Medical Centers: Many Specialties and One IT Infrastructure

Contents

Medical centers (MVZ) are outpatient healthcare facilities where several doctors – often from different specialties – work. The operator of an MVZ does not have to be a doctor, which can lead to supply structures that are sometimes sensible and sometimes purely economically motivated. The bundling of different specialties leads to different professional and administrative requirements. Accordingly, such practices must deal with the entire range of their practice management software (PVS) and the telematics infrastructure (TI).

Patient Master Data Management

The first application of the TI, patient master data management (VSDM), dates back so far that most employees in practices no longer perceive it as part of the TI. This means that since July 1, 2019, practices have been obliged to perform a real-time check for the existence of a valid insurance status by reading the electronic health card (eGK, colloquially “insurance card”). In addition, the patient's master data are checked for currency, updated if necessary, and reported back to the health insurance company. Anyone who wonders why service providers should be responsible for maintaining the insurance company's customer file is not working in healthcare, where people have stopped racking their brains over such questions.

E-Prescription

The first digitalization push in healthcare, which was also widely perceived, came with the introduction of the e-prescription at the beginning of 2024, even outside the model regions. Since then, prescriptions for most medications have been created in the PVS, digitally signed, and then uploaded to a cloud via the end-to-end encrypted TI.

Hardly any patient understands what happens during the e-prescription process. Many insured individuals assume that the prescription is on the eGK. As alternatives to inserting the eGK at the pharmacy, e-prescription apps, health insurance apps, or QR code printouts are available, but many insured individuals are unaware of them. Only interested nerds know that the data is made available via a cloud connection and that digital signature processes are involved on both the doctor's and the pharmacist's side.

Dr. Florian Brenck

Florian Brenck is a board-certified anesthesiologist with a subspecialty in “specialized pain management.” For over 10 years, he has been providing outpatient pain management care at a multidisciplinary medical center. In addition, he conducts research on data integration and usability in medical informatics.

To this day, not all prescribable active ingredients and medications can be prescribed via e-prescription, which is why every practice must continue to keep the familiar pink prescriptions according to Muster 16. The conversion of special prescriptions for prescriptions according to the Narcotics Prescription Ordinance (BtMVV) is on Gematik's agenda, but its introduction is not yet foreseeable. Therefore, the dot matrix printer for these 3-part forms with carbon copy cannot be dismantled. In a brochure, Gematik promises doctors more effective practice workflows and more time for the essentials, namely patient care. However, the fragmented rollout of a coherent process like the e-prescription generates more attention and additional clarification and time expenditure.

Electronic Patient Record

Even before the e-prescription is fully implemented, the next TI fireworks have been ignited with the electronic patient record (ePA). Since October 1, 2025, doctors are obliged to transfer all electronically available findings they have collected themselves within the current treatment context to the ePA. This is accompanied by information and disclosure obligations to patients. Once again, neither politicians nor insurance companies feel responsible for informing their citizens or their insured individuals. Now it is the practices' task to inform.

In most medical fields, a notice in the practice is sufficient; however, some specialties must inform every patient directly so that they are aware of the measure and can object to it easily. In a few areas, written information is necessary. In our MVZ, all three variants occur, which significantly increases the organizational effort. According to the law, the health insurance companies should have informed their insured individuals. However, most insurance companies explained so little that hardly anyone understood what the ePA actually is and how patients can use it. A non-representative survey in our MVZ revealed that the vast majority of patients had not even heard of the ePA. The functions, possibilities, and patient rights were almost unknown.

Our PVS often indicates that the patient does not have an ePA or has withdrawn our access rights. An inquiry to the patient usually ends with a bewildered look and a request for an explanation.

Malfunctions and Troubleshooting

Malfunctions in the TI modules are burdensome for two reasons: patient care relies on the TI components without practical analog fallback solutions existing. Although every practice management system can generate forms as paper printouts that become valid with the doctor's signature, patients have become accustomed after almost two years to ordering repeat prescriptions by phone or email and picking up the medication directly from the pharmacy with their eGK. The detour via the practice causes misunderstanding.

Furthermore, it is often unclear where the error is to be found, whether in one's own PVS, in the local network, in the connector, or in the central services bundled at Gematik. A self-contained localization of the problem is usually neither possible nor productive.

So far, the IT systems require more maintenance than analog solutions. Updates must be installed, hardware maintained, and workflows adapted to externally defined structures. In addition to these now normal duties, special actions are added. Two particularities from the recent past were, on the one hand, the unnecessary mandatory exchange of connectors with anxiety about the availability of devices, reconnection, and correct configuration. On the other hand, the chaos surrounding the exchange of electronic health professional cards. I received my replacement card 8 weeks ago, which is valid until June 21, 2026, which is why I have already applied for a new card.

Conclusion

The experiences presented here come from an MVZ with eight doctors covering the specialties of neurology, pain therapy, psychiatry, and human genetics. Doctors are medical professionals, not IT specialists. They rely on the support of software and hardware providers, for which they bear considerable costs. However, this support is often insufficient; repeated calls and remote sessions are the norm – a considerable effort that occurs before, during, or after consultation hours. Often, the support from service providers is also not available.

(dmk)