Draft “e-Health Act” – Update and forecast

On 4 November, a public hearing regarding the draft Act on secure digital communication and applications in the health care system (the “e-Health Act”) took place in the health committee of the German lower house of parliament, the Bundestag.

The aim of the Act is to introduce applications for the electronic health card, to establish a telematics infrastructure for secure communications in the healthcare system, to improve the interoperability of IT systems in the healthcare system and to promote telemedical services.

State of opinion regarding the draft Act

Most experts and representatives from associations in the healthcare sector approve of the basic direction taken by the draft:

• As far as patients are concerned, the emergency data on the electronic health card and the uniform medication plan are said to be particularly significant. It is pointed out that the exchange of electronic doctors’ letters is also important in practice, however.
• The combination of pressure and incentives designed to make sure that doctors and hospitals are quick to take up the new electronic applications (emergency data set on the electronic health card and electronic discharge letters) was especially welcomed.

Proposals were also made for additional amendments and developments:

• It was stressed several times that the emergency data on the electronic health card and the electronic discharge letter can only constitute the beginning of an e-health process which would continue to be developed. As the next step, many of those invited to the hearing were hoping for the introduction of comprehensive electronic patient records, with patients deciding themselves whether the data stored on their card should be released and passed on.
• The National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) and the Federal Association for Information Technology, Telecommunications and New Media (BITKOM) once again criticised the fact that the law will create incentives for parallel infrastructures during the transitional period until the telematics infrastructure is complete.
• A number of experts pointed out that the planned interoperability register (which will list the technical and semantic IT standards used in the healthcare system) only served as a stocktaking system and was not able to drive interoperability forwards. The German Association of Heathcare IT Vendors (bvitg) argued in favour of a binding process setting down the international standards to be used.
• In addition, the German Nursing Council (Deutscher Pflegerat) called on the legislator to consider people in the healthcare sector who are not physicians and to provide for better networking in these areas as well.

But on the other hand, the proposed draft went too far for other experts:

• Security concerns were repeatedly addressed. The data retention working group doubted whether all patients are capable of properly assessing the repercussions of a decision to release their data and pointed out the risks posed by attacks on the telematics infrastructure.

The plans were only rejected out of hand in isolated cases. The Stop the e-Card Alliance (Bündnis Stoppt die e-Card) demanded a “memorandum for the entire project” and remarked that there had been no cost-benefits analysis to date. It said that the structure of the emergency data records was too complex and that they were meanwhile like little electronic patient files. It also pointed out that the new functions of the electronic health card could not be used abroad. The Stop the e-Card Alliance pointed out the European emergency health card as an alternative to the electronic health card. It said that this paper document costs less and remains in the hands of the patient.

Outlook

The German federal government’s draft has been subject to the parliamentary process since May 2015. Since the reaction to the draft has generally been positive from most experts, we can assume that the Act will be adopted in the next few weeks with a few possible minor changes. The plan is still that the e-Health Act should come into force at the beginning of 2016. However, a few provisions in the planned legislation will only take effect later:

• Producing and loading electronic discharge letters is to be remunerated from 1 July 2016 to 30 June 2018.
• Patients will be entitled to the medication plan from 1 October 2016.
• Teleconsultations when evaluating the findings in X-ray images are to be remunerated from 1 April 2017.
• Saving emergency data on electronic health cards will be possible from 1 July 2018.

 

Further reading: eHealth & telemedicine – Federal Government announces bill