ID Cards in Germany and Integrated Care

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ID Cards in Germanyand Integrated Care
Summary
Niki Wirsz Siemens Medical Solutions IHE
Europe Committee Andreas Kassner VHitG
Projectmanager Telematics
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Movements in germany

• 2 significant movements
• bIT4health process (better IT for healthcare)
• Rollout of new Electronic Health Card and
• Health Professional Card (ID Card for doctors)
• Focussing the mandatory Issues of existing laws
• Leaded by national gematik (Organization of
  Selbstverwaltung)
• Initiative by the industry
• Development of new Business Cases of Integrated
  Care
• Focusing the Voluntary issues
• VHitG, Association of Health industry, 30
  companies

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bit4health-General Remarks

• Starting 2006 the Electronic Health Cards will
  replace the current health insurance card (70 Mio
  citizens)
• Designed to incorporate administrative functions
  also added health data
• Chip card suited to support
• Authentication
• Encryption
• Electronic Signature
• to ensure a high degree of data security
• Patient photograph imprinted for easier
  identification
• Implementation of new ID Card for Doctors and
  related persons (Health Professional Card for
  2.3 Mio Users)

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Contents of the Electronic Health Card

• Administrative Functionalitye.g. for handling
  electronic prescriptions
• Medical Data Only patient can enable use of its
  medical information
• European flip-side for health service providers
  in European member states

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Goals

• Improve quality of health services, e.g.
  medication safety
• Preserve patient data confidentiality
• Empower patient in making healthcare decisions
• Improve efficiency and transparency of services
  in healthcare
• Optimize healthcare processes
• Enable statistics on health information

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Applications of the Electronic Health Cards

• Administrative Part (MANDATORY)
• Insurance data including billing status
• Allowing medical care in other European countries
• Paperless transmission of prescriptions
• Medical Part (VOLUNTARY)
• Documentation of medication administration
• Emergency information (blood type, chronic
  diseases, allergies, heart conditions, dialysis,
  asthma)
• Additional health information (e.g. current
  diagnosis, surgery, vaccination and x-ray
  procedures)
• Possibility to record medical reports (Arztbrief)
• Possibility to store invoices/bills for the
  patient on provided services and costs
• Patient enables access to data blood sugar level
  for diabetics, patient availability

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Applications of the Electronic Health Cards
(continued)

• Data recorded either on the card (e.g. emergency
  information) or on servers (links on card)
• Functionality to be implemented in a phased
  approach
• Electronic prescription (mandatory application)
• In order to improve quality of health
  servicesinclude emergency information and
  documentation of medication administration

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Data Security

• Data security and confidentiality high priority
• Patient can decide IF and WHICH information can
  be recorded or deleted and WHO has access to it
• Strictly associated with the Health Professional
  Card with electronic signature (with very few
  exceptions ?!)
• Patient can view and print data from the card
• In association with another signature card
  patient can also administer own health data
• Audit trails for all transactions last 50 are
  always on record

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Benefits

• Patients
• Better access to critical information (e.g.
  emergency and when changing physicians)
• Improved quality of care and avoiding prescribing
  wrong medication
• Patients better informed on their health status
  (vaccination, allergies, disease status,
  prevention) patient own initiative and
  influence
• Healthcare Professionals
• Fast access to patients conditions and health
  data
• Optimized work processes (automatic transmission
  of data in and out of own records) more time
  for the patient
• Avoiding redundant procedures

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Project History Status

• Ministry of Health issued RFP in 2003
• Award to industry consortia led by IBM
  Deutschland GmbH bIT4health (better IT for
  better health)
• Framework Version 1.0 issued March 22, 2004
  (www.bIT4health.de) open for comments
• Timeframe
• Use step-by-step approach
• Pre-test in labs / off-site
• Mini-tests and pilot projects
• 1st mandatory implementation electronic
  prescription
• Follow with testing applications for
  documentation of medication administration and
  emergency data

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Timeline bIT4health

• 2004 bIT4health framework by industry-consortium
  
• End of 2004 new solution by Fraunhofer and new
  organisation protego.net
• 2005 expected final version by gematik (old
  concepts are obsolete)
• Tender for Infrastructure Components End of 2005
• End of 2005 first Testlabs
• Beginning of 2006 Roll out eCard/HPC in small
  areas
• Mid 2006 roll out national wide
• -Less political pressure because of reelection
  discussion
• -Parallel conceptualisation of nation wide EHR by
  health ministry and (independently) gematik

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Sources
ReferencesBMGSS http//www.die-gesundheitska
rte.de DIMDI http//www.dimdi.de/de/ehealth/karte
/index.htm bIT4health http//www.bIT4health.de
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Industry View

• Big pressure on industry for integrated care
  solutions
• Hospitals and GPs founding regional health
  networks
• Foundation of medical centers with GPs at a
  hospital
• More online communication needed between GP and
  hospital to optimize processes
• bIT4health will not serve any solutions for
  voluntary services and interoperability beyond
  mandatory services
• ?Initiative of VHitG to push interoperability
  movement in germany

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VHitG initiative

• Focus on communication between hospitals, local
  GPs
• Need to extend existing standards
• Working together with national standardization
  groups (HL7, SCIPHOX using CDA, IHE-D)
• No conflict with bIT4health, its an extension
• Compatible to future infrastructure requirements
  like authentication, encryption etc.
• companies are investing human resources and money
• 2 working packages. Not public and can be
  changed
• Patient identification, HL7 v3
• Reports from inhouse medical care, CDA Release 2

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Timeline VHitG

• Mid 2005 project starts
• End of 2005 publishing parts of the new profiles
• Testlab in spring
• Mid 2006 presentation of results on ITeG Congress

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Questions?