Plans to introduce electronic medical cards in Germany stall as doctors refuse to buy equipment

BMJ 2009; 338 doi: (Published 09 April 2009) Cite this as: BMJ 2009;338:b1522
  1. Annette Tuffs
  1. 1Heidelberg

    The nationwide introduction of electronic health cards in Germany, which was due to start in 2006, is in jeopardy because doctors are refusing to install the necessary equipment. Health insurance companies say they are ready to supply cards to their 80 million members but will not do so unless doctors and pharmacies are prepared to buy the equipment beforehand.

    The German health ministry has responded to the impasse by saying that it is still confident that all patients will be using electronic health cards by the end of the year, as planned.

    The Liberal Party, which hopes to form a coalition government in autumn 2009 together with Angela Merkel’s Christian Democrats, has already announced that it wants to abandon the project, mainly because of data safety.

    The aim of the electronic cards is to improve communication among all sectors of German health care—80 million patients, 140 000 general practitioners and specialists with practices, 2000 hospitals, 65 000 dentists, 21 000 pharmacies, and 230 health insurance companies.

    The card will replace the health insurance membership card, which only shows the name and date of birth of the holder and the name of the health insurance company. The electronic version contains a digital photo of the holder as well as basic health information, such as drug prescriptions and blood group. Optional data about drugs prescribed, data for emergencies (for example, blood group and chronic disease), history of surgery, radiography findings, or doctors’ letters can be stored if the patient agrees. The data can be updated online.

    The estimated costs of the switch to electronic cards of up to €2bn (£1.8bn; $2.6bn) should be saved within a few years, says the health ministry, by avoiding multiple examinations and paper documentation.

    Doctors, hospitals, pharmacists, and service providers in the health system are equipped with a matching professional card to allow them to read their patients’ cards, put prescriptions on the cards, and sign all entries. Data will be stored on a central computer. However, the installation of the equipment in individual practices is optional and has to be paid at least partly by doctors and institutions.

    After several successful test runs in eight German regions, health insurance companies have urged that installations are obligatory for all practices, pharmacies, and hospitals because it was too risky to send out millions of cards without the certainty that they would be used.

    Wilfried Jakobs, manager of the health insurance company AOK Rhineland, suggested that doctors and pharmacies should be obliged by law to participate. But his colleague Doris Pfeiffer, who heads the Association of Health Insurance Companies, warned that such a move might prove to be counter productive. The German Medical Association has also speculated that this might be the end of the health card.

    Concerns about data safety have played a minor role in the public discussion. A recent opinion poll commissioned by the German Association for Information Technology, Telecommunications and New Media, has shown that about 75% of the population is not worried about data safety and online transmission. Regional trials were successful and data safety officials were satisfied. An obstacle in the trials was the use of a personal identification number, which many patients found too difficult to remember.


    Cite this as: BMJ 2009;338:b1522

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