In the treatment of chronic diseases, where long-term optimum patient care is important, eHealth applications are particularly likely to improve the quality and economic viability of healthcare. But the combination of care given by a hospital, specialist doctors and general practitioners also presents new opportunities. The electronic health card (eGK) will be a centrepiece in the transformed, high-tech infrastructure of German healthcare. This will have far-reaching implications. Initially, the card will replace the current health insurance card for all members of state health insurance schemes, i.e. about 90% of the population. Private medical insurers will also join the project. It is foreseen that, in time, the card will cover the entire population. The pilot phase of this very comprehensive infrastructure project was launched at a regional level last year.
With the introduction of the eGK in 2007, the card will be used to identify patients, verify their insurance status and cover electronic prescriptions. Additionally, patients have the option of storing relevant emergency information, such as allergies, current medication etc. on the chip. These additional services in particular represent significant advantages compared with the current system.
In many European countries chip cards are already being tested or used in e-Government and eHealth services. Depending on the areas of use, card solutions differ greatly in terms of functionality, technology and security infrastructure. Some countries operate entirely without chip cards; instead they have developed network-oriented systems. Currently, about 15 European countries electronically process patients’ insurance data via cards or networks - some more intensively than others.
In the medium term, healthcare information such as emergency data or documentation on medication provided voluntarily by patients is to be made available Europe-wide. The European “eHealth Action Plan” is an important step in this direction by the European commission. This plan aims to make electronic healthcare services the norm for medical staff, patients and citizens by the year 2010.
In Germany, the European Health Insurance Card, EHIC, will be on the back of the eGK. It will replace the current system whereby people need separate documentation to prove they have medical insurance when travelling in Europe, and will facilitate non-bureaucratic medical treatment within Europe. Holders of the European Health Insurance Card will be able to receive emergency in- and out-patient treatment in all EU member states, as well as Iceland, Liechtenstein, Norway and Switzerland. Medical services can be used in the same way as they are available to those insured in the relevant countries. The relevant medical insurer refunds any costs incurred.
The optimised accounting system, electronic prescriptions and European validity of the eGK should result in significant cost savings. Particular savings of up to 80% are expected from the comprehensive use of e-prescriptions. However, as yet it is not possible to achieve a meaningful comparison of potential cost savings via the use of the eGK compared with the investment costs for the necessary infrastructure. Currently, the focus in the introduction of the eGK is on improving quality of care rather than on economics.
The project’s importance goes beyond introduction of the card, the necessary infrastructure and services. Surveys in Germany have shown that healthcare decision makers also expect significant improvements in organisation and processes. The eGK will be the basis for a comprehensive modernisation of the healthcare system due to the use of innovative technologies. Modern healthcare is a process that comprises screening, diagnosis, therapy, care and homecare. Electromedicine takes a central position in this system. Fast diagnosis with the most up-to-date imaging systems, such as CT with contrast media, and pinpoint therapy procedures, such as the opening and stabilisation of constricted blood vessels, are two examples. Teleradiology, tele-homecare, or the comprehensive care of chronically ill patients, will be implemented nationally and according to standardised quality requirements. Through the networking of existing data, this process will ultimately lead to the development of electronic patient records (EPRs).
At the same time, efficiency and quality of healthcare in Germany will improve: Repeat examinations will be a thing of the past; therapy-decisions will become more individually customised; no complications will result from administration of wrong medication, and the health of chronically ill patients will improve through better care. For example, if allergic reactions or mistakes in medication dosage can be avoided by checks against the EPR, if diagnoses and results of prior examinations are not lost but at hand to speed diagnosis, if an expert second opinion is available electronically to assess diagnostic images, then not only the patient benefits but also the entire care system, due to more efficient use of scarce healthcare resources.
ZVEI and its member organisations work together with medical users on practice-oriented, open solutions for these concepts within the initiative ‘Integrating the Healthcare Enterprise’. The implementation of the voluntary use of the eGK will attract additional investments and lead to a dynamic growth market for systems and solutions. In German companies, projects and processes arising from these developments also will help to open up international markets.
Intelligent regulations for new markets are important frameworks for such developments. These include the elimination of the most significant obstacles to investments in the healthcare market: Lack of financing and time-consuming, non-transparent procedures for the licensing of innovative products and methods. The investment backlog in Germany in medical technology is estimated to be around €10-15 billion. One the one hand, this is obvious from the age structure of equipment currently installed. In parts, 40% of equipment in certain product groups is more than 10 years old, which not only means the technical potential remains unused, but also that the pressure to achieve increased economic viability and changes in the way medical services are financed cannot be met in healthcare services.
Without comprehensive modernisation of the medical-technological infrastructure opportunities arising from eHealth cannot be totally utilised. All interested companies will need free access to the infrastructure of the eGK. Interested third parties will need the opportunity to develop and offer their own services, using the eGK. As in other fields, the competition of ideas and developments can increase improvements manifold.
The eGK will be a central part of networking in Germany and will be a basic requirement for significantly improved healthcare. Therefore, its importance for the development of the German healthcare system could be compared with the German motorways as the basis of developments in the German autos industry.
It also allows for a Europe-wide approach for the implementation of eHealth practices.