Masterarbeit
E-Commerce and Homecare in Germany - Opportunities and Limitations
Martin Wiesbeck (2001)
Homecare, defined as medical care at home, supports medical and social prognosis of patients suffering from chronic, lifethreatning diseases. Even so patients stay at home or live a "normal" life, the medical leadership resides with the treating hospital. Well coordinated communication between domestic and clinical area and good cooperation between all involved parties (patient, physician, nurse, supplier, reimbursing party) are critical to the success of homecare. Homecare challenges its partners with some complex logistical, administrative and medical issues.
In order to adress the technical issues means of e-commerce offer numerous solutions. According to the expanded definition of e-commerce in Directive 2000/31/EC, they derive from the fields of e-procurement and health telematics and telemedicine. E-health as offered today by many portals, is not suitable to support homecare.
In the fields of e-procurement the opportunities of B2B- and B2C-trade to consider. On the other hand a lot of avalible applications in telematics and telemedicine open interesting opportunities:
- electronic patient file
- electronic prescription
- data cards
- networks
- tele conference
- tele monitoring
- tele therapy
The discussed case studies could demonstrate, which problems can derive from therapies conducted in the domestic environment. They are suitable to show, in which cases and how e-commerce can intervene and support.
Homecare and e-commerce share a common lot in German healthcare. They are both broadly appreciated, but rarely implemented. Reasons are different, they meet however when e-homecare is subject to evaluation.
The crossfunctional approach of Integrated Care (Integrierte Versorgung) according to section 140a-h SGB V (German Social Security Act) provides an improved environment for homecare. The restructuring of hospital financing in 2003 will generate sufficient motivation to face the challenge. The legal requirements are met. It is now time to work on the skeleton agreements.
With regards to e-commerce, e-procurement and telematics/telemedicine need to be discussed separately. B2B-relations will succeed, provided they optimize existing supply chains. Additional players to the system will need to proove their added value. B2C-relationships are limited by the legally provided distribution channels, especially for medicinal products ("drugs"). As demonstrated in the case studies, it is possible to mobilize positive effects within the existing law, and one should do so. Broadly implemented B2C with medicinal products within the setting of homecare however, is no realistic option for the time beeing. B2C with medical devices gives a different picture and will succeed as soon as homecare has reached a critical mass.
The main road block for the implementation of health telematics and telemedicine is the insufficient implementation of suitable communication plattforms and standards. All the discussed components and applications are already availible today or technically realizable at anytime. The statutory bars of liability, professional, and data protection laws have been extensively cleaned out through the last years. German healthcare lacks a coordinating and leading function, which takes ownership of implementation and which pushes it forward. In order to resolve the problem the MOH-study suggets the foundation of a health platform.
Provided this, homecare concepts, as highly interactive systems, will then show the expected success. Their implemetation will take place as e-homecare automatically.
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