For people with chronic illnesses, laboratory tests are an important component in treatment management. Elderly, chronically ill patients and patients with reduced mobility in particular need nationwide testing options close to their homes, e.g. in pharmacies or medical practices. Low-threshold laboratory diagnostic services can help in combination with a digital infrastructure: They can help identify illnesses or changes in need of treatment at an early stage and offer patients easy access to diagnostic services. In times of increasing multimorbidity, chronic illnesses, increasing shortage of doctors and long waiting times for appointments in practice, they are thus creating an important basis for a sustainable, resource-efficient and prevention-oriented healthcare system. In order to be able to use this potential in a targeted manner in the future, the basis for low-threshold laboratory diagnostics must be created.

Strengthen access to preventive blood tests

A comprehensive blood test without a medical indication is currently only possible as part of the so-called “health check up”. This is only possible once for insured persons under 35 years of age, and only at intervals of three years for patients over the age of 35 years. However, according to surveys by the Central Institute for Statutory Health Care of the Federal Republic of Germany (Zi), in the years 2017—2018, on average, less than 50 percent of eligible patients took advantage of the “statutory health check over 35”. Patients currently have to schedule several visits to a doctor's office to carry out a statutory health check. This often involves waiting times of several weeks for appointments and examination results. There is therefore a need for low-threshold access to preventive blood tests, such as in test centers, pharmacies, German Red Cross (DRK) facilities or at home using selected test kits. Statutory health checks must also be continuously evaluated. In accordance with the latest scientific findings, it is necessary to check which blood tests should be offered at which intervals.

Enable blood collection outside the purely medical environment

So-called whole blood collection is currently only possible in a medical practice or if a doctor is within calling distance. In order to save medical resources, the collection of samples from the medical practice should be able to be delegated to pharmacies, for example. The subsequent evaluation and discussion of the results should continue to be carried out by a doctor. This saves patients unnecessarily long journeys and waiting times and relieves medical staff of routine tasks. The introduction of hybrid patient paths can also be useful: The whole blood collection can be carried out, for example, by qualified personnel in pharmacies or DRC facilities. In a telemedicine appointment arranged at short notice, the results of the blood test can then be discussed by a doctor. Only if the results are noticeable, further measures and a personal appointment on site are required. Capillary blood samples to check specific values can already be carried out at home or professionally in pharmacies using test kits. Depending on the patient's illness, this includes, for example, HbA1c, TSH or PSA values. All these values can be easily and precisely checked on a capillary blood basis with on-site diagnostics or in collaboration with specialized laboratories. Many doctors would like the opportunity to have certain blood values checked externally and then be informed about the results. Current diagnostic-based knowledge of patients' illness situation leads to higher quality of care and informed treatment decisions. Such an external measurement (in accordance with medical prescription) should be incorporated into the standard care provided by statutory health insurance companies. This relieves both medical staff and chronically ill patients who need to have certain blood levels checked regularly.

Ensuring interoperability and connectivity to medical diagnostics infrastructure

Communication about laboratory findings is currently based in part on paper forms and printed findings. The benefits of low-threshold laboratory diagnostics offerings can be particularly effective when they are connected to a fully digitalized infrastructure. Data transfers should be implemented to the established international standard in accordance with FIHR (Fast Healthcare Interoperability Resources) as quickly as possible. The MIO (medical information object) for laboratory findings should also be integrated into care structures as early as possible. In addition, providers of medical diagnostics should also be connected to the telematics infrastructure (TI) in order to be able to transfer data to electronic health records. Only when diagnostic and therapeutic offerings are designed to be equally interoperable and use the same infrastructure can doctors and patients take advantage of the full added value of these offerings. New routes of access to diagnostic services, for example through digital networking or the introduction of patient-related structures, will not replace diagnostics in medical practices. Instead, they conserve medical resources and at the same time promote health-conscious behavior among patients through low-threshold offers. With comparatively inexpensive low-threshold diagnostics, diseases are identified at an early stage and complex and treatment-intensive complications are reduced. As a result, high treatment costs can be avoided and patients are strengthened in the sense of a preventive healthcare system.

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