Statutory health insurance doctors require secure systems & digitization support

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The healthcare system is facing massive challenges – due to bureaucratic hurdles and demographic change. Inefficient patient management also burdens the system. The Kassenärztliche Vereinigung Westfalen-Lippe (KVWL) sees digitalization as a significant lever, provided that it functions smoothly and is implemented correctly. For years, digitization has still been “associated with a lot of frustration”, said the new KVWL board member Anke Richter-Scheer, at least when it comes to connecting practices to the telematics infrastructure and its products. “Frustration has nothing to do with prevention,” said Richter-Scheer. There are countless negative examples, she said, referring to the regular TI disruptions. The processes are often still “very error-prone”.

According to KVWL head Dr. Dirk Spelmeyer, the practice software should not mature in practices according to the “Chiquita principle”. According to Richter-Scheer, it is unacceptable for doctors to constantly have to put patients off when they ask for an electronic certificate of incapacity for work, for example, which cannot be issued due to technical faults. This was the case yesterday, for example. It is not a permanent solution that doctors first have to get their software up and running in the morning.

Doctors are in favour of digitalization

Despite the bad experiences with government-imposed digitization, doctors emphasize that they are not against digitization. For example, large language models can help with document analysis. According to Richter-Scheer, the electronic medication list contained in the electronic patient file has also proven to be very helpful. Laboratory results can also be stored there.

AI chatbots are increasingly being used in practices, for example to answer questions, AI voice assistants for automated call answering,“but also intelligent documentation of patient consultations, intelligent appointment management and voice-controlled dictation of findings and reports,” explained general practitioner Dr. Jens Grothues, who was also invited to the press event. Practices need to be brought on board.

AI is an issue

According to Grothues, AI in the practice simplifies many processes and saves resources. He has currently integrated an AI solution into his practice software, “which is more or less changing my work, but especially that of my staff. It screens which inbox comes in”. Medication plans are automatically created from hospital discharge letters, diagnoses are transferred and suggestions are made. “I am firmly convinced that health insurance requests today are often AI-generated. And I always say: AI-generated is AI-answered,” says Grothues. He wants to use AI to solve the “bureaucratic overkill that we have in the system”. It is becoming increasingly difficult to find qualified personnel. It is therefore important to better integrate digital processes such as the electronic patient file (ePA) and the e-prescription or the electronic certificate of incapacity for work into the software.

Digi-Manager should bring relief

A “Digi-Manager” would help to support practices with digitalization. Specially trained practice employees take responsibility for digitalization, analyse the level of digitalization in the practice, introduce new tools and train the team. The KVWL is also continuing its “Digi-Manager” program. It is aimed at nonmedical practice staff and teaches skills for the analysis and sustainable digitalization of practice processes. Following a successful pilot phase, the program will now be offered twice a year.

Practice Future Act

To advance digitalization in practices, the KVWL is reinforcing previous calls from the medical profession to introduce a Practice Future Act – similar to the hospital sector – to invest in IT in practices. This would allow practices to apply for funding to ensure digital equipment and operation. “The costs of digitalization must not be left to the practices,” says Anke Richter-Scheer, Deputy Chair of the KVWL Board of Directors.

“What we get reimbursed today via the telematics infrastructure flat rates is, quite honestly, a joke,” says Grothues. An innovation programme from the federal government is therefore “absolutely essential to be able to work more intelligently, faster and better with patients in the long term and to stabilize medical care in the long term”. Many practices have to change their practice management software, which costs between 3,500 and 5,000 euros and a quarter until everything has settled down.

Hardly any exchange with hospitals

Grothues criticized the fact that practices are obliged to connect to the telematics infrastructure and otherwise face sanctions, whereas this is not the case for hospitals. He calls for “hospital structures to develop accordingly”. Hospitals should also deliver doctors' letters electronically. He expects colleagues in private practice to receive a letter with recommendations for action in a timely manner. “Hospitals can't send us anything electronically these days, let alone a letter after a week”. Grothues was very annoyed. He receives letters from hospitals six months after discharge, “the patient died five months ago. That is standard”.

More efficient patient management

KVWL sees digitalization as an important building block, especially in patient management. The 116117 patient hotline and the associated online platform with digital initial assessment systems such as the “Patient Navi” are intended to enable targeted care according to medical urgency. Anyone calling 116117 will receive an answer regarding medical urgency after their initial assessment and will then be automatically forwarded to an appointment service with a PIN. If it is more urgent, the patient is advised to go to an emergency practice or make use of a home visit. If it is even more urgent, the patient must go to the emergency room. In Westfalen-Lippe, the aim is to work closely with hospitals. According to the planned emergency reform, the 112 and 116 117 numbers are to work together on a binding basis in future and be digitally networked to manage care in a more targeted manner.

(mack)