Lauterbach on electronic patient records: "We will get the green light"

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To mark the launch of the electronic patient file 3.0 (ePA), Health Minister Karl Lauterbach demonstrated its benefits in a doctor's practice in Cologne. The ePA is to be used nationwide by all stakeholders during Lauterbach's term of office, perhaps in just a few weeks. "The ePA brings enormous benefits for patients. Medication, for example, is safer," said Lauterbach. Thousands of people die every year due to drug intolerances. In some cases, doctors do not know what they have prescribed for the same patient. The electronic medication list, which is to be included in the ePA 3.0 right from the start, increases the safety of drug therapy. In the long term, treatment with the ePA is "simply better".

"Treatment is simply not optimal if I don't have the complete findings," explained Lauterbach. In his opinion, the ePA could save a lot of time, time that doctors need for the serious cases. In the long term, "a completely different kind of medicine" would be possible with the ePA. In addition, the ePA would provide "research data for anyone who releases their data, which is invaluable because such a database could be used for research purposes for our universities, for example for cancer research, for Alzheimer's research". So far, there is no representative data set for the population.

The database at the Health Research Data Center is to contain all health data – "from gene data to billing data, treatment data, X-ray data, nuclear spin data". This would be a "unique data set" worldwide, which would build up over the long term and significantly change medicine. "And this is where the electronic patient record has inestimable value, also for curing diseases that we are currently unable to cure".

"ePA like a patient doctor in the future"

Lauterbach was convinced that the EPR would later be like a patient and specialized doctor with whom the patient could talk about diagnosis and treatment. "If the patient later uses their electronic patient file to find out more about their illness using artificial intelligence, to have their illness explained to them, to find out what the best way to live with this illness is and so on. That makes for a completely different kind of empowered patient.

When asked about the specific benefits, the Federal Minister of Health said that patients would no longer have to go to the doctor's surgery for minor illnesses. The doctor's appointment could take place online, the e-prescription would be transmitted digitally to the ePA – which is already possible – and the medication would be delivered to the patient's home. He described this as a revolution.

However, Lauterbach did not comment on the abolition of the quarterly flat rate, which is necessary for this. The ePA would also ensure that patients with complicated cases could organize a second opinion. For cancer patients who have been treated for a long time, the overview of "what was actually done when, where and how" is particularly important. In addition, the data from the various doctors is then "complete" and no longer "fragmented". In the Scandinavian countries, where digitalization is "so much better", there are "great survival rates".

Timely start

Lauterbach expressed his gratitude to Gematik, which had improved the ePA together with 10,000 developers involved in the project. The ePA is the largest digitization project ever seen in Germany. The pilot project is due to start on January 15 and it is a "great moment to bring it online. This is something that still happens in Germany, that something starts on time," explained Lauterbach.

When asked about security, Lauterbach replied: "Citizens' data is safe from hackers", as the ePA is initially only available to citizens in the model regions and only to selected doctors. According to a BSI spokesperson, the launch of the electronic patient file is initially planned in around 300 healthcare facilities in the model regions. Further protective measures are currently being developed. Accordingly,"a white listing will beintroduced for the participating healthcare facilities so that only these practices have access to the ePA".

"This means that doctors in the pilot region will not be able to access electronic patient records of patients who live outside the pilot region and, of course, we are aware of the hacker attacks by the Chaos Computer Club. But these problems have all been solved for the pilot phase and will be solved for the rollout, which we will carry out in this federal government."

The Federal Minister of Health assured that the technical implementations have been in the works for a long time. "I myself am also in contact with the Chaos Computer Club in this regard and, of course, with the Federal Office for Security and Information Technology and," said Lauterbach, "we will get the green light from this Federal Office once we have implemented the points we have now agreed on. The electronic patient file will not go online if there is even a residual risk of a major hacker attack. According to Lauterbach, the problems are merely minor technical issues that still need to be resolved.

"Perfectly secure"

Regarding the pediatricians' recommendations and the statements by the head of the German Medical Association, who advises against the ePA due to the security problems, Lauterbach said that their opinion would still change: "I am quite sure that the medical profession, the pediatricians, the Medical Association, will recommend the ePA as soon as we have shown in the pilot region" that the ePA works in practice and is "also perfectly secure". Those responsible are aware that the trust of citizens is at stake. "That is why we are working very, very intensively, are in constant communication with the Ministry of Health, but also with the BSI, and we have jointly developed a catalog of measures to address the attack vectors that the CCC has identified in theory."

The measures are currently being implemented in accordance with the highest security standards. "We simply have to ensure that the data is 100% secure. We are working on this," says Lauterbach. Nowhere else has so much effort been put into data security.

Security measures

As a measure against the attacks presented by the CCC, Gematik wants to additionally encrypt health insurance numbers and expand "surveillance measures such as monitoring and anomaly detection", among other things. According to the BSI, Gematik will also keep a close eye on the "secondary market for practice infrastructure". Access and attacks can be traced back to the respective practice identity, which will not prevent criminals from gaining unauthorized access to the infrastructure.

A few days ago, a BSI spokeswoman said that the BSI is taking various measures to "limit the risks of a successful attack to the group of participating healthcare facilities" and considers the technical and organizational measures (TOMs) to be mitigating. Nevertheless, further TOMs must be implemented "in the short and medium term" to "further reduce the risk of a successful attack". The Federal Ministry of Health and Gematik will decide on the start of the nationwide rollout in due course. Before then, the measures implemented up to that point will also be reassessed by the BSI," said a BSI spokesperson.

Florian Fuhrmann, one of the managing directors of Gematik, also pointed out problems at the presentation of the ePA. He described it as an important point that "unfavorable tendencies between already running applications such as electronic prescriptions or electronic certificates of incapacity for work" would have to be looked at when the ePA was launched. In addition, intensive work is being done on IT security. Gematik is therefore reviewing the introduction in the more than 250 hospitals, surgeries and pharmacies participating in the test phase.

(mack)