Medical Device Daily Contributing Writer

BERLIN — The German Health Ministry, host for this year's European Union eHealth Week held here in mid-April, was unabashedly proud in promoting what is called the world's biggest IT project, a program progressively linking patient records for 80 million citizens.

Ultimately the German e-health system will link 190,000 doctors, 21,000 pharmacies, 270 health insurance companies and 2,200 clinics and hospitals through a distributed network, as opposed to a central repository, that will deliver for any patient anywhere in the country medication and treatment histories, radiology and diagnostic images, or lab results.

The key to unlocking these records is the patient's insurance card, a chip-embedded smart card called the the Elektronischen Gesundheitskarte (eGK), which is currently being tested in Flensburg and L bau-Zittau, with 10,000 cards issued in each of the regions.

Unlike European bank cards equipped with a memory chip, the eGK card has been called a "flat PC" with up to 1 gigabyte of memory for storing data and a processor capable of running applications.

In dozens of presentations during the conference, the German ministry described its successes and plans for rolling out progressively more sophisticated versions of card readers by the end of the year in five more regions — Bochum-Essen, Heilbronn, Ingolstadt, Trier and Wolfsburg.

The Bochum-Essen test, expected to start in June, is typical of the Ministry's model, with 25 physicians, 15 pharmacies and two hospitals serving the 10,000 citizens who receive the cards.

Meanwhile, the ministry said that in April a second level of testing was launched with the release of the medical profession card to pharmacists in the same seven regions. The card holds a unique identifier for each physician, pharmacist or allied health professional and carries an electronic signature.

The system will remain off-line for the remainder of 2007, with card readers capable only of recognizing the patient or professional card. It will go online in 2008 when a third version of the card readers enables connection with a network. Some 10,000 citizens in each of the test regions will receive the eGK cards

The connectors from several manufacturers are now being tested by Gematik, a non-profit agency charged with designing, implementing and eventually assuring the operation of the system.

Proof that the German-engineered infrastructure works was delivered at the conference not by the government but by two companies which, rather than waiting for the slow-moving pace of the field tests, have gone forward with a full implementation.

In June 2005, ICW (Waldorf, Germany) privately financed a start-up network for the German eGK by recruiting four physicians and four pharmacies in its home city to test the viability of the Gematik specifications. ICW designed its components to support the eGK, "and to explore how the system fits in the general practice setting," said Dirk Schumann, spokesman for the company.

After two years there are 500 patients participating and the trial network has been continuously updated to conform to Gematik specifications as they are released, he said.

"For example we created a prescription module, but Gematik was not sure if prescriptions were to be placed on the smart card chip or stored on a server, so we did both."

ICW is now expanding the general practice network to cover the larger Rhein-Neckar region that includes the cities of Mannheim, Ludwigshafen and Heidelberg and has a population of 2.3 million. Its partners include Cisco Systems (San Jose, California), Hewlett-Packard (Palo Alto, California), two German general practice software companies and a German provider of pharmacy systems.

The expanded program, called Good Health Initiative Rhein-Neckar, was to launch with an early-May press conference. A public campaign will encourage people to join the not-for-profit association and pay a monthly fee of 17 ($9.50). Members can create a personal health record that is shared with their doctor and are offered discounts for fitness clubs and other activities.

Doctors are recruited with a free offer to connect their practice management system to the network giving access to pharmacy registries. Another incentive for physicians to join the network will come when the Good Health general practice program dovetails with the Rhein-Neckar hospital network.

On April 25, ICW and Cisco reported an agreement with one of the largest medical centers in Germany, Heidelberg University Hospital, to build a system for sharing patient's medical data with affiliated hospitals of the region.

Architecture and software from ICW will enable the diverse legacy systems of the hospitals to communicate over Cisco routers creating a network to enable continuous care as patients move from facility to facility. Access to data is restricted to nursing staff and physicians involved in any given patient's treatment.

"We are pursuing two main goals with this project," said Bj rn Bergh, MD, director of information and medical technology at Heidelberg University Hospital. "Facilitating the access to relevant information of mutual patients and actively including patient participation in the treatment process.

In both instances, we have jointly developed a pragmatic concept to help us achieve these goals without interfering with existing systems."

Peter Reuschel, CEO of ICW, confirmed that in a second phase of the program, the company will integrate hospital information systems with the physician network.

Significantly, the German eGK card is not at the center of the program. "We found in our Waldorf experience that it is hard to get people onboard with just an e-card," Schumann said. "Instead, we focus on prevention programs, such as obesity, and we work with local fitness clubs. These are things people like because they connect the program back to their doctor. That connection is more important than the card.

"The government keeps trying to direct from the top down, saying to doctors that they must do this or must do that," he said. "Instead, we are going after the early adopters among the doctors who really do want to connect. We are actually trying to support Gematik. And this regional system will eventually connect perfectly with the national network."

He said the return on ICW's investment has already been realized in several programs as a result of underwriting a program that began with four doctors in Waldorf.

In late March, Cisco and ICW said they had been selected by the Bulgarian National Health Insurance Fund to run a pilot program to test an e-card with 1,000 patients, three physicians and five pharmacies.

The electronic card system to be used in the Bulgarian pilot is the same as the eGK card being tested in Germany.

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