Prof. Dr. Arno Elmer, Managing Director, gematik (Society for Telematics Applications)

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gematik Gesellschaft für Telematikanwendungen der Gesundheitskarte mbH Friedrichstraße 136 10117 Berlin

German E-Health Card – the Next Step toward Integrated Social and Health Care? Prof. Dr. Arno Elmer Managing Director

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The Connected Healthcare System - Telematics Infrastructre

general practitioners

pharmacists

medical specialists

dentists

insured persons

other healthcare professionals

hospitals

medical rehabilitation

facilities

health insurance companies

eHealth Card (eHC)

© gematik I Smarter Care Initiatives in Europe 2014 I Prof. Dr. Arno Elmer 01.04.2014

132 statutory health insurance companies

90% (~70 Mio.) insured persons

2.100 hospitals

21.000 pharmacies

208.000 primary care phycisians, specialists, dentists (incl. psychological psychotherapists)

2.3 million other healthcare professionals

80.2 million citizens

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Figures of the German Healthcare System


1 Quellen: KVNo, Statistisches Bundesamt 2 Quelle: Quelle: Pharmazeutische Zeitung 3 Quelle: Barmer GEK-Arztreport 2010 4 Quelle: Ärzte Zeitung Nr. 185 Jg. 2012 S. 17 5 Quelle: Statistisches Bundesamt 2013; Zensus 2011

1,48 billion doctor-patient contacts / year1

4 million patient contacts in pharmacies /day2

Ø 45 patient contacts per doctor / day3

5 billion documents per year 4

80 million people5

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Demography Report 2010 / EU Commission

26,7

23,7

21,3

20,5

19,7

18,9

18,8

18,9

59,5

60,8

61,3

59,5

56,7

54,2

52,3

51,1

10,6

12,3

12,7

14,4

16,6

18

17,8

17,8

3,1

3,3

4,7

5,7

6,9

8,9

11

12,1

0% 20% 40% 60% 80% 100%

1990

2000

2010

2020

2030

2040

2050

2060

0-19 years 20-64 years 65-79 years 80+ years


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gematik - Gesellschaft für Telematikanwendungen der Gesundheitskarte mbH


The German government adopted in 2004 the law to implement the eHealth Card. The purpose of this law is to modernize the statutory health insurance.

The self-governed entities of the German healthcare system, especially the statutory health insurance is responsible for establishing the telematics infrastructure and implementing the ehealth card.

gematik was founded in January 2005 It is the German central coordination and communication center for all

topcis related to telematics infrastructure and ehealth card

Currently there are around 200 IT experts, application specialists and project managers employed at gematik

Managing Director: Prof. Dr. Arno Elmer

Shareholders:

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gematik: Competence Center for eHC / TI

• Concepts: The gematik develops conceptual designs and specifications to define the standards of the components, services and processes

• Patient Safety: The gematik works closely with the Federal Office for Information Security (BSI) and the Federal Commissioner for Data Protection and Freedom of Information (BfDI) in order to assure security and the functionality of all project components.

• Testing: Methods to guarantee safety, functionality and quality of all project components.

• Authorization: The gematik grants the authorization for the health telematics, after approved and successful testing.procedures

• Tender Procedure: The organization conducts the tender procedure and awards contracts to the industry partners for the development, the testing processes and the rollout

• Corporate & Organization Responsibility: The gematik oversees the operation of the telematics infrastructure and additionally carries the responsibility for its proper functioning.

• Communication: The gematik supports its stakeholders and is the central point of contact in all questions related to the eHC and TI.


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Project Status – eHC Rollout Successfully Completed

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2011: 10%

2013: almost completed

2014 eHC becomes the mandatory proof of

insurance

2012: 70%

2014: mandatory


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Project Milestones 2013 / 2014


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Contracted Industry Partners

© gematik I BMG Patientenveranstaltung I Prof. Dr. Arno Elmer

Program

ORS1

Los 1 and 2 (establishing and operation of end-

user service within the testing region)

Los 3 (establishing and operation of the central services

of the TI)

G2

Los 1 and 2 (development

and provision of COS, initialized

cards and testing cards)

Los 3 and 4 (personalization validation and issue of HBA

and SMC-B inkl. PKI)

Los 5 (establishing and operation of the

CVC-Root)

Scientific Evaluation

Evaluation, acceptance an suitability for

daily use

request for proposals

09.04.2014

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Telematics Infrastructure – Connects Everyone

The telematics infrastructure offers: • Security, because it restricts the use to only

certified and proven interoperable components. The roles of the components are clearly defined.

• Constant availibility due to the centrally organized operations

• Guaranteed highest performance through unified standards

• Nationwide, cross-sector plattform

Secured investments for the industry: • Use is restricted to defined standards

• Continous, coordinated and approved development of the entire plattform and its components

• Persistent adjustments to the current security and data protection standards in order to remain conform with the legal requirements


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Telematics Infrastructure – Phase Model

Telematics infrastructure and first applications during the trial period (testing) (Phase I): • establishing the telematics infrastructure • online update of insurance data • qualified electronic signature • secure communication between service

providers (e.g. * general practitioners)

Planned Application (Phase II + et seq.): • emergency data management • migration of health and medical data services to

the TI, eg. electronic medical record • data management for medication safety

Other projects & applications: • organ donation, QS-markers, telemedicine,

eprescription, electronic patient file, epSOS (European Patient – Smart and Open Service)


*subject to resolution possed by the shareholders

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Exampe: Use Case Polypharmacy – Data Management for Medication Safety

Studies found that:

• 10% of all insured persons consult ten or more different physicians a year • Problem: It is unkown what physician prescribed what medication? • 20 to 25% of all hospital stays in the USA are the result of side effects of medication

and harmful interaction of different medications. • due to the absence of a communication, information plattform and missing

coordination polypharmacy and issues caused my medication sideeffects create additional costs in the billions.

Source: Arzneimittelreport 2013 Barmer GEK

The amount of different prescription medications that 1/3 of all 65 year old

persons take:

five or more

data provided to improve medication safety therapy helps to reduce physical

harm by patients


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Qualitative Future Benefits of Care

Additional examples of applications:

• eCase file

• ePatient file

• eMedication plan

• supplemental pay tracking system

• nursing file / nursing and care

documentation

• eDocumentation

• Medical diary (e.g. diabetes, pain

management, asthma,…)

• reminder function e.g. for

recommended screenings and medical

examinations

• eVaccination record

• Link between In- and Outpatient Care

• Bridge between Health and

Social Care

• Empowement of the patient rights

• Supporting AAL Assisted Ambient

Living Concept

• The industry invests already today

massively in the field of E-Health


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gematik EU Activities – Communication across Borders


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Conclusion

Goal: is to achieve full accessibility of the eHC/TI -potentials for the users. Additionally the validation of past and future investments by expediating establishment and availibility of added-value applications.

The successful realiziation requires:

- constructive partnership and cooperation as well as clear committment to the project by all shareholders

- efficient committee and steering structures - clear legal frameworks and support by the federal ministry of

health (BMG) - agreement and committment to the financing of the nationwide

rollout - billing regulations for added-value applications - the activities by all parties involved should be patient-centered - coordinated information and communication about the project


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We connect the healthcare system. Safe.

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Prof. Dr. Arno Elmer Managing Director

Thank you.

[email protected]

mailto:[email protected]

Prof. Dr. Arno Elmer, Managing Director, gematik (Society for Telematics Applications)

Healthcare

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