Challenge D

„The Medical Concierge“

Proposed by


Patients in need of ventilation require a high degree of monitoring when making the transition from in-patient to outpatient care or when returning to their domestic environment.

The Care Improvement Act implements a person’s statutory right to receive hospital discharge management pursuant to § 39 Paragraph 1a Clause 9 German Social Security Code V (SGB V). A framework agreement to this effect entered into force on 1 October 2017, and discharge management has thus now been enshrined in law.


When medical treatment is being provided at hospital, measures need to be instigated at an early stage to restore independent breathing by the patient as quickly as possible. A considerable amount of monitoring is therefore required within the scope of post in-patient care. This applies to the hospitals themselves (social services), to the insurance companies (supplementary medicines and aids), to the doctors providing follow-up treatment and to family members.

On the one hand, statutory health insurance companies incur high levels of expenditure if discharge management processes are not in place. On the other hand, there is no guarantee that discharge from hospital will lead to seamless transition to outpatient care in a way that is satisfactory for the patient and for the family.

In order to bring about an improvement in a patient’s health situation, it is essential for the necessary measures to be instigated in as timely a manner as possible and for the stakeholders affected to be duly informed. Secondly, all those involved must take on the responsibility of supporting the patient and the measures once discharge has taken place.

Actual Challenge

How can we ensure that all stakeholders and other parties involved cooperate actively in order to bring about a rapid restoration of a patient’s independence following a period of acute care? Can digital media provide support in terms of enabling all participants to be in possession of the same level of information with regard to the course of events and relevant communications?


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