Hospitals demand less bureaucracy

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Doctors and nursing staff in German hospitals spend an average of almost three hours a day dealing with bureaucracy, according to a survey conducted by the German Hospital Institute (DKI) on behalf of the German Hospital Federation (DKG). The DKG sees bureaucracy as a burden on patient care and is calling for a reduction in the amount of documentation required. Nursing staff and doctors are also critical of the fact that procedures are documented multiple times, and digitalization does not help here. DKG Chairman Dr. Gerald Gaß explains that an inventory of the processes to be digitized must first be made before digitization takes place.

Health Minister Karl Lauterbach wants to relieve the burden on hospitals in the future with a law to reduce bureaucracy and digitization; the DKG has now written a position paper on this. The obligations planned with the European Health Data Space, in addition to existing data transfer obligations, will also result in high levels of bureaucracy. For example, as stated in the position paper, a description of the data records that hospitals must transmit and check annually as health data owners is required.

No relief through digitization so far

Digitization has not yet been able to provide any relief. Moreover, many hospitals have not been able to expand it further due to an investment backlog, explains Andrea Bergsträßer, Director of Nursing at Westpfalz-Klinikum. Although the Hospital Future Act (KHZG) provides for the promotion of digitization, there are not enough software providers to implement the digitization requirements at the pace required by law. In addition, the KHZG only supports certain projects.

Even with the hospitals' financial resources, many systems are not interoperable, criticized Gaß. As an example, he cited decentralized blood pressure monitoring, laboratory results and the like not being automatically transferred to the patient file via the hospital information system (HIS) due to a lack of interfaces. Data is often collected digitally, but then has to be transferred to the HIS manually. This should change with the standardization specifications of Gematik as the future digital agency of the Federal Ministry of Health. According to Gaß, digitization – from speech recognition systems to information systems – can help, but it also requires corresponding investments, but not just one-off investments.

Three hours are missing from patient care

The DKI survey results show that full-time doctors spend an average of 2.9 hours and nurses 2.7 hours a day on documentation tasks and verification obligations. "Three hours per day corresponds to 116,600 of almost 343,000 full-time employees (34 percent) in the nursing service of general hospitals and 59,500 of a good 165,200 full-time physicians nationwide (36 percent). These specialists are not available for patient care during the time in which they have to fulfill the escalating bureaucratic obligations," says Gaß.

Over many years, documentation has developed from a necessary secondary activity into an extreme burden. "The problem of paperwork that is far too often unnecessary for medical and nursing purposes has gotten completely out of control," says the DKG. According to the DKG, reducing documentation tasks by just one hour per day and worker would ensure that 21,000 more doctors and 47,000 more nursing staff would be available to provide medical and nursing care.

What is documentation for?

We no longer even know what data needs to be collected for, explains Denny Götze, Head of Nursing for Anesthesia and Intensive Care at the Evangelisches Waldkrankenhaus Berlin. A large part is not used to prove the success of the treatment – for example, the regular documentation of the temperature of the refrigerators.

According to Götze, all documents that are relevant to billing must be checked during the coding audits with the hospital's medical controllers. In some cases, however, this is no longer possible, for example in the case of a patient who has been on the ward for several weeks and for whom several pages of paper are printed out every day. According to Götze, these must be checked in a dialog between medical controllers and doctors and nursing staff.

The German Hospital Federation is hoping for the bureaucracy relief law planned by the traffic light coalition and the Ministry of Health. "Politicians should keep their word. [...] They always talk about reducing bureaucracy, but this is not actually happening," said Dr. Peter Bobbert, President of the Berlin Medical Association. There is now a "shadow economy of over-bureaucratization". This bureaucracy drains a lot of energy from medical staff. Doctors don't want more money, they want more time. For every new form of bureaucracy, an old one has to give way. The current bureaucratic burden would endanger medicine.

(mack)