Electronic patient record: Directive promises better protection for children
Shortly before the nationwide rollout of electronic patient records, there is a new guideline designed to better protect children and young people.
(Image: Antonio Guillem/Shutterstock.com)
Shortly before the nationwide rollout of the electronic patient file (ePA), the Federal Ministry of Health (BMG) and the National Association of Statutory Health Insurance Physicians (KBV) have reached an agreement to better protect children and adolescents. After months of campaigning by the Professional Association of Pediatricians and Adolescent Doctors (Berufsverband der Kinder- und Jugendärzte, BVKJ), a new guideline is intended to give doctors and psychotherapists more certainty in their actions and focus on the best interests of the child. Children may only make their own decisions about their EPC from the age of 15.
The new regulation (PDF) stipulates that practices are not obliged to fill the electronic patient record of children under the age of 15 "if there are significant therapeutic reasons for not doing so" or "if there are strong indications that the welfare of a child or adolescent is at risk and filling the electronic patient record would jeopardize the effective protection of the child or adolescent". In such cases, the protection of the child takes precedence over the digital documentation obligation. The decision not to post data must be recorded in the treatment documentation.
"We are pleased about the agreement with the BMG that the ePA does not have to be filled with information that could endanger the child's welfare," says BVKJ Managing Director Tilo Radau. For some parents, the information when a 14-year-old is prescribed the pill is a sensitive issue. Another example cited by Radau is when the child's welfare is already at risk from the parents and there are references to the documentation of incidents in the ePA. Often, one of the parents is also the main insured party and therefore has access to the files. An agreement has now been reached on these points.
The BMG had previously admitted to the BVKJ and the KBV that confidential information in the ePA could endanger the welfare of children. According to the letter, which is available to the Ă„rztezeitung, Federal Health Minister Karl Lauterbach emphasized that "under no circumstances should dangerous situations arise for the well-being of children".
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And the billing data?
However, it is unclear how the BMG intends to prevent the billing data from being used to draw conclusions about treatments or whether a child's welfare is at risk. The health insurance companies automatically enter this data for all legally insured persons who have not objected. According to the Ă„rztezeitung, Lauterbach had promised measures in the letter: "In connection with the presentation of billing data in the ePA and the associated visibility of measures relating to suspected child endangerment, we will take measures to prevent identification".
A BMG spokeswoman did not go into the measures announced by Lauterbach, but pointed out, among other things, the possibility of objection: "The billing data of all ePA users is automatically entered into the ePA by the health insurance companies unless the insured person objects. An objection is possible at any time, for example via the health insurance company's ombudsman's office or via the ePA app. Insured people, not doctors or health insurance companies, can also view and manage the billing data via the ePA app, for example by hiding it from all service providers (the billing data can then only be viewed by the insured person themselves)".
Opt-out regulation for children
Only recently, the Lower Saxony Medical Association called for the opt-out rule for children and adolescents to be abolished in favor of an opt-in rule, as reported by the Ă„rztenachrichtendienst. The Medical Association sees it as a positive sign that the BMG has recognized the problem of data collection from children and adolescents. In addition, health insurance companies should be legally obliged to inform young people over the age of 15 of the possibilities of deleting their data. It is also demanded that data up to the age of 18 may not be used by insurance companies or, for example, as recruitment criteria.
All data is sensitive
"In the view of Silke LĂĽder from the independent medical profession, the concession by the Ministry of Health shifts the question of 'what is a sensitive date' to the discussion between doctors and parents." However, all data is sensitive, regardless of age. "Medical confidentiality applies equally to all medical data and the OPT-in rule should apply to everyone, i.e. genuine informed consent from the insured person," says LĂĽder. She argues that the right to informational self-determination should also be safeguarded with the ePA.
In addition, a further directive stipulates that no sanctions will be imposed on doctors and psychotherapists during the introductory phase of the ePA until December 31, 2025 if the ePA is temporarily not used. This is except in cases of gross negligence or intentional behavior. Both guidelines were agreed with the Ministry and came into force retroactively from the first of April following their publication.
(mack)
