.

The importance of a digital infrastructure was already known to us before March 2020, but the pandemic has shown even more clearly that digital offerings can support by relieving the burden on our health system. Digital triage facilitates administrative processes. The electronic patient file, the e-vaccination passport, or the e-prescription make processes more efficient and are service-oriented at the same time. Digital health apps (so-called DiGAs) on prescription go even one step further.

While such medical apps are not yet included in the benefits catalogue of the Austrian social insurance system, the so-called DiGAs are already increasingly being used in Germany. Since October 2020, doctors and psychotherapists in Germany have been able to prescribe them. These digital offers are intended to support the detection and the treatment of illnesses or treatment processes and, as a certified medical device, expand the range of medical services. The costs are covered by the statutory health insurance.

In the first few months, five DiGAs have already been accepted permanently and ten apps provisionally in Germany. These apps are currently used primarily for very specific conditions such as depression and depressive moods, sleeping disorders, multiple sclerosis in combination with fatigue, fears, phobias and panic disorders, tinnitus, migraine or back, knee, and hip pain as well as for obesity as a supplement to the usual treatment. They can also be used to alleviate psychological and psychosomatic consequences of diagnosis and therapies or to support aftercare, such as for malignancies or after a stroke.

These digital measures aim to positively influence the course of the disease in people who are already ill. Particularly in the case of chronic diseases, additional digital services offer added value for patients as they can take their health into their own hands. If additional complementary treatments are used in a familiar environment, inpatient or outpatient stays can ideally even be avoided.

German doctors are increasingly open to these digital health applications. In a survey commissioned by the digital trade association Bitkom and the medical association Hartmannbund, 24% said they would prescribe DiGA. More than two-thirds consider DiGA to be a useful addition to standard medical services. 29% believe that medical apps can even replace conventional therapies in certain cases, and just under one in three would like to see an expansion of the digital offering.

A few years ago, the picture was completely different, as the study series Doctors in the Future Market of Health by Stiftung Gesundheit shows in chronological order. The publicly displayed skepticism among the medical profession was comparatively high, but the applications at that time were neither technologically mature nor embedded in regulatory terms. Today, public opinion has changed in favor of digital solutions, but in practice, DiGAs have only been prescribed by 2% of doctors.

The reasons are complex but mainly relate to data protection concerns (57%) and lack of trust in the technology (41%). One-third said that they still had too little information to make an informed decision. Clinical trials and independent evaluation of digital applications by health insurers can help address these information deficits and accelerate the penetration of DiGA.

According to a recent study by the Boston Consulting Group (BCG), health insurers in Germany were budgeting single-digit million amounts for DiGA applications in their benefit expenditure for 2021. This results in total costs of over 1 billion EUR per year for the SHI system in the following years until 2025, assuming a DiGA penetration of up to 2%.

Digital applications not only have the potential of medical added value for patients, but they can also save conventional costs in certain areas. In this context, high standards of quality, data protection, safety, and performance must be met and a positive effect on care must be scientifically proven. App offerings from the lifestyle sector, such as fitness trackers or nutrition guides, are therefore generally not among the prescribable solutions. The technical possibilities, however, are also accompanied by increasing demands of the insured on the health insurance companies. In the meantime, they must increasingly provide advice beyond their traditional role as cost bearers. But if the digital transformation is approached proactively, there are great opportunities for a targeted and sustainable improvement in health care.

A further digitization push followed with the “Digital Care and Nursing Modernisation Act” (DVPMG), which came into force in June 2021. The DVPMG is intended to supplement DiGA with digital care applications, i.e. so-called DiPA. The range of digital applications will therefore continue to grow strongly in the coming months and years. Currently, more than 20 apps are already being tested, and according to the Bertelsmann Foundation’s White List, 50 more apps are at least already CE-certified, a basic requirement for approval by the Federal Institute for Drugs and Medical Devices (BfArM). Overall, the legislative initiatives implemented in Germany can bring about a fundamental change in health care and serve as a positive example for other countries.