Last week I read this in the Wall St Journal’s 10 Point Briefing:
Today’s Question and Answer
In response to our question about big tech getting involved in health care:
Robert Bauer of California said: “No one else is doing it, so why not big tech? The only issues that I see are some proper controls on privacy and mining the data for more nefarious purposes. But some HIPPA legislation should be able to address that. When I was on a foreign assignment in Germany, at doctor visits all I had to do was give them my health-insurance card and they could access my complete records from a central database and see all the tests, doctor visits and prescriptions in one place. It made for much simpler and superior integrated health care. In addition, doctors didn’t need the overhead of administrative staffs to process insurance claims since that was integrated as well. For such an advanced country, we seem to be the last ones to adopt the very technologies we create, leading to huge cost overheads.”
Here is a link:
Needless to say I was intrigued to see how this was being done.
This seems to provide a useful pretty recent summary:
, 2018
Digital Health in Germany — 2018 and beyond
This post shall give a rough summary of the recent events in the German Digital Health sphere and a brief outlook on what awaits us in 2018 and beyond.
The E-Health Law sets the roadmap
The E-Health Law, which came into effect in 2015 and delivers the roadmap for implementing digital applications in the German health care system specifies some objectives:
- By the end of 2018, all medical practices and hospitals are expected to be connected to the telematics infrastructure.
- Maybe the most exciting area for startups at the moment is telemedicine. Since April 2017 some medical specialists are allowed to conduct online consultations for certain indications. The primary goal is to support people with limited mobility. The National Association of Statutory Health Insurance Physicians (KBV) and the National Association of Statutory Health Insurance Funds (GKV) have determined the technical requirements, mainly for security and data protection. An extension of the range of services is proposed, but it’s uncertain if it will happen this year. More on telemedicine later.
- Also since 2017, patients taking three or more medications have the right to request a paperbased medication plan with the goal of avoiding dangerous drug interactions. In 2018, the medication data shall be collected in a standardised way that enables its storage on the electronic health insurance card. From 2019 on, all physicians and pharmacists must be able to update such an electronic medication plan.
- Health Insurance Data Management („VSDM“) and online data synchronization: medical practices are obliged to obtain the necessary technical equipment for an automatic online validation and update of the patient‘s health insurance data. This ensures up-to-date data and prevents benefit fraud.
- Since January 2018, emergency relevant medical information like pre-existing illnesses can be stored on the electronic health insurance card upon the patients request.
- Electronic Medical Record: from January 2019 on, the electronic health insurance card must be capable of gathering, processing and using data concerning medical findings, diagnoses and treatment measures. Furthermore, patients will gain the option to upload their own data (e.g. from wearables) and transfer it to physicians. By the end of 2018, all requirements for this shall be met.
- In June 2017, vesta, the directory for interoperability, was launched. It‘s now accepting requests for adopting new IT standards. In the future, new digital health applications can only achieve coverage by statutory health insurances, if they meet the interoperability requirements.
For each of these applications of the electronic health insurance card, the patient can decide separately to make use of it or not.
More here:
So what we have is a system building on the National Health Insurance Infrastructure which is progressively using the Health Insurance Card as a way to access clinical information held by the Health Insurers and which is updated at each medical contact if needed.
The plan is to have the health insurance card progressively be the single EMR from 2019, presumably with a copy held by the insurer for backup etc.
This link places what is happening in the larger card based context:
This system has the advantage of real personal control and just one live copy of the data held by the patient. Germany has a universal health insurance system but multiple providers of insurance as one could expect with a population of almost 80 million.
It is important to note that they are also on a journey towards both clinician support and patient control.
David.
2 comments:
Germany's eHealth System is (and probably always will be) different from Australia's (and the UK's and the USA's) because the health and welfare systems are different.
Health care in Germany: The German health care system
https://www.ncbi.nlm.nih.gov/books/NBK298834/
myhr is a total mess because it is a solution looking for a problem, not finding one worth solving, has created extra costs and risks privacy. Adopting any other country's system will end up being a similar mess.
It could also be that Germans trust their government more than Australians trust theirs. And that's an even bigger problem than the myhr. It's another reason why the myhr will fester and die, no matter how many registrations there are.
Yes different business, funding and operating models as a start. Still be good if the GP practices could engulf the path and pharmacies under a single operations.
Of note this weekend the Governments HR system will be upgraded from 9pm Saturday 8 Dec to 7am Sunday 9 Dec 2018 (AEDT). During this time your record can be accessed but you won’t be able to link a myGov account to a new or existing My Health Record:
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