“At the national level, the introduction of the electronic health card (elektronische Gesundheitskarte – eGK) is by far the most important project for the standardized exchange of information across health care sectors. Introducing the eGK, as well as securing a safe data exchange, has been entrusted to the corporatist associations and the gematik GmbH since 2005. Since 2015 the use of electronic health cards has been compulsory in order for insurees to be entitled to SHI benefits. By January 2019 all physician, dentist and psychotherapist practices had to be furnished with a reader device and other technical equipment for the eGK (basic roll-out). If individual practices do not connect to the safe data exchange, their overall reimbursement level can be cut by 2.5%. All physician practices without patient contacts (e.g. laboratories), pharmacies and hospitals should also have connected to the safe data exchange network by the end of June 2020 at the latest, while midwives, long-term care institutions and physiotherapists can connect to the network on a voluntary basis.

“The eGK contains (by law) administrative data such as name, address, date of birth, insurance number and insurance status and a photograph of the insured (the photograph requirement applies to everyone aged 15 years or older, but not for individuals requiring a high level of help in their daily activities; for all specifications see §291 SGB V). The back of the eGK is actually the European Health Insurance Card which facilitates cross-country provision of care in cases of emergencies when people are abroad. The eGK is designed to allow medical data to be stored in future expansion stages, such as emergency data (e.g. diagnosis, medications, allergies, drug intolerances and contact details of GP or family members), an electronic patient file (elektronische Patientenakte – ePA; obligatory from January 2021 onwards), medication plans (a paper form has been standardized since 2016) as well as organ donation declarations, or a patient’s ‘living will’ (advance directives for medical treatment). Except for the mandatory administrative data, patients can voluntarily decide on which parts of their medical data are accessible to different medical providers via the eGK.”

Source: Blümel M, Spranger A, Achstetter K, Maresso A, Busse R. Germany: Health system review. Health Systems in Transition, 2020; 22(6): pp.i–273.

“Communication between providers is subject to the same legislation as the eGK (2004, 2015, 2019) and should benefit from the same nationwide secure data exchange system, partly from using a guaranteed electronic signature. In 2017, however, the vast majority of communication between providers was still done via postal letter and fax and only 4% of physicians used the electronic physician report regularly (Ärztezeitung, 2017). Since 2016 physicians have been incentivized through additional reimbursement to use the electronic physicians report (€ 0.55 for each report), share diagnostic material (e.g. CT scans) and offer online consultation hours. Along similar lines, the use of electronic prescriptions and electronic transferrals should be enabled by 2022 (see Section 6.2 Future developments).”

Source: Blümel M, Spranger A, Achstetter K, Maresso A, Busse R. Germany: Health system review. Health Systems in Transition, 2020; 22(6): pp.i–273.

“The most discussed concern surrounding the eGK is data security and preventing (abusive) access by unauthorized parties to the exchange network and individual records. This is despite the fact that there are several mechanisms in place to secure a high standard of data security, e.g. the card processor saves only administrative data, emergency data and the electronic medication plan, while other sensitive information is stored in several disparate locations. In addition, due to the slow implementation process (originally the eGK should had been implemented by 2006), by 2018 several individual sickness funds had launched electronic patient files (elektronische Gesundheitsakte – eGA); but these are based on insurance data alone. From 2022 onwards, members of SHI sickness funds will have rights regarding data transfer from their eGA into the ePA.

“There are fluctuations in the use of information technologies in the health care sector among the population according to age and social status. In 2019, 91% of German households had internet access. The availability of internet access correlates with monthly net household income: 80% of households with monthly incomes under € 1500 have internet access, whereas this rises to 99% for households with monthly incomes over € 3600. Additionally, 84% of single-occupancy households have internet access compared to 99% of households with at least one child. The population group aged 16–24 records the highest level of internet access (99%), while the lowest is 70% for those aged over 65 years (see Section 2.8.1 Patient Information) (Statistisches Bundesamt, 2019h).”

Source: Blümel M, Spranger A, Achstetter K, Maresso A, Busse R. Germany: Health system review. Health Systems in Transition, 2020; 22(6): pp.i–273.

“In the world’s most advanced health care markets, calls are growing to move away from fee-for-service care and toward value-based care. Such a transition includes a number of structural changes involving new payment models such as increased use of bundles, thoughtfully collecting, analyzing, and sharing patient-reported outcome measures (PROMs), and re-organizing health care delivery infrastructure into integrated practice units.

“Although payment models in the US have evolved since HITECH (for example, as seen in both private and public initiatives to encourage the use of bundles), EHRs are typically linked to revenue cycle management and traditional, fee-for-service billing. Consequently, some technology remains at odds with—or at least partially misaligned with—target payment models. Ideally, databases designed for the delivery of value-based care would go beyond “standard” medical data to include data on social determinants of health and other factors.

“The potential mismatches between the design of digital tools and the goals of the health care system are worth keeping in mind: Software systems designed around fee-for-service health care delivery will perpetuate existing waste and shortcomings, while design that builds in opportunities for broader data collection, user-friendly personal health records, and the evidence-based deployment of personalized digital tools will support the transition to value-based care. In this respect, both the US and Germany have a long way to go. Germany, in particular, has a great opportunity to thoughtfully roll out such tools over the years ahead.

“Furthermore, to take full advantage of digitized health care delivery data, systems must develop algorithms based on large and diverse population data to ensure that risk adjustment for individuals can be done on the basis of representative data from an appropriately comparable group. Algorithms need access to unprecedented amounts of anonymized data, which in turn need to be “cleaned”—not only for errors and incompleteness, but also for inherent biases.”

Source: “On The Brink Of A Digital Health Care Transformation: What Germany Can Learn From The United States, “ Health Affairs Blog, October 20, 2021.
DOI: 10.1377/hblog20211018.865750

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.

Page last updated Oct. 20, 2021 by Doug McVay, Editor.