Electronic patient records and more: it won't work without interoperability

From January 2025, all doctors – both in hospitals and in surgeries – should be able to fill in the electronic patient file. For this, it is important that the software is also "ePA-ready". For the "new ePA", the ePA 3.0, "interoperability and the binding nature of the interoperability process" are important building blocks. Susanne Ozegowski, Head of the Digitalization and Innovation Department at the Ministry of Health, explained this in a Q&A session at the 9th German Interoperability Day. Otherwise, the ePA could not work in Germany.

According to Ozegowski, the spread of the ePA has so far suffered from the fact that doctors have been unable or unwilling to use it. This is set to change from January. There will certainly be points "where there is pain, where errors still occur", but there is "a clear process" on how to deal with this, Ozegowski said confidently.

In order to strengthen the binding nature of the IT systems, there is now a "whole catalog of different instruments" – including, for example, more powers for Gematik as the health agency of the Federal Ministry of Health (BMG). The Competence Center for Interoperability in Healthcare (KIG), which is based at Gematik, is intended to ensure the interoperability of applications.

No wave of lawsuits so far

Ozegwoski presented the laws announced for this purpose at the last German Interoperability Day – which also include the possibility for software companies to sue each other if they do not adhere to the Gematik guidelines. A wave of lawsuits has so far failed to materialize. Ozegowski also responded to the question posed by Melanie Wendling, Managing Director of the German Health IT Association, as to whether regulation inhibits innovation by stating that "standards are actually the basis for innovation in the first place", for example to prevent lock-in effects.

The question also arose as to how to reach people who want an EPR but are unable to register for one, and whether the Minister of Health's awareness campaign for "nine reasons for electronic patient records" was enough. Since the launch in 2021, 1.5 million people have created an ePA so far. As this is not enough for the BMG, it is now coming automatically for everyone.

"ePA for everyone" adapted to needs

According to Ozegowski, there is a large section of the population that says: "I want my medical care to work, but I don't want to have to actively deal with it myself." This part of the population does not want to go through a registration process and issue authorizations themselves. The BMG also wants to meet this need with the ePA 3.0. She also expects that there will be more active users who at least want to view their own data or receive vaccination reminders, for example.

A better exchange on interoperability should be possible between the various players, hospitals, doctors, health insurance companies and the industry with "the various working groups that are also docked with the Interop Council or the KIG". One hope with regard to interoperability is also the topic of AI. Generative language models are already in use that listen in on doctor-patient conversations and automatically transcribe, analyze and encode the conversation.

However, digitalization always requires investment, which initially takes time to amortize. At the same time, there is a lack of money; when asked about the ongoing budget discussions, Ozegowski admitted that she did not have a suitcase full of money. Asked how things should continue – if the current coalition no longer exists –, Ozegowski replied that many changes are anchored in the Social Code SGB V.

(mack)