This post is a response to the HIMSS article: "Electronic Health Records: A Global Perspective". Since this article is quite large, I’ll try going through it one country at a time. This week is Germany.
It seems that the country with a healthcare system that is the most similar to the USA's system is Germany, except Germany has no governmental subsidies.
One major similarity between the German system and the American system is the way clinicians are rewarded. Basically, the more complex a condition, medication or procedure is, the more a clinician will be paid. I've heard of clinicians trumping up a diagnosis so they get paid more.
Which then leads me to the next major similarity, none of Germany's current health IT systems support either disease prevention or "assisted ambient living" and their government system is used only to facilitate administration. Oh, by the way, that’s what the company I work for does; check it out here at www.dovetailhealth.com.
Oh yeah, one last similarity: the top major issue for Germany is "The aging of the population and its related shifts in income vs. Health-cost."
Kinds odd that the government can see that acute disease management for the aged is going to be a problem in the future, but current paying models cause doctors to keep the patient in hospital causing a burden on the health care system, don't you think?
Anyway, Germany’s new “Elektonische Gesundheitskate” or Electronic Health Card, is what is currently being tested as a EHR platform. People carry around a card with their an ID number that links to their medical details on a centralized database. As internet connections all throughout Germany are between 1 to 6 MB, a centralized system under a Service Oriented structure is fine. The basic coding for conditions in this system is HL7, which is fast becoming what the world uses.
In general, GP (or PCP, for yanks) buy-in has not been achieved, as they need to enter their own card and PIN number before each patient entry, and since this is a primarily admin focused system, they don’t see any see real benefit over a paper and pen approach. Hopefully in future they tie the use of the system into a pay for performance model like the US is starting to try and adopt. This could make buy-in easier, as people in general tend to go where money is easy to get.
If you are interested in detailed designs of Germany’s EMR, check out www.gematik.de. And look for the EPA.
