Health goes digital
Hannover’s image as an industrial location makes the huge significance of the healthcare sector recede into the background. And yet the Region Hannover is one of Germany’s leading healthcare locations, with well-known hospitals, many care facilities, insurance companies and research institutes, as well as a large number of high-tech companies that are driving eHealth.
As at 2021, most of the 525,000 employees in the Region Hannover work in the healthcare sector, with around 80,000 people employed in hospitals and institutes, medical practices, pharmacies, retirement and care homes and for home care service providers. Healthcare is thus the most important sector of the economy in the Region Hannover, before the skilled crafts (a good 70,000 employees) and the logistics industry (around 60,000 employees), and well ahead of image-defining sectors such as the automotive industry or the financial and insurance industry (with around 25,000 employees each).
The region and above all the state capital have numerous medical institutions with a national and even national reputation. The first of the hospitals to be named is the University Hospital of Hannover Medical School (MHH). With its 7,500 employees and 3,400 students, it is a global leader in various disciplines such as implantology and cardiology. A similarly leading position, this time in neurosurgery, is played by Madjid Samii’s private International Neuroscience Institute Hannover (INI), which now also has subsidiaries in Beijing and Tehran.
General medical care for the population at large is provided by the Klinikum Region Hannover (KRH) hospital group, with 8,000 employees at ten sites throughout the region making it one of Germany’s largest public-sector hospital operators. The social welfare organisation DIAKOVERE also operates three significant healthcare sites. DIAKOVERE is Lower Saxony’s largest non-profit company with 5,400 employees, and is opening a new maternity unit called “Henrike” in 2023. It is being constructed at the independent children’s hospital “auf der Bult” that has specialised in child and adolescent medicine and treats more than 50,000 patients each year. The children’s clinic at MHH has also specialised in adolescent medicine.
Research landscape
Medical research in Hannover is usually associated with Hannover Medical School (MHH). But in fact, the region’s research landscape has a far broader basis. Over the years, the Medical School and Leibniz University Hannover (LUH) have been joined by numerous other institutes. These include the non-university INI and the Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), as well as, and in particular, joint facilities run by several universities which frequently also include institutions from the whole Metropolitan Region of Hannover Braunschweig Göttingen Wolfsburg. After all, cutting-edge research is team work, often with an interdisciplinary basis, as shown by the L3S. The research centre is a joint institution of Leibniz University, the MHH and TU Braunschweig and pursues research into AI applications in production, mobility, education and medicine (see overview).
Profitable ecosystem
The growth of the scientific institutions and the success of the start-up centre Medical Park Hannover that opened in 1987 has led to a broadly based corporate landscape. According to the economic development agency of the Region Hannover, there are about 80 companies involved in the wide field of pharmacy, care and medical products as well as the healthcare economy, computer science and the life sciences.
This development is not self-evident, as the city and its surroundings are not traditionally a location for the pharmaceutical industry. In Springe, Octapharma produces ultra-pure medicinal products from human blood plasma. Furthermore, the medical device and diagnostics specialist Abbott Group has a pharmaceutical division that is present in Lower Saxony with sites in Hannover (research and development) and Neustadt am Rübenberge (production).
Statutory health insurers fund digitalised medicine
All this good medicine has its price. It is therefore all the more important to have direct links to the funding agencies who support innovative digital care programmes. One example here is the AOK Lower Saxony: the largest statutory health insurance fund with more than 2.9 million policy holders in the state has its headquarters in the state capital.
In May 2022, the AOK launched its “Herodikos Plus” scheme for people who suffer from pains in their backs and knees. This is a telemedicine complete programme that provides AOK policy holders with individually customised exercise therapy supported by an app. It also includes regular video consultations with experienced physiotherapists. If necessary, policy holders can use the app as a means of contact, for asking questions and to have their training plan adapted.
The app is a certified medicinal product developed by doctors and trained physiotherapy specialists. “The aim is to provide long-term motivation so that people do something for their musculoskeletal system. This should bring down the high impact of such complaints in terms of the economic costs”, says Frank Preugschat, CEO treatment and benefits management at the AOK Lower Saxony.
Akzept*D: new ways of fighting depression
A more complex affair is the interdisciplinary research project with the unwieldy title “Do patients with depression and their practitioners accept online health services?”, abbreviated to “Akzept*D“, with the AOK Lower Saxony as the health insurer involved in the project. It is funded by the state of Lower Saxony and the Volkswagen Foundation, with scientific support from three institutions under the auspices of the MHH: the MHH Clinic for Psychiatry, the Institute for Economics and Management and the Institute for Health Economics at Leibniz University Hannover (LUH), and Ostfalia University of Applied Sciences.
The “Akzept*D” project is running until 2024. The research team is seeking to examine ways and means with which people suffering from mild to moderate depression can be better motivated to use online services for improved medical care. “We want to improve how the widespread condition of depression is treated, enhancing the quality of life of those affected and closing gaps in the medical care”, says Professor Kai Kahl, psychiatrist and psychotherapist at the MHH. He refers to the growing number of people who suffer from mental health issues, particularly following the Covid-19 pandemic, and also draws attention to the scarcity of medical staffing resources.
The healthcare sector at a glance
Hospitals: DIAKOVERE (three sites, four as from 2023). Klinikum Region Hannover (KRH) with ten sites. Other well-known hospitals are the children’s hospital “auf der Bult”, the Vinzenz hospital, the DRK hospital Clementinenhaus and the Sophienlinik (private hospital).
Patient care and research is pooled by Hannover Medical School (MHH) and the International Neuroscience Institute Hannover (INI).
Research and teaching: Centre of Biomolecular Drug Research (BMWZ) at the Leibniz University Hannover (LUH). Comprehensive Cancer Centre Lower Saxony (CCC-N) of the MHH and the University Medical Centre Göttingen. Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM). Hannover University of Applied Sciences and Arts with Faculty V for Diaconic Studies, Health Care and Social Work. Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE), run by MHH, LUH and TiHo. Centre for Experimental and Clinical Infection Research (TWINCORE) of MHH and the Helmholz Centre for Infection Research (HZI). in Braunschweig.
Data-driven, networked medicine (eHealth): eNIFE is a research centre specialising in biomedical technology at the Faculty for Electrical Engineering and Computer Science at the LUH. The L3S Research Centre is mainly run by the LUH, MHH and TU Braunschweig and pursues research into AI applications, among others in medicine. At the Leibniz AILab future laboratory, scientists from LS3 and international partners will be pursuing research into AI for personalised medicine in a project running until 2023. The Peter L. Reichertz Institute for Medical Informatics (PLRI) is a cooperation between MHH and TU Braunschweig.
Robotics in nursing: The MHH Centre for Nursing Practice (PPZ)
Start-up centre: Medical Park Hannover
Associations and networks: BioRegioN Network for Life Sciences and Medicine of Lower Saxony Innovation Centre. Gesundheitswirtschaft Hannover e.V. (Healthcare Economy Hannover), aligned to cross-sector cooperation (outpatient and inpatient care, prevention). The network Digital Health City Hannover by hannoverimpuls is new. The network Future Laboratory Health is one of several future laboratories of the ZDIN – Centre for Digital Innovations Lower Saxony. It pools universities and companies throughout Lower Saxony to promote digitalisation in research and practice.
Statutory health insurance funds: Headquarters of the AOK Lower Saxony and the Kaufmännische Krankenkasse Hannover (KKH). Also numerous service branch offices for other health insurance funds.
KKH funds health apps nationwide
Another player on the side of the funding agencies is the KKH (Kaufmännische Krankenkasse Hannover) which looks after 1.6 million people nationwide. Like other health insurance funds, it is increasingly using apps to support its policy holders. For example, children receiving speech therapy can practice better home with the “neolexon” app. Moreover, parents of children with atopic eczema can use the “Nia” app to record the course of the disease. This should make it easier to detect triggers for eczema episodes and give the doctor a better basis for treatment and therapy.
Kipoly – AI made in Hannover
A few months ago, the software developer edicos from Hannover created the “Kipoly” brand, which the company is using to develop data-driven applications for the healthcare sector in cooperation with various partners, including the MHH. One example is the “CarePoint App”, which edicos has already put on the market in the Middle East and which should be available also in Germany by the end of 2023. As with solutions from other providers, this app works on the basis of the electronic patient file (ePA) that was launched in 2021. However, it also intends to offer innovations including simple recording and documentation of side effects by patients on medication.
“One hospital – one software. That is our aim, for a smooth flow of data that gives a complete overview of all medical and financial KPIs of a hospital at any time”, explains Kipoly co-founder Reza Esfahanian. The software is currently in use in more than 100 hospitals, clinics and private practices in the Middle East. It is supposed to come on the market in Germany in the second quarter of 2023.
edicos uses artificial intelligence (AI) to diagnose traumatic brain injuries and breast cancer. The software is not intended to replace the actual medical diagnosis, but to provide decision-making support. The software analyses the data generated by the usual test such as mammograms, CT and MRI scans. “In the case of breast cancer, the software is able to detect the size and type of tumour and also to give a prognosis of its further development”, explains co-founder Esfahanian.
The data comes from a partner network of university hospitals in the Middle East. “We compare the diagnoses made by the doctors with the diagnoses made by our software. We feed the results into the system so that this is constantly being improved”, he explains. In 2023 there are plans to start a clinical study as the basis for obtaining approval for the US market in 2024. “That would be the breakthrough”, says Esfahanian.
The “CarePoint Portal” is already in use: this is a cloud-based software for management of a whole hospital and private medical practices. It can be easily adapted to the different workflows in the various departments, thus making local software solutions superfluous.
Data-driven research in the fight against RSV
Respiratory Syncytial Virus (RSV) or RSV infections tend to be harmless for most adults However, children and above all infants can become seriously ill with RSV and suffer permanent harm. The Institute for Experimental Virology at TWINCORE, the Centre for Experimental and Clinical Infection Research, is therefore currently working with the MHH children’s hospital as part of the “RESIST” cluster of excellence to pursue more detailed research into the genetic causes for severe RSV infections.
“We want to know why some children just have a runny nose while others are taken so ill that they are taken to hospital and are put on a ventilator”, explains research leader Professor Thomas Pietschmann. To this end, since 2019 he and his team have been examining the genetic material – so-called sequencing data – of hundreds of children who have been seriously ill with RSV.
Putting it simply, they use computer-assisted methods to compare the genetic material of healthy children or children who are only slightly ill, with the genetic material of children who are seriously ill. The statistics of any deviations are recorded and weighted, and then examined more closely to see what they actually mean. “In the end, we want to identify those genes in the genetic material that encourage an outbreak of the infection. We also want to understand how these genes affect the course and severity of the infection”, explains Pietschmann.
His aim consists of a diagnostic method that can help to clarify the risk for a severe infection already before being infected with the virus. On the basis of such a test, particularly vulnerable children could then be offered specific protection, for example with an antibody against the virus to protect them from being infected. “But more data and more development time is needed to obtain such a test”, emphasises Pietschmann.
The future of radiology begins in the KRH
Radiological examinations by computer tomography (CT) or magnetic resonance imaging (MRI) are important means of diagnosing injuries or the causes of a disease. But there is a shortage of medical technical radiology assistants (MTRA) to operate the equipment, which is a problem particularly when a patient needs an emergency diagnosis.
A few years ago, the KRH Klinikum Region Hannover therefore launched an innovative remote control project with Siemens to make it possible for an MTRA in Gehrden, for example, to control the equipment in Neustadt am Rübenberge. With the founding in mid-2022 of the cross-site KRH Institute for Radiology, the company now plans to expand this remote control to all MRI sites.
Financial support will be available through the “Krankenhauszukunftsgesetz” (KHZG – hospital future law) of the federal and state governments with a total budget of 4.3 billion Euro, of which the KRH has managed to safeguard 30 million Euro for altogether ten projects. The company is planning an online portal so that patients can document and manage their health data and treatment in the KRH on their smartphone or with another digital device. For example, they can have their data sent to other practitioners in medical practices or other hospitals.
Digital Health City Hannover
The regional economic development agency hannoverimpuls has launched the project “Digital Health City Hannover” (DHCH) to strengthen the digital healthcare economy. At the opening event in July 2022, for the first time start-ups, established companies, care facilities, hospitals and funding agencies came together to expand networking activities and to discuss the potential of the Region Hannover in the field of digital health. As part of the network, hannoverimpuls offers, among others, targeted support for start-ups, particularly by women in the field of gender-sensitive medicine. Furthermore, regular online seminars and discussions are offered on various topics.
A project is currently being implemented that will bring companies, hospitals and funding agencies together to work specifically on the joint development and implementation of innovative projects for nursing and healthcare. The aim is to develop demand-driven solutions for patients and processes in everyday medicine. “It often happens that products or services emerge that fail to take account of actual needs. We are therefore creating a framework for coordinated collaboration between companies and service providers”, says project leader Andreas Müller from hannoverimpuls.
Header picture: MHH
