The benefits that healthcare digitization could bring to nursing care

The telematics infrastructure (TI) – the data highway of the healthcare system – is set to play a greater role for the care sector in the future. Care facilities are to be connected to the TI by July 2025, but experts believe this date is unrealistic. We spoke to Bruno Ristok, Managing Director of C&S Computer, about the hopes and hurdles associated with the TI connection. He is trying to advance the digitalization of care.

heise online: What advantages does the TI offer for care facilities?

Ristok: The advantages of the TI for care facilities are manifold. Firstly, it offers GDPR-compliant communication with doctors and other healthcare providers. Secondly, it enables a secure digital identity of the respective recipient. This is relevant to avoid fake doctors or clinics, for example. Thirdly, care facilities gain access to data that was previously inaccessible, but the electronic medication list, for example, is important for care. Overall, the TI improves productivity in care facilities and the quality of care for patients.

And what about the implementation of the e-prescription? Are there still any uncertainties?

The e-prescription is part of the medication process, which is currently still doctor-centered. This means that care facilities are often left out. The process is currently designed in such a way that it is cumbersome for care facilities to redeem the prescription – for example, they need a separate health card for each resident to obtain the medication from the pharmacy. This process, as well as the process relating to medication, in particular what was specifically dispensed by the pharmacies, should be transparently available to the care facilities. Such and similar processes should be handled via Gematik's FHIR server, but overall, there is a lack of an overall view of the processes and thus interoperability in some places.

Are there any plans or proposals for simplifying this process?

Yes, there are plans to simplify the process through dynamic consent. This means that the care facilities could act with the consent of the clients or their legal representatives. Another possibility would be to optimize the processes through digital communication, as made possible by KIM (communication in medicine).

You mentioned the electronic patient file (ePA) earlier. What role does it play in this context?

The ePA is a central element of the TI, as it can provide data across all sectors. It makes it possible to manage and share medication plans and other important health data digitally. The main benefit of the ePA is improved communication and coordination between different healthcare providers. However, the focus of data maintenance lies with the medical service providers and clinics.

What about the acceptance and connection of the TI in the care sector?

The implementation of the TI is definitely a long-term process that will take years. It is important that care facilities and other stakeholders provide continuous feedback to improve the process. The key is to rethink and optimize processes rather than simply digitizing existing procedures. What would help in nursing care would be, for example, the transfer sheet for information objects in nursing care (PIO) or, in the case of TI Messenger, communication with relatives.

What advantages does the PIO transfer form promise?

It standardizes and improves the quality of the transfer from one healthcare provider to another. This increases the level of information available to the receiving care provider. The so-called onboarding of a client should therefore be more efficient and of better quality. At the same time, the continuity of care for the client is improved. This increases the quality of life and reduces healthcare costs.

PIO transition sheet

A care information object, PIO for short, provides information in a structured form that is relevant to the area of "care". The PIO transfer form is used to transfer care and care-related information about the person requiring care between facilities. The PIO transfer form can be sent via the KIM service or uploaded to the ePA for everyone.

In addition, the PIO transition form is also an important signal for other professions in the healthcare sector, especially nursing. After all, it would be the first application in the TI to be implemented specifically for nursing. An important sign that the TI is more than just medicine.

The PIO transition form has been announced for years. Why has it failed?

The PIO transition form was actually supposed to be introduced on January 1, 2025. The basis for this was the Digital Care and Nursing Modernization Act (DVPMG) on 9 June 2021 and the publication of the National Association of Statutory Health Insurance Physicians in the Interoperability Navigator INA in December 2022.

And then, with the Act to Accelerate the Digitization of the Healthcare System (DigiG), the federal government abolished this date in March 2024 and postponed the new date to a legal ordinance to be issued. And since then, the care sector has been waiting for this ordinance. I find this decision very problematic for several reasons:

So far, the PIO transition form is the only application specifically for nursing care. It would provide concrete added value for nursing care as well as for care in general. The fact that it is not being introduced for now is a fatal signal to the care sector. This will once again undermine confidence in legislative appointments. In addition, it is becoming increasingly difficult for entrepreneurs and SMEs in particular to make investment decisions to gain market share as early adopters, for example.

What do you hope for from politicians regarding digitalization in the care sector?

Above all, I hope that politicians will adhere to deadlines when implementing legal requirements. It would also be desirable to pass a Care Future Act that, like the Hospital Future Act, brings digitization in the care sector to a new level of digitization through start-up funding. It would also be helpful if nursing and the other professions in the healthcare sector were placed more in the focus of telematics. The current focus on doctors is a relic from the last millennium. Health is no longer defined by one professional group alone.

What could the future of care look like?

Networked. Nursing needs networking. Here is a practical example. Let's assume a person is discharged from hospital but still needs nursing care from an outpatient nursing service. Wouldn't it be great if the insured person could use their electronic health card to order meals on wheels on their first visit in a legally binding manner? Technically, this is possible. And as far as networking and interoperability with other sectors is concerned, I think we need Gaia-X compatibility.

Why Gaia-X in particular?

Holistic care and support encompasses more than just the healthcare sector. People want to live independently in their homes for as long as possible. To make this possible, we need services and interfaces to other domains. For example, mobility or smart living.

To illustrate this with an example. To get to the doctor, I may need a mobility service. Using the Gaia-X concept with its services, uniform digital identities and semantic interoperability, this is easily possible without having to program X number of interfaces. This makes sense both at service provider level and for society as a whole. After all, it reduces costs and increases productivity in the healthcare sector at the same time. Considering the lack of skilled workers, this is an aspect that should not be underestimated. And Gaia-X is about more than that. It is about Europe's digital sovereignty. It is about our European understanding of the citizen's data sovereignty.

What other digital topics are important in the care sector?

Other topics are, for example, ambient assisted living (AAL). This enables citizens to live independently in their homes. This includes not only the elderly, but also people with disabilities. Built-in sensor technology can help to increase safety, detect changes and offer individualized assistance. Here, too, it is important to think in a networked way. Another technical basis would be Gaia-X. In ForesightNEXT, a smart living data ecosystem based on Gaia-X is currently being developed with funding from the BMWK, which also includes the connection to the healthcare domain.

(mack)