Developers on patient files: From January "dark green shriveled banana software"

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The new version of the electronic patient record (EPR) faces considerable challenges. The test periods are constantly being postponed. The entire ePA will not be available in the productive environment until January 15. Tests will then start immediately in selected practices in the test regions of Hamburg, Upper, Middle and Lower Franconia as well as in other voluntary practices in North Rhine-Westphalia. The nationwide roll-out will then begin and the ePA will be available to everyone from March. "Performance tests will already be carried out in the reference and test environments by then," says the Federal Ministry of Health on request.

Technical problems and lack of approvals

So far, neither of the two ePA file systems from IBM and RISE –, where the insured persons' health data is stored –, has been approved by Gematik. "The statutory health insurance funds have their IT service providers develop the file systems and the insured person user interfaces (ePA apps). The technical developments will be completed in the 4th quarter of 2024 with the approval of the file systems and ePA apps," says the BMG.

"Until then, software developers will have to test their unfinished software against another, also unfinished, unapproved software," says Erich Gehlen, manufacturer of the practice management system (PVS) Duria eG. The planned four-week test period is too short for such an extensive project. Critics had criticized this from the outset, as well as the fact that it will mainly contain PDF documents at the beginning. In addition, the chairman of the GP association had demanded that the "metadata fields of the PDF/A documents to be uploaded can be filled in easily, automatically and unambiguously in the PVS systems".

The situation surrounding the ePA is tense. Manufacturers are confronted with unstable test systems and unclear specifications, which significantly hinders the development and integration of the ePA into existing systems. On January 15, 2025, there will only be – if at all – dark green shrivel banana software in practices and pharmacies, according to another PVS manufacturer known to the editorial team.

Test systems are not available

According to Gehlen, it was actually promised months ago that the trusted execution environment (VAU) and both ePA file systems would be available for testing from mid-October. However, it has only been possible to test parts of it so far. Among other things, the approvals are still pending.

So far, only an unfinished file system manufacturer is available, which only works with a workaround. In addition, there have been difficulties in identifying the correct ePA server using the institution identifier (IK). All eGK test cards would also have the same IK, which does not match the specifications. It is possible that components could be brought to their knees due to too frequent OCSP queries, as was the case with the e-prescription launch.

Manufacturers must adhere to specifications

When asked how the BMG intends to ensure that the ePA 3.0 can cope with the payload, a spokesperson said: "It is gematik's task to continuously monitor the telematics infrastructure. To this end, gematik is in contact with all stakeholders and experts involved. In addition, numerous redundancy and backup systems stabilize the TI". As soon as problems arise, these are "addressed" with the manufacturers of the practice and hospital administration systems as well as the ePA file system providers. Gematik has also "defined concrete requirements for the ePA file systems with regard to the performance to be maintained in its 'overarching specification – performance and quantity structure TI platform'".

It was only recently announced that initially no image files may be uploaded to the ePA in JPG or PNG format. Before uploading, as with the majority of other files, a conversion to PDF/A format must take place. This is then carried out by the primary systems.

Performance concerns for some time now

Andreas Hempel, Solution Architect for e-health at Asklepios Service IT GmbH, had already expressed concerns about performance in April 2024. In addition, there is an "enormous background noise of error messages" with a simultaneous "support hell" and a lack of overall responsibility, which is repeatedly criticized. He also wanted information on what is happening in the TI and which protection goals still need to be addressed.

Many doctors are skeptical about the ePA. At the beginning of the year, the e-prescription had already caused disruptions in practices. The electronic patient file offers many more opportunities to hinder practice processes. As the ePA will initially mainly contain non-searchable PDF documents, with the exception of the electronic doctor's letter, doctors are afraid of a "digital scroll".

(mack)