Electronic health record

The Electronic Health Record or EHR, Eng. electronic health record, is a planned database in which the patient's history, treatment data, medications, allergies and other health data of the statutory health insurance sector and case across, the country should be saved uniform. The eGA is in German speaking countries a central pillar of the policy pursued by industry and health authorities e-health concepts. It is an expression of the form of electronic files.

Doctors, dentists, pharmacies and nursing facilities when needed they should be able to recall without loss of time everywhere. The data can be stored centrally or locally depending on the model. Participation will initially be voluntary for all players. Patients should be allowed to decide on the extent and the duration of storage.

The design of the national systems shall be regulated by law. As access key issued by the health insurance health insurance card ( e-card in Austria, health card in Germany and Switzerland ) and the Health Professional Card (HPC ) to serve. The goal of innovation is to be able to control processes and quality of results in medical treatment processes. This reflects the state- planned systems differ fundamentally from private internet-based services such as Google Health, HealthVault (Microsoft) or Evita (Swisscom ).

Austria launched the National Electronic Health Record named ELGA despite massive criticism on 2 January 2014.

In Germany, the concept is explored with regional model experiments since 2011.

• 2.1 United States
• 2.2 Germany

• 3.1 online
• 3.2 Online ( adjusted )
• 3.3 offline on a USB mass storage
• 3.4 solutions outside the Federal Republic of Germany

General

For years, the health care system developed there, that data is increasingly stored electronically and are also centrally available. An electronic health record ( eGA, English personal health record PHR) is similar to the electronic medical record of a hospital, a collection of medical data of a person. In addition, the eGA has over electronic health record (EHR, electronic health record EHR english ) on ways non-medical information ( wellness information, diets, physiotherapy notes, ...) to integrate. It is Internet - based with minimal client requirements. The data sovereignty has only the user, not an institution of health care. He may, after a complex security concept other people such as doctors or institutions such as hospitals grant access to the information (read and / or write) or not.

Benefits

• Every doctor has all the important data available quickly.
• In an emergency, doctors can see in the hospital right away which a patient has pre-existing conditions and if he does not tolerate certain medications.
• Patients, regardless of the documentation requirements for doctors and dentists to store and manage to improve its information position in the healthcare medical data.
• For insurance arise efficiency benefits when letters of referral, prescriptions and medical reports will be electronically issued in the eGA the patient.

Disadvantages

• Many physicians reject the electronic medical record. They believe that handwritten notes are more detailed and contain more relevant details.
• Because of personal style is relevant from the handwritten notes could extract information quickly. A study in the British Medical Journal refuted these objections.
• For the eGA there are no requirements in terms of access rights, nor technical specifications for the protection of data (such as cryptographic techniques ). The German Medical Association ( GMA ) requires the stringent requirements of data protection of the health card for the eGA.
• After the patient has decision-making authority about which data are stored and which are not, the health data in the EHR by the information only partially contained are of limited value only. The polling doctors or dentists can not rely on them alone or derive diagnostic or therapeutic consequences with it.
• Input errors, misdiagnosis or non-validated data can lead to false medical conclusions.
• Future desires to the data by policy, health insurance, insurance companies or employers can not be excluded.
• The data protection, also in terms of doctor-patient confidentiality is permanently not guaranteed and depends on the progress of information technology.

Differences and benefits to other electronic records

According to the treatment contract ( secondary obligation ), professional law and other legal requirements that come under medical action to fruition, guided by the treating physicians and dentists documentation of treatment measures must be currently in evidence, be detailed, accurate and complete. The EHR exists usually the doctor or dentist in the clinic or practice IT system and are maintained and administered by this as the primary system of his medical documentation. The records remain most protected in the device internal local infrastructure, as doctor and dentist does not expose the risk to store them beyond their control. At his doctor every patient can gain access to his medical records or copies of medical records. In everyday practice it is rarely made use of. The reason for this lack of interest is less suspected, but the fear of many, the doctor could request the information be interpreted as distrust, which the patient must fear disadvantages in its further treatment.

The most important distinguishing feature of the electronic health record for facility-based, physician -run EHR is the sole disposal of the patient about his acts, and thus their medical data. He alone decides who stores data in his file, and change who is allowed to view and use that information. The patient obtained by the use of a eGA the opportunity to pursue any treatment process and to critically question. He can actively influence the maintenance or recovery of his health. The decisions that affect the health continue to focus on the expertise of the doctors.

Include this personal documentation can medical case-related documentation, as well as single use his own content (eg own observations, measurements ), regardless of whether the patient self-adjusts the information in the file, or may appoint a doctor with it. In contrast to the storage of patient data by his doctor, the patient does not subject itself to the commandment of data minimization of § 3a of the German Federal Data Protection Act. Therefore, it can collect and store his health and disease information in any quantity. It is expected that in electronic health records more information will be included, as in electronic health records.

It can be the example of radiological examinations avoid unnecessary radiation exposure.

Challenges of the concept of eGA sees in terms of ensuring the confidentiality, reliability ( integrity, authenticity, non-repudiation, integrity ) and availability of data.

Interaction of the different files types

General Practitioners and Dentists have an EHR in their practice software. Thus, they document their treatments and communicate partially electronically directly with medical colleagues, for example, by e -mail. Simultaneously, a resident doctor to participate in a practice net, which is a virtual EHR leads together. There, copies of medical documentation from the medical data are stored. In addition, the same doctor can but also in other practice networks or disease-related networks ( Breast Cancer Network, diabetes network, etc. ) take part, where a virtual EHR is also performed. This communication is only allowed if the patient has given birth to the doctor or dentist of his secrecy explicitly for the individual case. Furthermore, there are doctors and hospitals that are not electronically communicate and document internally only. All these distributed information available can be controlled with an electronic health record by the patient at least summarized as that is transparent where which information is available.

The concept of electronic health record takes into account the need of various parallel patient records to physicians and hospitals. However, the eGA can pursue a higher goal, where it represents a superior authority of various acts forms to physicians and dentists and integrates them. This is an important requirement for interfaces to other IT systems (especially for practice and clinic computer systems ) for the common exchange of information (ie, the digital import and export of data) out loud. From the perspective of effective treatment and an exchange of information between the treating facilities is required.

Legal regulations

United States

The Health Insurance Portability and Accountability Act of 1996, shortly (HIPAA ) does not regulate in the United States, the electronic processing of patient data, however, the private providers.

Germany

Since 2004, a personal electronic health record ( eGA, PHR) is according to § 68 SGB V a statutory enabled power in the statutory health insurance. The BVA approved since 2005 statutes on the basis of the software license fees are covered by health insurance. According to § 305 SGB V have legally insured entitled to be informed in writing of invoiced. According to § 84 SGB X they can correct, delete or block data.

Provider ( examples)

Some providers have withdrawn from cost and demand reasons from the market.

Online

No special cards or readers are required for this access.

• Atos IT Solutions and Services GmbH
• Careon GmbH
• Georg Wittschier
• Gesakon GbR pilot project (closed user group ) by the North Rhine -Westphalian Ministry of Health. *
• Microsoft HealthVault
• IhrArzt24 eGA
• Robert Leibold (of Diweka Ltd. )
• SDR North Quality UG
• Vita -X AG

Online ( adjusted )

• ICW AG

Offline on a USB mass storage

Should the security concerns but be too large, so of course you can save the data on a USB stick or memory card in the same form as in the online version. However, these data can not be replaced (if not also stored elsewhere ) at a loss. Examples:

• Ivan Moro There are encrypts the medical patient data and equipped with access rights, so that they are not readable by the loss of the stick for others. Even after the loss of the password (but not the USB stick ) by the patient are the data for health providers with access rights continue to be used.
• Georg Wittschier

Solutions outside the Federal Republic of Germany

• Microsoft ( UK, U.S.)
• Umedex AG (U.S., CA, EU)
• In Austria, a national electronic health record (EHR ) is developed with the aim of linking all healthcare providers. For the reaction, which was founded in November 2009 ELGA GmbH is responsible. Owner, the not-for- profit society, are federal, state and social security.