JMIR Publications

ABSTRACT

Background:

Since their introduction with the Digital Care Act in 2019, DiGA are a part of the German statutory healthcare system. In order to become a DiGA, mHealth apps have to complete a certification process covering both technical and evidence related aspects. After completion, DiGA are added to the DiGA-directory, containing a list of all reimbursable DiGA within German statutory health insurance (SHI). The first apps were added at the end of 2020 with the number steadily increasing. The novelty of the introduction leads to problems and barriers to optimal use along the way, which is studied from different stakeholder perspectives in this research article.

Objective:

The aim of the survey was to identify problems and barriers in the context of certification, financing and use of DiGA in Germany.

Methods:

We used semi-structured expert interviews to evaluate the perspective of stakeholders of the German healthcare system on DiGA. The interview guide was developed according to Helfferich, the interviews were transcribed and analyzed using the qualitative content approach by Mayring and Kuckartz.

Results:

We identified problems from stakeholder perspectives regarding the certification/admission, financing and service distribution regarding DiGA. The interviewed stakeholders reported problems with authorization of DiGA and the corresponding process. DiGA prices and the different negotiation positions were criticized, as well as financial challenges for smaller DiGA-manufacturers. Within service provision, technical problems, e. g., with activation codes or software surrounding DiGA-prescription were mentioned. Problems were also seen in insufficient knowledge and skills on the side of the patients as well as the medical providers.

Conclusions:

mHealth applications provide potentially disruptive innovations within the healthcare sector. Nevertheless, since the evidence-based and regulated use of this technology is relatively new there are still problems and barriers limiting the optimized, patient-centered use. This study provides an overview of problems in the context of DiGA in Germany from the stakeholder perspective. Since other countries showed interest in potentially adopting the German system, valuable implications can be drawn from this survey.