Missing Link: Telematic Infrastructure – the scorned side of the system

The Patient Data Protection Act (PDSG) has been in force since last Monday. This “law for the protection of electronic patient data in the telematics infrastructure” regulates a large number of things – from IT security in hospitals, which must be observed from 2022, to the creation of an insured person’s emergency data set by the doctor. Many of these new regulations lead to changes elsewhere. For example, doctors are paid special remuneration for creating the emergency data set (NFD) from October 20, 2020 to October 19, 2021, after which this should be routine work.

What is missing: In the fast-paced world of technology, there is often the time to rearrange the many news and backgrounds. At the weekend we want to take it, follow the sidewalks away from the current, try different perspectives and make nuances audible.

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Some regulations have implications for the insured themselves. For example, they should receive a new electronic health card (eGK) with an NFC chip for the electronic prescription, which is to come in mid-2021, and a PIN letter to activate the card. With an APP and an NFC-enabled smartphone, they can then select the pharmacy in which the e-prescription is redeemed. Another app comes with the electronic patient record (ePA), which doctors are supposed to fill with diagnoses and data from their practice management systems (PVS) from the beginning of 2021. The EPR is patient-centered: the insured have the option of deleting diagnoses or hiding them (from mid-2022) if they do not want certain doctors to see diagnoses, for example the dentist indicating a mental illness. As a sort of compensation, KIM is started, the secure “communication in medicine” that connects doctors, hospitals and health insurance companies.

With the advent of computers in medicine many years ago, doctors feared a “degenerate, diagnostic-therapeutic self-service shop” like the one at that time mirror formulated in 1970. What they got were practice and hospital management systems (PVS / KVS) to manage the patients, combined with ever greater documentation requirements in the electronic medical record.

The idea of ​​networking all of these individual systems and building something like health telematics can be dated back to 1997, when management consultant Roland Berger carried out the study Telematics in Healthcare – Perspectives for Telemedicine in Germany (PDF file) published. The extremely optimistic report raved about the introduction of an electronic patient record, in which all doctors save the medical data of an insured person across all systems and sign their findings with a key. Roland Berger’s move on behalf of the Ministry of Research and the Ministry of Health fizzled out.

The situation changed in 2001 when with the so-called Lipobay scandal the problem of drug therapy safety (AMTS) was discussed. After deaths due to the use of two contraindicative drugs, the introduction of a mandatory medication pass for all citizens was discussed. Under Health Minister Ulla Schmidt, this idea resulted in the introduction of an electronic health card (eGK), on which the medication plan and electronic prescriptions are saved.

Doctors, pharmacists and the insured should be able to access the eGK and exchange data on the eGK via their own telematic infrastructure. The health card should be introduced by law on January 1, 2006, the telematic infrastructure should be planned and built by a project company called Gematik, in which doctors / dentists, pharmacists and health insurance companies each exercise voting rights through their respective associations.

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