Initial assessment software SmED can relieve the burden on emergency rooms and rescue services from less acute treatment cases

11.05.2023 17:21

As part of a two-day “user conference”, the Central Institute for Statutory Health Insurance (Zi) presented the current development status and concrete application potential of the initial assessment software SmED (Structured Medical Initial Assessment in Germany). Experts from outpatient and inpatient care discussed their previous experiences, study results and application scenarios. The motto of the event was “Get medical care in the right place at the right time”. The cross-sector, interdisciplinary exchange showed how this can be achieved using numerous practical examples.

For several years, intensive work has been carried out to better network the emergency services, the medical on-call service and the emergency departments of the clinics. This is intended to avoid parallel care structures, unclear responsibilities or a lack of cross-sector coordination in (outpatient) emergency care in Germany. The goals are to assess the urgency of treatment according to mutually agreed criteria and to guide patients quickly and safely to the right place for treatment. Digital instruments are essential for this: These include, on the one hand, software as a decision-making aid as part of a structured initial assessment, and, on the other hand, tools for digitally registering patients in doctor's offices and securely passing on diagnostic data.

Implementation of a standardized initial assessment procedure

The reform of acute and emergency care is also high on the health policy agenda in this legislative period. Those seeking help with acute health concerns should be able to get advice as easily and at any time by telephone or digitally before they use the emergency services or an emergency room. The central component for this is the implementation of a standardized initial assessment procedure. For this purpose, the Zi provides the software SmED, which it co-developed. SmED offers a high level of patient safety, user-friendliness and medical evidence.

A central area of application for SmED has been established since January 2020. “Since then, those with statutory health insurance have had the opportunity to receive an initial telephone assessment of acute symptoms with the support of SmED under the patient service number 116117 of the statutory health insurance associations. The callers are questioned in a structured manner by qualified staff. On this basis, the statutory health insurance associations provide medical care appropriate to the urgency. Since January 2020, around 4.4 million callers have taken advantage of this advice, including 1.7 million in the last twelve months alone. The digital self-assessment configured via a chatbot has also been online on the 116117 website since December 2021. Since then there have been a good 172,000 queries. Since April 2023, the electronic appointment service has also been activated, through which those who are initially assessed for help can book a doctor's or psychotherapy appointment directly using a referral code - everything purely digitally and without additional phone calls," said Zi CEO Dr. Dominik von Stillfried. Other fields of application such as SmED Contact, which is intended to support the emergency services with the question “To the clinic or to the doctor's office?” and SmED Contact+ for the common counter of contract and hospital doctors, at which it is decided whether those seeking help should be sent to The emergency room, on-call practice or general medical care are to be controlled immediately for practical use.

Immense pressure for reform in acute and emergency care

Both Dr. Janosch Dahmen, health policy spokesman for the Alliance 90/The Greens parliamentary group, as well as Dr. Doris Reinhardt, deputy chairwoman of the Baden-Württemberg Association of Statutory Health Insurance Physicians, made it clear during the panel discussion that there is immense pressure for reform in acute and emergency care, which practically demands innovative control solutions such as SmED. While Dahmen is aiming for a systematic reform instead of further lighthouse projects in medical care, Reinhardt called for the upcoming reform process to learn from existing control experience instead of building up completely new structures. The shortage of personnel does not allow further resources to be invested in emergency care. Rather, existing resources would have to be used to steer patients with less acute health complaints from emergency care to regular care. In addition, the considerable maintenance costs that already exist at the statutory health insurance associations would have to be financed and which would increase significantly as a result of the planned measures if, for example, all those seeking help who present themselves directly to an emergency room in the future can in the future contact themselves in advance by telephone or digitally with the help of one structured initial assessment. Dahmen was convinced that the digital SmED self-assessment via the 116117 website with subsequent independent electronic appointment scheduling could become a “game changer” in acute and emergency care. It immediately becomes clear that it is much more resource-efficient to book a doctor's or psychotherapy appointment from the comfort of your own home after an initial digital assessment via SmED than to wait frustratedly in the emergency room at high noon with a long waiting time.

“Data evaluations show that every tenth insured person goes to the emergency room of a clinic independently once a year. However, at least a third to around half of these patients can be treated on an outpatient basis by a contracted doctor. This could save resources that are actually used to treat medical emergencies - especially given the increasing shortage of medical professionals, particularly in the emergency services and in the emergency rooms of hospitals. “SmED can support decisions so that patients are directed to the right place of treatment at the right time,” says von Stillfried.

SmED safe for patients and efficient for users

“We have shown that SmED is safe for patients and efficient for users. The evidence on how better control of care is possible is currently being continuously improved through numerous projects and studies in the emergency services, at rescue control centers and associations of statutory health insurance physicians as well as in emergency rooms. Against this background, we want to establish the software as a uniform language for all those involved when it comes to the question of whether patient control in statutory health care is recommended. We are making the software available as a service immediately. The ongoing maintenance of the medical device represents a high cost factor that is passed on to the community of organizations that use SmED. There are no costs for patients who want to use SmED as a digital self-assessment. Our first user conference showed that there is a high demand for use in acute and emergency care, but very different application constellations. That's why we want to continue to bring users and interested parties together to exchange experiences and thus establish a user community for the further development and improvement of the software," the Zi CEO concluded.