E-patient records & e-prescriptions:Issues stressing out doctors and pharmacists

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Since the beginning of the year, an electronic patient record (ePA) has been created for all those with statutory health insurance who have not objected. As the TI dashboard reports, 40,881,740 electronic patient files were opened last week. However, only the number of technical accesses is counted. It is therefore possible that a patient record “is accessed in different facilities on the same day. These accesses are counted as multiple file openings,” Gematik stated in response to a query from heise online. Overall, there is still room for improvement in the use of the ePA, as concerns from doctors and pharmacists make clear.

ePA module not yet available for many

The National Association of Statutory Health Insurance Physicians (KBV) warns that the software in many practices does not yet have the ePA module. A quarter of manufacturers have not yet provided any feedback, or the ePA module is yet to be rolled out, according to a survey conducted by the German Health IT Association (bvitg) and the KBV. KBV board member Dr. Sybille Steiner described this as “highly critical”. Practices must now have the opportunity to integrate the ePA into their everyday work and provide feedback to manufacturers and Gematik.

Steiner advises practices without an ePA module to check their practice management system (PVS) to see whether the module needs to be activated. If there is any uncertainty, the manufacturers should be contacted. The functionality of the ePA also depends heavily on the software. In the past, it was said that some practices would have to change providers as the manufacturers would probably no longer implement the ePA module. The currently unstable telematics infrastructure is causing additional problems, with frequent outages affecting the acceptance of the ePA among doctors. According to Steiner, there is positive feedback on the electronic medication list, but many practices are critical of the handling of metadata –, for example when uploading findings or searching for documents –.

TI disruptions also hinder pharmacies

The regular disruptions to the telematics infrastructure, the “health data highway,” also hinder pharmacies. In a letter to Gematik, Claudia Korf, Managing Director of the Federal Association of German Pharmacists' Associations, described the disruptions as hindering operations. Among other things, she calls for a reassessment of reliability, as reported by the Deutsche Apotheker Zeitung, among others.

The outages led to loss of earnings for the pharmacies impacted, as prescriptions could not be delivered. Overall, there was a clear deterioration in application stability compared to the previous year. The Pharmacists' Association of Westphalia-Lippe (AVWL) is also talking about similar problems and is calling for greater reliability in the TI. “This could become a risk for our patients,” warns Thomas Haddenhorst, Chairman of the Warendorf district group of the AVWL. Anyone who is acutely ill needs the medicine immediately. “If you're ill, you can't go to several pharmacies until you finally find one that isn't affected by the disorder in question,” says Haddenhorst.

According to a Gematik spokesperson, the “temporary disruptions to which Ms. Korf refers in her letter to Mr. Florian Fuhrmann [...] did not affect the entire TI or the e-prescription system, but rather specific components or services. All faults have been completely rectified, and the services have been running stably ever since.”

In addition, the rectification of faults was “usually implemented quickly [...]. In more complex cases, however, troubleshooting – can take more time despite the intensive efforts of all those involved,” the spokesperson said. Gematik is in close and continuous contact with manufacturers, providers, and service providers. “In addition, the providers are continuously implementing technical and organizational measures to increase operational stability,” said the spokesperson. The reliability of the TI and its applications will continue to be worked on “within the scope of the legal possibilities.”

Electronic patient file: Insured people not sufficiently informed

In addition to the faults, Steiner sees the lack of information for patients as an obstacle. The health insurance companies need to become much more active here. Steiner recommends that practices refer their patients to the health insurance companies if they have any questions. The KBV offers an overview of the level of equipment with ePA modules. This is based on data from the bvitg and the KBV and is intended to create more transparency about the progress of the introduction.

(mack)