Health: Lauterbach’s “turbo” plan for digital patient files

An electronic file for findings and laboratory values, prescriptions on the cell phone instead of on slips of paper: millions of insured persons should be able to access new digital options more quickly for everything to do with health. Federal Minister Karl Lauterbach (SPD) presented plans for a “restart” on Thursday in order to achieve more speed after a long struggle.

As the future heart, e-files are to become the norm for all those with statutory health insurance by the end of 2024 – unless you actively reject it. More data evaluations for research should also be made possible. Patient representatives and the healthcare industry were open to more momentum, but many questions still need to be clarified.

Lauterbach said in Berlin: “Germany’s healthcare system is decades behind in digitization. We can no longer take responsibility for that.” It is now really “to reach the connection with a turbo boost”. Using the advantages of digitization makes treatments better. A package of laws is planned, which is to be presented in the next few weeks – including more precise regulations for practical implementation. An overview of the key points:

E-file for everyone

A breakthrough is finally to come for the electronic patient files (ePA), which were launched as a voluntary service in 2021. It is about personal data storage for reports, X-rays and lists of medication taken, for example. In principle, this e-file should accompany patients throughout their lives and with all doctors. This should improve the supply. Lauterbach explained that examinations are often repeated unnecessarily if, for example, cardiologists do not know the previous results of other specialists.

The only problem is that so far not even one percent of the 74 million people with statutory health insurance have an ePA. The declared goal is now to reach 80 percent by 2025. To this end, the SPD, Greens and FDP had agreed in the coalition agreement to switch to the “opt-out” principle. Specifically, everyone should automatically receive an e-file by the end of 2024. Those who do not want one would then have to object instead of actively applying for one as before. The file should also be retrievable on a smartphone with certain identification rules. How the procedure should look in practice is still to be clarified.

Between skepticism in practices and data protection

Lauterbach made it clear that a certain “defeatism” in terms of digitization among doctors should also be overcome. There are delays in networking the practices, and disputes about data protection are smoldering on several issues. The health insurance companies warned that doctors actually had to post treatment data. “The file only starts flying when it is an integral part of every doctor’s visit,” emphasized Jens Baas, head of Techniker Krankenkasse. The Greens expert Janosch Dahmen said that the patient file must be “easy to use like a search engine”. The National Association of Statutory Health Insurance Physicians warned against too much haste and “immature concepts”.

A hot topic is data protection for sensitive personal information. Lauterbach’s strategy is aimed at more leeway without “classic veto rights”. Instead of the “agreement” with data protection authorities that had to be established so far, a committee is to act in an advisory capacity, which includes representatives from medicine and ethics in addition to data protectionists. The consumer centers demanded that it must be easy to determine which doctor was allowed to access which data. An “all or nothing” is the wrong way. The German Foundation for Patient Protection warned that citizens should not be deprived of control over their medical data. “Because silence does not mean consent”.

E-prescription and research data

A breakthrough should also come with electronic prescriptions, the start of which was delayed several times. Most recently, further steps were put on hold in the only pilot region in Westphalia-Lippe. In principle, patients should get a code on their cell phone instead of the usual pink slip to pick up medicines from pharmacies. If you don’t have a smartphone or a special app, you can get the code printed out on paper for the time being. The new target is that e-prescriptions should be easier to use and become a mandatory standard by early 2024.

More data evaluations for research are also to be regulated by law. Among other things, a central office is to be set up for this purpose, which should enable access to pseudonymised data from various sources such as registers and health insurance data. This should significantly speed up knowledge. A role model for this is Israel, which began digitization more than 25 years ago. During the Corona crisis, Germany had to look at such research data from other countries, explained the chairman of the Health Advisory Council, Michael Hallek. Because in this country there is still “zero data” from our own supply for it.