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Heilbronn health region- a test region in Baden-Württemberg

The Heilbronn region has many years of experience with telematics projects. In October 2007, the region started a field test in which GPs and pharmacies were asked to test the functionality of the electronic health card in the region.

The municipal district of Heilbronn has approximately 450,000 inhabitants and is located in the north of Baden-Württemberg. In December 2003, Wirtschaftsförderung Raum Heilbronn GmbH created an information and communication platform for health insurance companies, hospitals, physicians and pharmacies – the Heilbronn health region. Based on this platform, the representatives of the individual groups started working in cooperation with each other, and now the Heilbronn University of Applied Sciences has put in place its “Medical Informatics” course as a complement to the cooperation. The goal of the initiative is the promotion of information exchange and knowledge transfer as well as the creation of an effective innovation climate in the healthcare management sector. For quite some time, the region has also been involved in telematics projects. One of the reference projects in this field is the “photo insurance card” developed for the AOK Baden-Württemberg health insurance organisation. This pilot project, in which a photo of the insured person on the health card was regarded as a simple step towards increasing the card’s safety, was successful. The Heilbronn region also stands out for the fact that almost all physicians, pharmacists and hospitals are equipped with PCs and certified software.
Telematics: The term telematics is composed of the terms telecommunication and informatics. In general, telematics means the integration, processing and distribution of decentralised datasets. In the health sector (health telematics), it is the basis for cross-sector services in a cross-liked health system and improves the communication and interaction between GPs, medical experts and hospitals (Jahrbuch der Gesundheitswirtschaft 2008).

First release in autumn 2007

Early in 2006, the Heilbronn region was selected by the German Health Minister, Ulla Schmidt, as a test region for the electronic health card (eHC) in combination with an electronic health professional card (HPC). The field test is being managed by ARGE eGKBW (consortium for the introduction of the electronic health card). In cooperation with gematik mbH, the first field test began in autumn 2007 involving 10,000 insured people, 14 physicians, ten pharmacists and one hospital in the Heilbronn region. In this first release, the eHC is being tested with real data. The function of the insurance master data, the prescription of drugs and emergency data are tested offline, which means that the data are not connected up with the telematics infrastructure. In the second release, it will be possible to access and update the data online.
Informational schematic detailing the features of the electronic health card (Figure: German Federal Ministry of Health/gematik GmbH)
gematik mbH (Gesellschaft für Telematikanwendungen im Gesundheitswesen) is a company organisation founded in 2005 by the principal organisations (health insurance companies and associations) of the German healthcare sector that are working on the introduction of the eHC. A major goal of gematik mbH is the introduction of a telematics infrastructure in Germany that enables the nationwide communication between doctors, insurance companies and hospitals, based on a common interface. The eHC is such an interface, and it is also hoped that it will provide patients with a greater transparency in regards to their health records (vaccinations, allergies and diagnoses). Since the health records will be stored on the card, it is assumed that this prevents unnecessary second examinations. This would then lead to the reduction of health insurance costs. The insured patients are however able to determine the data to which their doctors have access.

Storage of data only with the consent of the patients

Electronic health professional card (HPC) (Photo: German Medical Association)
The eHC can store compulsory and optional data. Compulsory data relate to the application of the card for the transmission of insurance master data, the reading of electronic prescriptions as well as the use of the European health insurance card (EHIC). The provision of health data is done on a voluntary basis. This includes emergency data, including blood groups and surgical interventions as well as patients’ individual drug histories. Patients can store their emergency data together with the name of their doctor, including the doctor’s health professional identification. The doctors and patients have an individual PIN, which assures that only those data that the patient has agreed to are stored on the card. The first Germany-wide tests that were carried out between June and November 2007, enabled gematik mbH to revise the system and deal with the problems that arose, for example with the different PIN methods, which are now being standardised.

First positive results

Test laboratory of gematik mbH (Photo: gematik mbH)
The Heilbronn SLK Hospitals (Heilbronner Stadt- und Landkreis-Kliniken) are participating in the test. The insured people use the new cards in the hospitals in Heilbronn. “We are pleased that the SLK Hospitals are the first German hospitals to test the electronic health card,” said Dietmar Imhorst, Managing Director of the Heilbronn Hospitals speaking in Heilbronn on 4th December 2007. “Our participation in the project enables us to communicate our requirements and thus contribute to improving the eHC.”

At the Medicine 2008 exhibition held in Stuttgart in January 2008, the chairman of ARGE eGKBW and chairman of the AOK Baden-Württemberg board of directors, Dr. Rolf Hoberg, reported on the positive results. “About four months into the project in the Heilbronn test region, we have had many valuable experiences. From contact with the participating doctors, pharmacies and patients we know that no big problems have occurred in the connection between the eHC with the HPA, the reading of the insurance master data and the reading and writing of electronic prescriptions."
During the study period, a total of 150 eHC were used by the participating GPs in the Heilbronn region who wrote 100 e-prescriptions. One of the major tasks of the field test is to contribute to the improvement of GP practices and the training measures offered by these practices. In addition, the test also seeks to analyse user acceptance of eHC and HPC. This is assessed in a survey carried out by ARGE; Heilbronn University of Applied Sciences is also undertaking an independent technical and scientific evaluation. The two-year study, which is being carried out by the Department of Medical Informatics, is supervised by Prof. Dr. Oliver Kalthoff and Prof. Dr. Nicola Marsden. Major focus is being put on the protection of privacy.

Critical comments of the doctors

Besides the many positive test results there are also many criticisms expressed by the doctors. An important point of criticism is the unclarified question of costs. The German federal government estimates that the area-wide introduction of the eHC will cost approximately €1.4 billion. A study that gematik mbH commissioned to the consulting firm Booz Allen Hamilton, but which in the end was not accepted, estimated that approximately €2.8 billion would be needed. In 2006, the study was circulated by the Chaos Computer Club and is now used as a reference by eHC critics. The doctors also complained about the envisaged high costs for private practices. On 18th February 2008, the insurance company head associations and the KBV (National Association of Statutory Health Insurance Physicians) agreed on the first stage of financing, in which each doctor’s practice will be given a lump sum to cover the costs arising from equipping the practice with mobile and stationary card terminals.

Another point of criticism is the protection of privacy. In December 2007, the German Medical Association called for a more effective protection of sensitive patient data from access by third parties. In addition, the Association also called for emergency data to be replaced by “basic clinical information”, in which long-term diagnoses and medication will be stored, which will then be available for general treatment as well as in cases of emergency. The study “Monitoring eHealth & Gesundheitswirtschaft Deutschland 2008” showed that 52 per cent of the participating doctors rated the implementation of the telematics infrastructure and the eHC in their own practices as negative.

Nevertheless, the introduction of the area-wide use of the electronic Health Card in Germany seems to be not far off, despite all the criticism. The Heilbronn test region will most likely be part of the ‘Release 2’ field test in spring 2008.

Reference: Jahrbuch Gesundheitswirtschaft 2008, published by Wegweiser GmbH Berlin, 3. edition, Jahrbuch Gesundheitswirtschaft series

ap - 20.02.2008
© BIOPRO Baden-Württemberg GmbH

Further information:
Arbeitsgemeinschaft zur Einführung der
eGesundheitskarte in Baden-Württemberg (ARGE eGKBW)
c/o AOK Baden-Württemberg
Heilbronner Straße 184
70191 Stuttgart
Tel.: +49 (0)711 2593-7688
Fax: + 49 (0)0711 2593-504
E-mail: presse@gesundheitskarte-bw.de
Website address: https://www.gesundheitsindustrie-bw.de/en/article/press-release/heilbronn-health-region-a-test-region-in-baden-wuerttemberg