BMJ 2015;350:h2991 doi: 10.1136/bmj.h2991 (Published 1 June 2015)
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NEWS Germany is set to introduce e-health cards by 2018 Ned Stafford Hamburg
Germany’s federal cabinet has approved a new law designed to ensure that the so called electronic health card system is operating by 1 July 2018. The e-health card, known in other nations as medical smartcards and which allow digital storage and retrieval of patient data, has been plagued in Germany by controversy and delay since it was first proposed in 2002.
“Bickering has gone on for far too long,” said the German health minister Hermann Gröhe in announcing the new law. “It is now finally time to focus on patients and the concrete benefits of the electronic health card for patients.”
In 2004 the German government officially began working towards introducing the e-health card system,1 despite widespread concern among doctors about the security of patients’ data and the potential harm to patient-doctor confidentiality.2 The initial 2006 deadline was not met,3 and in 2009 the system stalled again when doctors refused to buy necessary IT equipment.4 In 2010 the system, with costs already hitting €1.7bn (£1.2bn; $1.9bn), was put on hold,5 and progress since then has been minimal. Gröhe said that the new law, officially called the “law for secure digital communication and applications in healthcare,” would ensure that implementation would not be delayed any further. The law gave “clear legal guidelines” and deadlines for involved parties, who include doctors and Germany’s public and private health insurers. Doctors and insurers who embrace the e-health card system and meet deadlines will be rewarded financially, he said, while those who did not would be penalised.
The German Medical Association, whose previous strong opposition to the e-health card in recent years seems to have softened slightly, issued a statement saying that the new law had not ensured the security of patients’ information. The association said that it regretted the failure of the federal cabinet to incorporate “constructive suggestions” that it had offered, adding that the law as it now stood could weaken patients’ trust in the “digitalisation of healthcare.”6
The law, outlined in a 71 page document approved by the federal cabinet on 27 May,7 still needs official approval of the Bundestag, Germany’s lower house of parliament. But this is seen as a mere formality, as the federal cabinet comprises ministers of Chancellor Angela Merkel’s “grand coalition” government.
The law decrees that a “modern basic management data” system be operational in test regions by 1 July 2016. In this initial phase the system must be technologically capable of securely holding basic data on all insured patients and must be operational throughout Germany by 1 July 2018. Doctors who before 1 July For personal use only: See rights and reprints http://www.bmj.com/permissions
2018 are able to access and store basic data files for their patients will receive bonus payments. After that date, doctors not participating will risk reductions in patient fees. Beginning in 2018 the e-health card should be capable of storing patient information, such as allergies, blood type, and previous illnesses, that can be quickly retrieved in case of a medical emergency. The law does not require patients to store the medical emergency information on their cards, but doctors will receive a bonus payment for each patient’s medical emergency data that they enter into the e-health card system. Likewise, patients who are prescribed three or more drugs can voluntarily have this documented from October 2016 to avoid potentially harmful drug interactions. The documentation, called a Medicine Plan, will eventually be stored on the e-health card. Another key aspect of the law concerns digitalising communication about patients between doctors, which in German is called Arztbriefe, or “doctor letters,” which are currently dispatched on paper as letters. Doctor letters, which for example include referrals of patients from GPs to specialists, are a key component of Germany’s public health insurance system, which covers more than 90% of the German population. To encourage doctors to communicate with each other electronically, doctors in 2016 and 2017 will receive 55 cents, the cost of a postage stamp, each time they send a doctor letter electronically. From 1 July 2016 hospitals will receive €1 for each electronic patient discharge letter, while the doctor who is able to read the electronic discharge letter will receive 50 cents. To encourage telemedicine, doctors will receive a bonus payment for each consultation conducted electronically involving x ray results or diagnostic evaluations.
The health ministry said that the new law “especially” focused on the key role of healthcare administrative organisations in ensuring that e-health card deadlines in the next three years were kept to. The administrative organisations include the National Association of Statutory Health Insurance Physicians and the National Association of Statutory Health Insurance Funds. 1 2 3 4 5 6 7
Tuffs A. Germany plans to introduce electronic health card. BMJ 2004;329:131. Stafford N. Germany set to introduce electronic patient cards despite doctors’ opposition. BMJ 2008;336:689. Tuffs A. Introduction of Germany’s electronic health cards is delayed. BMJ 2006;332:72. Tuffs A. Plans to introduce electronic medical cards in Germany stall as doctors refuse to buy equipment. BMJ 2009;338:b1522. Tuffs A. Germany puts universal health e-card on hold. BMJ 2010;340:c17. E-Health-Gesetzentwurf: Chance verpasst! www.bundesaerztekammer.de/presse/ pressemitteilungen/news-detail/e-health-gesetzentwurf-chance-verpasst. Gesetzentwurf der Bundesregierung www.bmg.bund.de/fileadmin/dateien/Downloads/E/ eHealth/150527_Gesetzentwurf_E-Health.pdf.
BMJ 2015;350:h2991 doi: 10.1136/bmj.h2991 (Published 1 June 2015)
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Cite this as: BMJ 2015;350:h2991
For personal use only: See rights and reprints http://www.bmj.com/permissions
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