Expert: Germany is “particularly picky” about data

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Data must be better exchanged between doctors and be available digitally. These are demands related to digitization in the healthcare sector. For the best possible treatment, detailed information is necessary, said Ferdinand Gerlach in the Dlf. He is chairman of the expert council for the assessment of developments in the health system and director of the institute for general medicine at the University of Frankfurt am Main.

In the Dlf, he also affirmed that the corona vaccinations could succeed more quickly with the use of family doctors.


Read the full interview

Jürgen Zurheide: On the one hand, there is a great willingness on the part of people to give data somewhere and not exactly know where. On the other hand, those who move around in the system are not allowed to do much with data. Is the finding correct?

Ferdinand Gerlach: Yes, unfortunately that is the sad truth. If we look at our analyzes, and we have done it Europe-wide, worldwide, then you can see that the high-tech nation Germany looks like a developing country with a view to the digitization of the healthcare system. We actually still have the fax standard in many places when doctors communicate with each other, we have a mess of paper, the data is scattered in the system. And the listeners probably know that, as the patients themselves carry the information back and forth between the doctors. Then you are on the way with a bag with X-rays, with doctor’s letters, as far as they are still available. And when you come to the practice or the hospital, the doctor should find the right, important information in this pile. That is actually embarrassing in an international comparison. And we should change that urgently – in the interests of the patients.

(imago / Martin Bäuml)Electronic patient record: breakthrough or flop?
It was a long process: the electronic patient record has been law since January 1st. Statutory health insurance must make it compulsory. Patients can decide whether their data should be recorded and stored in it. There are still concerns about data security.

Zurheide: In a practical way, where could data really bring progress? I mentioned it when we know better where, when, for how long people get sick, how they are treated, or if one could draw conclusions from this, that is done internationally. Give an example!

Gerlach: There are many examples. Let’s take cancer. We now know that cancer is a very complex disease. It used to be thought that there are two or three types of breast cancer that can be seen under a microscope. Today we know it’s probably 60 or more. We can distinguish this molecularly and genetically. And that’s important because different types of tumors respond differently to different drugs or combinations and to radiation. This means that if we want to treat patients individually and in the best possible way, then we need this information, and it has to be exchanged. Another example: a patient comes to the hospital, may not be responsive, is confused, is very ill. If the doctors do not know that he is taking a blood-thinning drug or that he has an allergy, the treatment can lead to considerable problems, which can also be life-threatening. Simply because important information is not available. These are two examples out of many, and this series could be continued considerably.

Germany is particularly picky in international comparison

Zurheide: You spoke in the Advisory Council in your report that you presented on Thursday that progress needs to be made through the donation of data. They say this is the gold dust of research. Which data donation are you thinking of?

Gerlach: We didn’t call that data donation at all, we said we had to find a new balance between data protection on the one hand, which is important, and the patients’ right to the best possible use of the available data for their treatment. And I think it is not clear to many that we in Germany, let me say, deal particularly closely and finicky with data if you compare it internationally, especially in Europe, where the General Data Protection Regulation applies everywhere. Then we make it unnecessarily difficult for ourselves. And this becomes particularly clear in the example of the electronic patient record that is now being introduced. We are piling up several hurdles on top of one another. This makes it very difficult to use for the patient. And we have already seen in other countries such as France, for example, that this means that this electronic patient file, which we need so urgently, does not fly, that it is not accepted, that it is not implemented in everyday life. And here we propose drastic simplifications, improvements in processes, more clarity for patients, but also for health care workers.

Zurheide: Now you’ve just said you want data protection. Then of course there is always the objection from outside, well, in the end you no longer want data protection. What do you answer them?

Gerlach: But we want it, but we want to balance it with other values. We know, I’ve just given a few examples, that sharing data means we can heal better. And so we have to have a debate in Germany about the balance between data protection and technical data security, with which we ensure that data is not misused. We are even of the opinion that there must be criminal sanctions, sensitive criminal sanctions for those who cross the boundaries drawn by the legal or solidarity community or only try to do so. That means we need a new orientation, how should health data be used in our health system? We are of the opinion that the legislature should even make a law on this, which it checks whether a health data usage law, in which this is regulated, can not bring us forward.

Vaccination by family doctors: “They can do it much easier”

Zurheide: That is the proposal of the council of experts. So far we have spoken to you as chairman of this council of experts. Now I make a conscious cut and say, you are also the chair of general medicine at the University of Frankfurt. And I want to come to the topic of Corona, which I have deliberately not addressed until now. Soon the general practitioners should also vaccinate. First the basic question, is it faster then?

Gerlach: Everyone who knows how family doctors vaccinate is absolutely convinced of this. Please make it clear to yourself that the 20 to 30 million people in the winter are vaccinated calmly and silently by general practitioners; many, many other vaccinations are also carried out in general practitioners’ practices. They need an average of ten minutes for this, very effectively. And they can do this much more easily, closer to home and also in relation to the individual patient than would ever be possible in vaccination centers.

ILLUSTRATION - 19.03.2018, Mecklenburg-Western Pomerania, Torgelow: In a treatment room in a practice, a stethoscope hangs in front of a _digital patient file_.  A nationwide model project for better medical care for patients in rural regions has started in Western Pomerania.  40 general practitioners and specialists and two Ameos clinics in Ueckermünde and Anklam can provide the medical data of the patients across disciplines faster and less bureaucratic and can also exchange it with each other.  Photo: Stefan Sauer / dpa-Zentralbild / dpa |  Usage worldwide (dpa-Zentralbild) (dpa central image)Data protection concerns to the end: Dispute over electronic patient files continues
There have long been concerns about the electronic patient record (EPR). But a few weeks before they are introduced, the dispute escalates. The reason: The Federal Data Protection Commissioner Ulrich Kelber officially warns the health insurers against the introduction of the ePA. And he could go a step further.

Zurheide: On the other hand, there is the question of what conditions are needed to make things really go faster. Or do you also say, you’d better leave a few conditions away – for example, when prioritizing – then it’ll be faster, and you will accept that in the weighing of interests. How do you measure that?

Gerlach: Here, too, I would recommend taking a look at other countries that are ahead of us, such as Great Britain. They do it that way, over half of all patients in general practitioners’ practices are vaccinated. General practitioners know their patients and they are also very good at assessing who has a special need. There are still patients who are virtually forgotten at home, who are seriously ill but are unable to drive to a vaccination center. Sometimes there are also young patients who are not old enough, but who have serious illnesses. I would simply trust the family doctors, they do it very well, are close to home, and incidentally, they can also convince skeptics much more easily. In this respect, now is really the time to trust. My prognosis is that general practitioners will do this very well if you let them.

“We have a lot more advantages than disadvantages”

Zurheide: That means prioritization, which I just mentioned, even if you deviate, you say that you would have this confidence that it would then happen – and not the private patients the first thing to get the vaccination now?

Gerlach: I wouldn’t fear that at all. The family doctors are very responsible, there may be a small deviation from the prioritization at one point or another for pragmatic reasons. Incidentally, this is also reported to me from the vaccination centers, it may not be possible to prevent it. We should now tolerate that if there are small deviations, because in the end it will go faster that way, it will go nationwide. You have to realize that there are 70,000 general practitioners’ practices. When they start to vaccinate the patients as small vaccination centers, so to speak, close to their home. We have considerably more advantages than we may have disadvantages if the vaccination sequence was not followed exactly anywhere.

Statements by our interlocutors reflect their own views. Deutschlandfunk does not adopt the statements of its interlocutors in interviews and discussions as its own.





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Expert Germany picky data

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