Confusion about electronic patient files: Doctors demand later start

Contents

The events surrounding the electronic patient record are coming thick and fast. The unprepared launch of the electronic patient record (EPR) is causing displeasure not only among software manufacturers, who are still struggling with the specifications. In addition to patient protection organizations, doctors are now also speaking out, calling for a "significant delay" to ensure a "secure launch" of the ePA. From January 15, the ePA version 3.0 will initially be launched in model regions, after around four weeks it will then be rolled out nationwide. The short test phase and implementation time had already caused criticism in June.

"Since June, MEDI has been vehemently calling for a significantly longer test phase for the ePA. By now at the latest, it should finally be clear to the BMG that the nationwide rollout in mid-February cannot be adhered to after the providers of the practice management systems (PVS) made their concerns clear," warns Dr. Norbert Smetak, Chairman of MEDI Baden-Württemberg. There is still no test environment available for the manufacturers of the practice systems. The medical association is calling for a "significantly longer test phase" for the electronic patient file. The BMG should "realistically and transparently" adapt the launch of the ePA.

"We are just before the Christmas period, in the middle of a wave of infections that will continue for a long time and are operating in a completely overloaded healthcare system. It is irresponsible that a mega project like the ePA is now to be implemented in practices within just a few weeks," says Smetak. Unrealistic planning is "negligent for a project worth billions [...]". The General Practitioners' Association had also already warned of a chaotic start. The security of the ePA has also not been fully clarified. For MEDI, medical confidentiality and the confidential handling of health data have top priority.

No sanctions for doctors

After software manufacturers asked the Federal Ministry of Health (BMG) to postpone the deadline, the BMG made some concessions. Accordingly, the ePA modules for the primary systems for practices and hospitals only have to be available after a successful trial period. Following media reports and much discussion in the social media due to a postponement of the start date for the electronic patient file, Susanne Ozegowski commented on the "rumors" on LinkedIn. For many, the changes are causing uncertainty. "The BMG's current communication on the timetable is causing confusion among doctors in private practice," criticizes the medical association MEDI Baden-Württemberg.

As PVS manufacturers are no longer obliged to provide the modules for the ePA by mid-January, according to Dr. Sibylle Steiner, board member of the National Association of Statutory Health Insurance Physicians (KBV), it is "self-evident that practices should not be punished with sanctions if they do not have an up-to-date ePA module". Therefore, the TI lump sum should not be reduced. "We have already written to the BMG about this and assume that the ministry will confirm this view," says Steiner.

Who informs patients?

While doctors have long been aware of the possibility of sharing patient data easily and securely, the reality could be somewhat more complicated. "First of all, it is the task of the health insurance companies to inform and educate their members about the ePA. Practices are already working at their limits and don't have the capacity to teach their patients the basics of the ePA," explains Dr. Roland Stahl from the KBV. The KBV's current practice barometer on digitization shows that the majority of practices (90 percent) fear "that the ePA will lead to a high administrative and time expenditure".

Practices must inform patients which data they store in the ePA. "This can be done verbally or via practice notices. If patients object, this must be documented in the treatment documentation. [...] If patients agree to the storage, this must also be noted," explains the KBV. Doctors and psychotherapists must also inform their patients of their right to object in the case of particularly sensitive data, such as mental illnesses or abortions. According to the KBV, objections must be "recorded in the treatment documentation". "If genetic test results are to be entered into the ePA, patients must give their written consent," it continues.

Concerns about administrative burden for practices and clinics

There are also concerns among doctors in hospitals about the new information obligations. "This is not currently envisaged in hospitals and will lead to a lot of resentment. The acceptance of the ePA in hospitals will also suffer as a result," says the German Hospital Association.

It is also unclear when the software in hospitals and surgeries will be "ePA-reay". For hospitals, it will take additional time until not only the hospital information system, but also other systems such as radiology information systems and laboratory information systems are connected. According to the DKG, this cannot be achieved across the board by the statutory start date. A more realistic date for the nationwide rollout would be mid-2025.

(mack)