Electronic patient file – documenting data correctly and securely

Since January 2021, holders of health insurance in Germany have had the right to an electronic patient file (ePA), which is being rolled out across the country in several stages. Stage three was scheduled to start in January 2023 . Alongside registered practice doctors, care facilities, insurance providers and the public health service, this will also see hospitals using the ePA, meaning the vision of a digital health care system can finally become a reality after years of discussions. 

When you consider the challenges involved, however, this timeframe was on the tight side . Only a few of the roughly 2,000 hospitals in Germany can so far show they have the technical infrastructure and workflows required for the ePA to function as planned. This involves digitalizing their care records and integrating hospital-wide data sharing into their established processes. In addition, their IT systems need to be connected to the telematics infrastructure (TI), and doctors, pharmacists, therapists, hospitals and insurance providers must be networked with each other. Since the start of 2022, provision has been in place to penalize any hospital that doesn’t rise to this challenge, with a write-down of one percent of the billed cost for each in-patient or day-patient case.

Legislators are therefore bringing incredible pressure to bear to ensure the electronic patient file develops as intended. The aim is for not just the 70 million people in Germany with statutory insurance to benefit, but also all the other service providers in the health care system.

While the ePA may only be one digital component among many, it does offer a clear indication of the ultimate goal and the advantages that lie in store. The electronic patient file stores personal health details and medical documentation in a single digital document. For example, patients can use a smartphone app to manage their electronic health card, medical report, dental bonus booklet, antenatal card and much more besides – the equivalent of switching from a stagecoach to a high-speed train.

After all, in most cases, patients’ personal health data is currently still in the form of hard copies to which the insured parties have no direct access. For the first time, the ePA stores all medical documents and information transparently in a single electronic patient file that patients can share with specific service providers in the health care system, with their practice and also with their insurance provider or a pharmacy.

Funding of over four billion euros from German governments at federal and state level is intended to enable hospitals to establish this kind of care and treatment documentation that is electronic, available to all staff involved in the treatment process and fully incorporated into both internal and external network infrastructures.

Even these examples of requirements show just how comprehensive and complex the change processes are that hospitals need to go through in a relatively short space of time if they are to achieve the patient data documentation status that is required for the ePA. It’s not just the technical obstacles that are considerable. The ePA-related demands on doctors and other staff members are increasing dramatically because, for instance, they have to get the hang of voice-based documentation systems or new software and apps for electronically supported ward rounds and role-based authorization concepts.

The success of this switch is therefore only partly dependent on ensuring implementation of the new hardware and software systems, including the necessary interfaces, goes as smoothly as possible. It is at least as important to systematically upskill all the staff involved – by no means just doctors – to ensure they accept the new applications and can use them without making mistakes. Training courses before, during and after the go-live are absolutely essential in this context – not just to ensure that electronic forms are filled out properly in the first instance, but also that important information always finds its way correctly into the appropriate electronic patient file.

In view of the scale and speed of the ongoing digital transformation, however, even more is required. What is needed is a digital mindset characterized by an eagerness to learn and an openness to digitalization.

Digital adoption is based on a multi-stage training concept that should ideally be complemented by context-sensitive software referred to as a digital adoption platform. Unlike formal training formats, a digital adoption platform offers direct assistance in the workplace, perfectly tailored to employees’ roles. As a result, doctors, nursing staff and administrative personnel, too, receive exactly the support they themselves need to operate the apps and systems confidently and in line with compliance guidelines – online, on mobile devices or a PC, without having to seek additional assistance.

A digital adoption platform plays a valuable role, especially in transformation projects that take place in the midst of hectic hospital life, because of the particularly big need for ad hoc support in this setting. It prevents mistakes that could have fatal consequences. An incorrect medication regime that could put a patient’s health at risk is just one example. The digital adoption platform plays a major role in ensuring, without lengthy training, that doctors, nurses and administrative staff get off to a flying start with the change processes and are able to work ever more effectively. At the same time, using this platform minimizes the amount of in-person training and conventional onboarding required.

Legislators are naturally also aware how important change measures are for the success of digital transformation projects. As a result, digitalization projects are, for the first time, being fully funded through federal subsidies under the terms of the Hospital Future Act (KHZG). Alongside the costs for procuring and implementing hardware and software, initiatives such as change measures that ensure hospitals operate in line with compliance and process guidelines are therefore eligible for funding, too.

This also applies especially to activities for improving IT security, which were previously excluded from grants from the hospital structural fund. Under the KHZG, at least 15 percent of the requested funding is now to be used for measures to improve cybersecurity. Concepts that safeguard IT systems are included, as are concepts that contribute to the secure, GDPR-compliant processing of information – as part of the electronic patient file, for example.

IT security in particular is a subject that must not be underestimated under any circumstances. The increasing digitalization of health care provides greater scope for cybercriminals, and the number of attempted hacking attacks has already reached a dangerous level. According to a report from the German federal government, a total of 43 successful attacks took place in 2020 between January and the beginning of November – more than double the figure for the previous year.

A digital adoption platform can provide tailored support in this regard, too, because it offers role-based assistance in processing patient information and other sensitive data in line with compliance guidelines and the GDPR, while also adhering to the applicable security regulations – a benefit that will become increasingly important over time.

In conclusion, it is high time to press ahead with digitalizing health care. The main focus must be on the users of the new software solutions. If necessary, they should receive appropriate support, such as the kind provided by a digital adoption platform. That is the only way to ensure they operate all systems properly and comply with the relevant processes. Only then are the foundations laid for the successful roll-out of the electronic patient file (ePA), offering patients, doctors and insurance providers a centralized platform for consulting and maintaining health-related data.