A common misconception in the debate about digital healthcare processes such as digital preoperative patient education is that digitalisation makes medicine less personal. The opposite is true – if it is done properly. An end-to-end digital pre-admission process does not create distance between physician and patient. It creates space: space for the patients who really need personal attention.
This article shows how the combination of a digital medical history and smart risk classification leads to physician time being used in a more targeted way – with a measurable effect on patient satisfaction and quality of care.
1. The core problem: all patients go through the same process – regardless of need
In a traditional pre-admission workflow, preparation follows the same pattern for every patient: appointment at the pre-anaesthesia clinic, fill in the paper form, consent discussion, signature. Whether it is a healthy 35-year-old having an uncomplicated knee operation or a 72-year-old with heart failure, diabetes and five long-term medications – the process is largely identical. The discussion does take longer with higher ASA class and surgical risk (Kieninger et al. 2018). But the steps are the same for everyone.
This is structurally inefficient. The uncomplicated patient waits for a discussion that would hardly be necessary at this depth for them. The complex patient may not get the time their case deserves – because the physician’s next appointment is already waiting.
Physicians do not have too little time
The problem is that the available time is not consistently distributed according to clinical need.
Digital processes can change that.
2. Risk classification through a digital medical history: who needs how much attention?
A structured digital medical history records far more than name and date of birth. It systematically collects all clinically relevant information: pre-existing conditions, current medication, allergies, previous anaesthetics and how well they were tolerated, family history, smoking and alcohol consumption, cardiopulmonary symptoms. Properly designed, it provides a data basis on which a preliminary risk assessment becomes possible – even before the patient enters the hospital.
The principle of differentiated care
On the basis of the medical history data, patients can be divided into risk groups – shown here in simplified form in three categories:
| Risk group | Profile | Recommended process |
|---|---|---|
| Low risk | Young, healthy, no pre-existing conditions, no long-term medication, routine procedure – (ASA I and ASA II patients) | Digital medical history + automated patient education + short confirmation discussion (telemedical option available) |
| Medium risk | Single pre-existing condition, limited medication, familiar procedure – (ASA III patients) | Digital medical history + individualised patient education + face-to-face discussion with the physician |
| High risk | Multimorbidity, complex medication, rare/high-risk procedure, older patients – (ASA IV and above) | Digital medical history as preparation + detailed, focused face-to-face discussion with the physician on a complete information base |
This classification is not a substitute for the physician’s assessment – it is preparation for it. The physician makes the clinical decision. But they make it on the basis of complete, structured advance information – and no longer on the basis of an illegibly completed paper form.
3. The low-risk patient: safely supported without tying up unnecessary physician time
A patient without relevant pre-existing conditions who is undergoing an elective routine procedure needs correct, comprehensible patient education – but not an extended discussion. They have no complex questions about interactions, no particular risks, no specific concerns.
In a digitally supported process, this patient can be fully supported without placing a significant burden on the physician’s time budget:
- Digital medical history at home: complete, checked, transmitted in structured form
- Automatically generated patient education: individualised on the basis of the medical history data, with video explanation and digital consent sheet
- Electronic consent: legally sound, with consent trail and time stamp
- Short confirmation discussion: the physician confirms completeness and answers any questions – in a few minutes
The result: the low-risk patient is well informed, educated in a legally sound manner and optimally prepared – with a fraction of the time required for a conventional in-person appointment.
In many pre-anaesthesia clinics, experience shows that a large proportion of patients belong to the low- to medium-risk group. If digital processes carry the main load for this group, time is freed up – specifically for patients with greater care needs.
Dr. med. univ. Max Rechenmacher
4. The high-risk patient: more time, better preparation, higher quality
This is where the real benefit of the model lies. A patient with a complex medical history – heart failure, renal failure, anticoagulation, multiple previous operations – needs a real conversation. They have questions. They have fears. They need a physician who listens, weighs up and explains.
In a non-digitalised system, this patient is one of many appointments that morning. Records and test results are often missing: at Regensburg University Hospital, this was the most common reason for granting surgical approval only with reservations or not at all (Kieninger et al. 2018).
In a digitally supported system, this patient enters the discussion differently:
- The physician already knows the full medical history – prepared in structured form, with automatically flagged risk factors
- Patient education has been individualised in advance – the patient has already informed themselves and knows the main risks
- The discussion starts with the substance – not with the question “What medication are you taking?”
- The time gained goes into clinical depth – risk-benefit assessment, discussion of alternatives, personal support
This is not just more efficient. It is better medicine. The complex patient gets more of what they need: the physician’s attention, well-founded support in decision-making and the feeling of really being seen.
Digitalisation does not mean
that physicians are needed less
Efficient digitalisation ensures that physicians are needed for what they were trained to do – not for tedious data entry, documentation and paper management, but for targeted treatment and risk assessment.
5. Patient satisfaction as an outcome – not a by-product of chance
Patient satisfaction does not come from elaborate measures. It comes when patients feel: I am well informed. I am taken seriously. My case is treated individually.
An end-to-end digital pre-admission process addresses exactly these three dimensions:
“I am well informed”
The patient receives their patient education in advance – not as a dry form, but as a comprehensible video with an accompanying consent sheet. They can inform themselves at their own pace, repeat sections and note down questions. Systematic reviews show higher knowledge scores with multimedia patient education; they found no consistent effect on preoperative anxiety (Kinnersley et al. 2013, Farrell et al. 2014).
“I am taken seriously”
When a patient comes to the pre-anaesthesia clinic and the physician already knows their case – their pre-existing conditions, their medication, their concerns from the advance questionnaire – this sends a clear signal: We have prepared. Your case matters to us. That is a qualitative difference from a discussion that begins with the sentence: ‘Can you briefly tell me why you are here?’
“My case is treated individually”
Patient education is not generic – it is tailored to the specific procedure, the specific risk factors and the specific situation of the patient. This not only increases the legal quality of the consent, but also the patient’s subjective experience.
Measurable effect: In a prospective study at University Hospital Würzburg, the median physician discussion time before cholecystectomy fell from 8.1 to 1.5 minutes (−81%) with video-assisted patient education; patients’ understanding and satisfaction remained high. (Source: Leicht et al., World J Surg 2026)
Conclusion: digitalisation as an instrument for more humanity
The question is not whether hospitals and practices should introduce digital processes. The question is whether they do so in a way that really benefits the quality of care.
An end-to-end digital pre-admission process – from the structured advance medical history through individualised patient education to electronic consent – is not an automatism that replaces the physician. It is an instrument that directs physician time to where it creates the most value: with the complex patient, in a real conversation, in the clinical decision.
For the low-risk patient, this means complete, comprehensible support without unnecessary waiting times. For the high-risk patient: more time, more depth, more quality. And for the whole team: a process that conserves resources and systematically creates satisfaction – on both sides of the table.
