This document summarizes a tri-national workshop on healthcare delivery in peripheral regions. The workshop brought together participants from Germany, France, and Switzerland to identify challenges in peripheral healthcare, develop collaborative projects to address these challenges, and plan next steps. Three priority projects were selected: 1) A platform for hospitals to share best practices and develop an adherence app, 2) A workshop on technological solutions to attract physicians to peripheral areas, and 3) An exchange program for nurses and nursing students to collaborate with technology companies and work towards harmonizing training across borders. Immediate next steps included reporting outcomes to relevant conferences and planning an expert workshop in early 2020.

1. Tri-national workshop 15 November 2019
Healthcare Delivery in the
Periphery

2. Our workshop!

3. Participants
Name First Institution
Zeisberger Peter Regierungspräsidium Karlsruhe
Friesecke Manuel Regio Basiliensis
Clement Amélie Pôle Emploi Direction régionale Grand Est
Meier Birgit Gesundheitsdepartement des Kantons Basel-Stadt
Janiczek Renate Regierungspräsidium Karlsruhe
Oppel Thomas Universitätsklinikum Freiburg
Jouin Patrick Agence Régionale de Santé
Durupt Cedric Agence Régionale de Santé
Indra Peter Gesundheitsdepartement des Kantons Basel-Stadt
Burg Florian Koordinierungsstelle Telemedizin Baden-Württemberg
Primosig Andrea Amt für Gesundheit Kanton Basel-Landschaft
Daunke Rouven Universitätsklinikum Freiburg
Dussap Anne TRISAN
Schaller Claude-Henri République et Canton du Jura, Service de l’économie et de l’emploi
Donzé Florent République et Canton du Jura, Service de l’économie et de l’emploi
Klöpper Christof BaselArea.swiss
Glauser Stefano BaselArea.swiss
Kumli Frank BaselArea.swiss

4. Goal for the day
Develop an agenda and concrete steps to
collaboratively tackle the challenges and
opportunities of Healthcare delivery in
our region

5. Steps to reach our goals
Agree on the main challenges and opportunities of Healthcare delivery in the
periphery for our region
I
Identify those that should be tackled in a collaborative effortII
Ideate initiatives that we could collaborative launch to do soIII
Develop a plan drive these initiatives forwardIV
Agree on immediate concrete next steps (and on resources and financing)V

6. Step I: Brainstorming on challenges and opportunities
Patient
• Sensibiliser les patients
aux nouvelles possibilités
de soin
• Emergencies – urgences
• Prévention – promotion
de la santé
• Pathologies chroniques
• Mentalités
• Peur de la tech
• Zugang an Randzeiten
• Personal Prevention
• Distance géographique
• Lange Wege
• Quel accès
• Proximité des soins
• Ältere Menchen sind
einer fragmentierter
Versorgung ausgeliefert
• Mobilität
Attractivity
• Zu wenig Fachkurse auf
dem Land
• Arbeitsattraktivitat ↓
• Attractivité
• Attractivité des régions
péréphériques
• Reactive approach to
healthcare
• Diferent salairies across
the border
• Aussprache der
Bevölkerung
• Sicherstellung des
Notfallversorgung
• Mangel an Hausärzten
/Betreungspersonen
• Rendre attractif les
métiers de la santé dans
les périphéries
• Landl. Versorgung
• Hausarztpraxen
• Drain to the center
• Salaires
Training
• Utiliser les nouvelles
technologies pour
développer de nouveaux
parcours de fornation et
attirer nouveaux profils
• Intégrer les évolutions
tech dans la formation
des soignants
• Human resources training
• Kooperationsbereitschaft
• Chance –Arbeitsteilung
• RH – GPMC
• Cloisonnement
• No cross-national
Network harmonization
• Corporatisme
• Berufsbilding ->
unterschiede
• Sprache D/F/E
• General Interest
• Lack of required
workforces
Structure
• Was ist Peripherie
• Kostenstruktur
unterschiedlich
• Différents systèmes
• Différentes pratiques
complémentaires
• Alles zentralisieren ist zu
teuer
• Hopspitalo-centrisme
• Eine Region? Oder drei
Regionen
• Abrechnung mit den
verschiedenen Kassen
• Tarification
• Nutzungsmöglichkeiten
von gü Service
• Ist peripher schlechter als
Zentral?
• Landesgrenzen als
Hindernis
• Tarification transfer
• Reimbursement
• Braucht es immer den
Rolls Royce?
• Connection Internet
Solutions
• Integrierte Versorgung
• Daseinsvorsorge
• Healthcare Promotion
• AAL
• P4P
• Health data monitoring
• Telemedizin
• Möglichkeiten der
Telemedizin
• Suivi a distance
• Digitalisation des soins de
la santé
• Integration Telemedizin in
den G.-systeme?
• Telemedizin
• Fehlende Datenbanken
• Wissens-management
Barriers
• Datenschutz
• Legal Issues
• IT standards lack of
harmonization
• Reception de la tech par
les usagers

7. Step I: Structuring the challenges
Patients
Integrated Healthcare Delivery
Supporting Technologies
Attracting
Physicians in the
Periphery
Adapting Training
Curriculum
Adapting
Structures
1
2
3 4 5

8. Step I: Structuring the challenges
Main challenges are the access to
Integrated Care Delivery.
Technologies such as telemedicine
are expected to enable new
delivery models.
There is a drain of physicians to
the center. Different salary
structures, different languages,
lack of training make the periphery
less attractive.
The curriculums and trainings are
not adapted to the challenges.
New curriculums (nurse
practitioners, technologies etc) and
innovative approaches would help.
There are major systemic barriers
between the healthcare systems in
the three regions. It was agreed
not no focus on these in this
workshop.
What we discussed!

9. Step II –V : Develop projects
Selection criteria:
• Concrete
• Pragmatic
• Technology-supported
• First results in 6 months
Challenges and
Opportunities
Our three projects
Integrated Healthcare
Delivery
A platform to harness
Hospital Innovation in the
region
Attracting Physicians in
the Periphery
New models for healthcare
delivery in the periphery
Adapting Training
Curriculum
An exchange between
Nurses and Nurse-students
and Technology players
1
2
3

10. A platform to harness Hospital Innovation in the region
Integrated Healthcare Delivery
What is it about?
Hospital Innovation
• Sharing innovation best practices between hospitals in
the region
• Exchange son what works and what doesn’t
• Exchanging on methodologies ad frameworks to
support innovation
Adherence app
• An application developed between hospitals as an
initial test of collaboration
• An application that supports patient adherence to
medication
• An application that allows the exchange of medication
information with physicians and pharmacists across
our borders
Scope
• Workshops and events to sharing innovation best practices and methods
between hospitals in our region
• Collaboratively develop an initial solution focused on adherence
Why should it be tri-national
• The three regions share the same bottlenecks as it related to innovation
• An adherence app would support the management of medication
information for patients traveling across our borders
What are the bottlenecks?
Hospital Innovation
• Innovation is hospitals happens in siloes (also inside
hospitals)
• The ”wheel” is reinvented for each challenge
Adherence app
• Adherence the medication difficult especially for
patients with poly –medication
• Exchange of medication information is often lacking
(at the pharmacy or at the doctor) and even more
difficult across borders
Team
Birgit Meier, Renate Janiczek, Rouven Daunke, Florian Burg, Thomas Oppel,
Frank Kumli
Deliverables in the next 6 months
• An initial workshop between hospital innovation teams in our region

11. New models for healthcare delivery in the periphery
Attracting Physicians in the Periphery
What is it about?
• Provision of healthcare in the periphery is getting
harder due to the difficulty to lure general
practitioners into the regions
• Financial incentives and new forms to work together
(shared doctors' office) might have a positive impact
but group agrees that these will not solve problem
alone
• That’s why also organizational (nurses taking over
more tasks) and technological solutions would be
needed
Scope
• Workshop for decision makers in healthcare provision at Oberrhein
• Presentation of different technological solution (Medgate Miniclinics, Apps
from Grand Est)
Why should it be tri-national
• Problem affects all parts of the Oberrhein
• Problem is not connected to the border but every region has peripheral parts
(Vosges, Schwarzwald, Jura)
What are the bottlenecks?
• No single easy solutions to the problem
• No general understanding/information which
technological solutions might alleviate the problem
Team
Anne Dusap, Manuel Friesecke, Andrea Primosig, Peter Zeisberger, Christof
Klöpper
Deliverables in the next 6 months
Event workshop organized that bring together decision makers and suppliers of
technology

12. An exchange between Nurses and Nurse-students and
Technology players
Adapting Training Curriculum
What is it about?
• Every Country and even Region has it’s own
curriculums for healthcare professionals, therefore
for also for nurses
• To hire someone cross border is therefore still
nearly impossible and makes it hard to satisfy the
demand for HCP’s
• Different skills and level of skills in different
hospitals/clinics/POC makes it hard to unify a
curriculum/diploma
• Most of the times technologies are just shown top-
down, but actual “users” are not getting asked
Scope
• The long-term scope is to unify / translate the individual skills of a
HCP over all 3 borders
• Secondly getting a glimpse and understanding of potential future
technologies used in nursing, as well as already in use tech
Why should it be tri-national
• We’re a region with a lot of exchange and flow of people, therefore the
country border should not be a career border
• The workshop will also give the chance that all nursing schools in the region
have the chance to do something together for a first approach to “unify”
their curriculums
• Unifying nursing technologies cross border can help to reduce shortages in
HCP’s by solving issues in new ways
What are the bottlenecks?
• Complexity of the curriculums
• 2 Level of translation needed : 1) Language 2) Skill
• Different durations for training (f.e. F 2 years, DE 3
years)
• Technology and Processes in Hospitals
• Still language barrier => how to prove that someone is
able to use the language correctly (no negative impact
for patients)
Team
Clement Amélie, Join Patrick, Durupt Cedric, Schaller Claude-Henri, Stefano
Glauser
Deliverables in the next 6 months
• An initial workshop between hospital innovation teams in our region where
nursing professionals can get in touch with innovative nursing technologies

13. Next steps by Claude-Henri Schaller
Report to the Plenary Session of the Conférence du Rhin supérieur /
Oberrheinekonferenz on 22 November 2019
Transition lead to the future presidents of the working groups “economy
and labour” and “health policies”
Organization of a workshop at expert level during the first trimester 2020 in
co-operation with Euro-Institut in Kehl and BaselArea.swiss/DayOne on a
specific topic to be defined by the two working groups
1
2
3

14. An initiative managed by BaselArea.swiss
in close collaboration with
the Canton of Basel-Stadt.