Berlin Health Minister Karl Lauterbach wants to “keep a 20-year promise,” as he said at the federal press conference on Thursday. It’s been so long since the foundations for the electronic patient file were laid.
“In fact, it was never implemented properly,” said the SPD politician. In Germany, attempts have been made for decades to introduce nationwide digital health records so that doctors, researchers and companies can access treatment data. So far, however, this file only exists for a very small proportion of patients.
Lauterbach wants to change that and finally give a boost to digitization in the healthcare sector. His plans are also intended to give research companies better access to health data and curtail the influence of the federal data protection officer. “Germany’s healthcare system is decades behind in digitization,” said Lauterbach. “We can no longer take responsibility for that.”
He must succeed in what none of his predecessors have succeeded in doing – and also reckon with resistance that is already looming. Otherwise he too will end up in the digitization trap.
The e-file was introduced as a voluntary offer in 2021, but only around one percent of the 74 million insured uses it. One reason for this is that it has hardly any functions so far and the registration is far too complicated. Lauterbach said many had already given up on the project. “There has been a kind of defeatism among doctors.”
“Restart” of the electronic patient file
By the end of 2024, Lauterbach wants to make the e-file mandatory for everyone – unless you expressly refuse. This so-called “opt-out” procedure should mean that by the end of 2025, 80 percent of those with statutory health insurance in Germany will have an electronic file. Lauterbach wants to present the necessary law in the coming weeks, he speaks of a “restart”.
Some questions are still open. It is not yet clear how exactly patients can object. It is also unclear how older medical data should be included in the electronic file. There is no process for this yet, said Lauterbach. One way would be for family doctors to load the data into the electronic file.
The response to the plans was mixed. The head of the National Association of Statutory Health Insurance Physicians (KBV), Andreas Gassen, said that the mandatory introduction in the coming year was “recognisably unrealistic for everyone”. There was a lack of concrete content-related specifications, “the technical specifications derived from them and their data protection-compliant implementations in the IT systems”.
The health policy spokesman for the Greens, Janosch Dahmen, warned: “There must be no additional effort.” The digital file must become the standard.
>> Read also: Where there is a problem with electronic sick leave
The head of Techniker-Krankenkasse, Jens Baas, spoke of an “important push” for the e-file. However, the “opt-out” rule alone will not increase use in medical practices. “The file must not be a silent companion in the background, but must be actively used by doctors and patients,” said Baas.
To do this, it must be technically easy to use and, above all, it must be filled in automatically every time you visit a doctor so that it is always up-to-date. FOM College health expert David Matusiewicz said the “reboot” was badly needed to “clean the dust out of the system.”
Other countries are far ahead of Germany
A look abroad shows how this can work. A study by the consulting company Boston Consulting Group (BCG), which is available to the Handelsblatt, shows how other countries are doing better. “In an international comparison, Germany is one of the tail lights in the field of digital health,” says Andreas Klar, Managing Director and Partner at BCG.
The international analysis shows that there is only one area in which other countries look to Germany – and that is digital health applications, with which certain health apps can be reimbursed by health insurance companies on prescription. However, Germany has nothing to show for important fields such as electronic files.
Digital patient records are to be introduced automatically
The “opt-out” procedure has already been tested in many countries, as the analysis shows. These include Austria, Denmark, Sweden and Estonia. In the Eastern European country, 95 percent of the medical data has been in a central e-file since 2015, and all service providers – such as doctors and clinics – are connected to it and obliged to fill it in. Klar sees this point as a key success factor.
Industry may conduct research with patient data
In an international comparison, Germany is also at the bottom when it comes to making health data available for research. “The situation for companies that want to do research with health data is inadequate in Germany,” says Klar. The conditions here are not good because health data is not stored centrally and made available to industry, as is the case in Sweden or Denmark, for example.
>> Read also: Comment – The German healthcare system is many things, but it is certainly not fully economized
This is a significant locational disadvantage. Health Minister Lauterbach, for example, regretted that the Mainz-based company Biontech was relocating its clinical research from Germany to Great Britain due to a lack of patient data.
Michael Hallek, Chairman of the Council of Experts for the Assessment of Developments in the Health Care System, warned that Germany is falling well behind other countries, for example in cancer research. The corona pandemic in particular has shown that patient data is not available in Germany, only evaluations from Israel or Great Britain. “If we continue like this, we will remain a dumping ground for innovations from other countries.”
Lauterbach wants to change that. The minister announced that 300 research projects should be able to use electronic patient data by the end of 2026. In concrete terms, it should be possible to access the data pseudonymously via the research data center. Name and other characteristics are replaced by a pseudonym so that they can no longer be assigned to a specific person.
Companies should be able to submit applications for research projects to a commission, which will then decide on approval. BCG expert Klar says the project will close a gap with other European countries. But that won’t fix slow contract negotiations and clinical trial approval processes, he said.
Gematik is nationalized
Lauterbach is also going too slowly. He wants to curtail the veto right of the Federal Data Protection Commissioner and the Federal Office for Information Security (BSI). In the future, they will be part of a committee in which representatives from medicine and ethics will also discuss such decisions. This is how you gain “quality and time,” said Lauterbach.
In addition, Lauterbach wants to completely nationalize the majority-owned company Gematik and convert it into a digital agency. The authority is responsible for the digitization of the healthcare system, so far organizations of doctors, health insurance companies and clinics have also been involved. Lauterbach also hopes that this will increase the speed at which decisions are made.
The health policy spokesman for the Union Tino Sorge (CDU) criticized the fact that such important actors were excluded. “This conversion will do a disservice to acceptance among doctors, pharmacists and in clinics,” said Sorge. “It will only increase the distance between the government and medical practice.” Doris Pfeiffer, Chairwoman of the Central Association of Statutory Health Insurance (GKV), called the decision “not sensible”.
More: How economists and politicians want to save the health insurance companies