Primary Care IT Strategy in Germany_Rose

8/9/2019 Primary Care IT Strategy in Germany_Rose

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First US-German Summit on Primary Care

IT-Strategy to Support the Vision

of Primary Care in Germany

Jochen Rose, MDCOO Hausrtzliche Vertragsgemeinschaft

Washington, 9th April 2010


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Agenda

Background: HVG

Role of IT in Primary Care Contracts Software: Practice IT-System

Telematics and primary care network

Regulatory background on telematics in Germany

Outlook


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Hausrzteverband and its associated organizationsOverview

Ca. 32.000 Members, organized in 17 Chapters

(Landesverbnde)

50% 50%

Training

Politics

Contracts;Management

company

Data center


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HVG independent management organizationKey data 2010

Contracts

Management of more than 20primary care contracts (PPC) Local contracts (AOKs

Baden-Wrttemberg,Bavaria, Berlin)

Nationwide IKK SignalIduna, TK

Contracts followingarbitration: Bremen,Bavaria, Baden-Wrttemberg

Arbitration proceduresongoing with many sickfunds in all states

Reimbursement

Reimbursement volume in2010 ~ 1,1 bln.

Management of the primarycare for over 4 mio. enrolledpatients and 10.000 familyphysicians

Since 2008 billing faster thanthe fastest KV (Associationof statutory sick fundphysicians)

Financing

Financially completelyindebended No liabilites at any

bank Growth entirely

financed by own cashflow

Legal form: Incorporatedcooperative (e.G.) entirelyown by the 17 chapters ofthe Hausrzteverband

2007 (small) dividend paid tothe 17 chapters


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Growth take off with passing of act in 2008

0

300

600

900

1.200

1.500

2006 2007 2008 2009 2010P 2012

R

eimbursemen

tvoluem

(mio.)

?HzV-actpassed

Market shareof ~ 10 %


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Agenda

Background: HVG

Role of IT in Primary Care Contracts Software: Practice IT-Sysem



Outlook


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Take over of responsibility to organize primary care byHausrzteverband within the next years

Primary Care contracts will improve quality and efficiency of care

To accomplish these aims, a modern, powerful and custom made ITinfrastructure is a prerequisite - two major components

Custom made software to support the care processes at thepoint of care, i.e. the doctors desk

Data security, especially during online transmission

IT Key Feature of Primary Care ContractsBackground and Aims

Strategicaims

Legal initiative of the German goverment to establish a standardizedtelematic infrasturcture (gematik) is far behind plan (complete

failure)Therefore, Hausrzteverband has and will develop a propietarynetwork to interact with enrolled family physicians

Back-

ground


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Online data transmission key issue

Substantially improvement of admin processesAll Hausrzteverbands primary care contracts require onlineinfrastructure for each participating practice

Some business processes (doctor Hausrzteverband/ HVG)substantially improved by online connection

Software Release

Reimbursement

Other business processes to work only with online connection Test of current patient enrollment status

Exchange of medical data between family physicians andcollaborating specialists

Insurance status (VSDD)

Processexamples

Primary Care Contract is used as killer-

applikation to restablis a safe online infrastructure


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Agenda

Background: HVG




Outlook


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Entire IT-life-cycle establishedSpecification, core and certification

Content

Scope andfunctionality ofdoctors IT-systemkey part of thePCC

Role,responsibility andrights of eachpartner alsodetermined in PCC

Programming ofCore (and standalone system)

Programming

Import of coreinto IT product(s)of each provider

Primary CareContract (PCC)

Core ProgrammingIT Specs

I II III IV

Hausrzte-verband

Sickness fund

Hausrzte-verband

(Sickness fund)

IT-partner ofHausrzteverband IT-Systemvendors(currently ~20with a marketshare of 90%+)

Respon-sible

Test of all mainfunctions of eachIT-systems (~100test cases)

Rollout (routineupdate) ofcertified IT-system by vendor

Certificationand rollout

V

Hausrzteverband

Specification forproprietarymodule (core)and Doctors IT-system to bedetailed


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2 principles for PCC-specific IT-system

Additional stand-alone software Core

CurrentIT-system

Current IT-system

Quick

Niche solution for IT-systemswith small market share

Standard

Certification

Protection of intellectual properties ofHausrzteverband and sickness funds


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Examples for PCC-IT-functions

Documentation of enrollment status of patient (and doctor)

Documentation of PCC-reimbursement positions

Documentation of status chronically ill (additionalreimbursement, P3)

Documentation of ICD 10 diagnoses and date for each doctorpatient contact

Documentation of practice fee (Praxisgebhr, legalrequirement to pay 10 out of pocket for each quarter with at

least one doctor patient contact)Medication control tool


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Agenda

Background: HVG




Outlook


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HW-VPN

Serverwith core Connector

Practice 1

3 different data transmissions principles in use

VPN-Concentrator Router 1

ICW

Serverwith core SW-VPN (1)

Practice 2

Serverwith core

Practice 3

KonzentratorVPN = FW

HVG Data Center

HTTPS-Server

AR 2

HVG data center

Router-ARZ

HVG Data center

S-VPN

HTTPS

(1) Software-VPN

SSL

S-VPN

AR HVG

IPSec3

IPSec1

IPSec2


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HVG Experience with different VPNs

HardwareVPN (=connector) as well as software VPN capable to

support current processes in primary care contracts

Connector substantially more expensive ( 2.000 +) than

software based solutions ( 500)

Software VPN more reliable connector had to be replaced in

many practices


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Agenda

Background: HVG




Outlook


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Gematik supposed to develop nationwide telematicinfrastructur

Self administration authorized by a federal law to develop (animplement) a nationwide standardized telematic infrastructure

Company founded ~10 years ago (gematik), main shareholder are

National association of sick funds (SpiBu)

National association of sick fund physicians (KBV)

Other national provider organizations

Multimillion budget, estimated 800,000 pages of technical specificationhave been produced

No 1 single bit transmitted, but the shareholder agree to disagree


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Highly sophisticated telematics infrastructure2009

EPA

Update/ HVG-

Abrechnung

= RMS


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Agenda

Role of IT in Primary Care Contracts

Software: Practice Administration System (PAS) Telematics and primary care network


Outlook


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Importance of IT will increase in PPC

IT will cover more and more processes, both administrrative

and medical

IT-vendors will have to accept the role of Hausrzteverband

ins setting standards

Due to lack of national standard in secure data transmission,

Hausrzteverband is forced to expand its own network

Primary Care IT Strategy in Germany_Rose

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