>> "Can the eGK still be saved?" is the title of a recent press release from Vitabook. In it, you claim that the "concept of the electronic health card has failed." Why are you taking such a pointed stance against the eGK?
Because it may sound harsh, but it's true: After more than eleven years, the bitter truth is that the electronic health card is nothing more than a simple insurance card without an emergency record, without a medication plan, and without any of the other promised functions, and on top of that, it has swallowed up around 1.7 billion euros.

Where should the data be stored anyway?
No idea. The card still doesn't contain the emergency data record or even the digital medication list, let alone the option to use it as an electronic patient record: The chip offers just 12 KB of storage space. But since one letter requires exactly one byte, with 80 lines per page – assuming a line has 60 lines – that's 4,800 bytes, or 4.8 KB. This means that the chip can only store just under three fully written pages, but not a single image.

Now, the eGK is only supposed to serve – together with the doctor’s health professional card – as a key to the telematics infrastructure.
I'm not saying anything against the key function as such, even though there are much more intelligent ones available by now. The problem lies in the logic of the eHealth Card. What everyone hopes it will do is significantly more than just a key; it's synonymous with a central data repository that stores all data...

… and makes it available to all participants in the healthcare system, thereby connecting them.
But this only underscores the futility of the eGK. Anyone who thinks outside the box quickly realizes that suitable connectors don't exist in the EU or anywhere else in the world. Therefore, anyone abroad should avoid getting into an emergency situation if possible. But even in Germany—even if all the advertised data could be stored on the eGK—hardly anyone would use it. The data can only be read using connectors, which so far only one company offers, and for which doctor's offices have to shell out exorbitant amounts. Accordingly, many don't yet have these readers.

This is likely to change as soon as the threatened sanctions take effect.
Coercion always helps. But I doubt whether it promotes acceptance of the system. But that, too, will somehow resolve itself over time. It's just that the underlying problem persists.

Which one would that be?
All projects based on the logic of the telematics infrastructure, which defines the access barrier with a connector and two cards – patient and doctor – can, if that is the access level, simply forget about the patient, because he can only view and manage his data in the presence of the doctor.

What is the logic behind Vitabook?
It's completely patient-driven. We see ourselves as a service provider for citizens and are the only one – to date – with different interfaces for all stakeholders in the system. Anyone who opens a health account with us can have data sent digitally and make it available online to any healthcare provider anytime, anywhere. The concern many citizens have that their data stored on their electronic health card could end up with health insurance companies without their consent is also eliminated with the online health account: Here, the account holder, i.e., the patient, alone determines which data is disclosed to whom and to whom. Incidentally, we have long since implemented the medication plan and emergency data record, rightly demanded by politicians.

What do you do with the gematik eGK?
In fact, the entire eGK journey—determined by the paternalistic view of humanity with which the health insurance system was created 135 years ago—is stillborn: It is simply incompatible with the patient's right to data sovereignty! While throwing the card away would be advisable, it would also be a shame, given the billions of euros that financed it. At least you can continue to use it purely as a key, which we also offer with our additional service, "Health Card Update": This actively links the otherwise quite useless card to our valuable online health account. Every German citizen can do this now, by the way, and doesn't have to wait until the beginning of 2019: At www.gesundheitskarten-Update.de, everyone can get an emergency data record with an emergency QR key chain for a one-time fee of €22.90. The associated health account also costs just €1.95 per month.

Which the patient pays?
Many of our customers do this because they value the associated benefits. However, 20 health insurance companies now cover the costs for their insured members, albeit without access to their respective health accounts.

Can the patient do this from home, all by themselves using their PC, laptop, smartpad or even their mobile phone?
Just like online banking, it's no longer magic. Every patient can access their account and all the data contained therein from anywhere in the world and make it available to all their healthcare providers, wherever they are in the world – if they so wish. The data is highly encrypted and stored in the Microsoft Cloud Germany, highly secure in two German Telekom data centers.

In addition to the online health account, they now also offer a discharge management system.
Correct. Implementing the new law, which stipulates standardized discharge management, represents an enormous challenge for hospitals. Hardly any hospital is prepared for it; many don't even know the start date – even though the corresponding framework agreement already came into effect on October 1 of this year. In addition to numerous structural and organizational details, every patient and the physician who will provide follow-up care must receive a discharge letter on the day of discharge. This letter contains, among other things, all diagnoses, the discharge report, prescribed medications, including a medication plan, and a contact person's telephone number for any queries.

Can your online health account already do this?
Of course, yes. All a clinic needs to do is connect to our system.

When an IT person says „just“…
...in this case, he means the two to three days it takes to set up a virtual communications server, which is then put into operation within the hospital and the hospital network so that it can communicate directly with the relevant hospital information system. Once this is done, the server stores all the patient data necessary for discharge management in a single file until the day of discharge. Only then does this server contact the patient's online health account and transfer the necessary data and the discharge letter.

What if the patient does not yet have their own online account?
The server then automatically creates a new account and copies the necessary data and discharge letter into this new account, ensuring that the patient retains sole control over their data. To ensure access to this account, the patient, a family member designated by the patient, or an authorized care provider receives an email informing them of access to all data after the appropriate password has been assigned.

How do general practitioners access the data?
The person entering the data selects who should be the target doctor. The hospital could, of course, also do this, but only if the patient has previously consented to entering and releasing the data. The reverse direction is also possible: from the patient to the doctor to the hospital. The patient always determines who should have access to their data.

And all without an expensive connector?
Why bother? Simply take the patient's health card, which we issue and which is linked to their online health account, insert it into a reader that costs just €100, and that's it: All account information can be read, the insurance number and master data entered, and you can also specify which doctor, clinic, and pharmacy should have access to which data. Of course, specialists and other practitioners can also be added.

And health services research?
We already have 184,000 patients using our system, although for many of them, health insurance data is not yet available. However, this will change quickly as the politically mandated deadline for making patient records available approaches. We will then be able to make all the patient data stored in our system available to healthcare research in anonymized form, provided the patients have consented to this use, which we will encourage. Our mindset is explicitly shifting toward healthcare research: We are firmly committed to pursuing this path.
Vitabook has now also created an implant registry.
We first built an implant management system with the Hannover Medical School, which then, more by chance, evolved into a hospital-owned implant registry. However, in various discussions, the idea arose that we could not only aggregate implant data into a central registry, but also add a lot of other data—such as billing data or data that needs to be passed on to the MDK (Medical Insurance Fund).

This could be a completely new data interface.
The challenge now is to connect as many clinics as possible. This will generate very interesting data in the implant field and many other areas, which could then be used by health services research.

That sounds like a big deal.
It would be. Such a system could keep everything structured that can be registered and shared, if it makes sense. But such an idea has to be born first. Perhaps we simply haven't thought big enough so far, probably also because we've repeatedly encountered the limits of the healthcare system's willingness to innovate with much smaller solutions like the online patient record, the medication plan, the vaccination record, and even the refugee card, which is available in no fewer than ten languages. And those limits, I can say from many years of experience, are reached quite quickly.

Why is that?
On the one hand, this is because the level of transparency possible with such systems is not actually desired. On the other hand, it is because some large payers prefer to retain control over their own data.

No matter what costs they incur?
The larger health insurance funds have enough of their own money to handle such projects themselves, even if it might not make complete sense. Therefore, our business clients are primarily smaller health insurance funds that are accustomed to thinking more pragmatically.

Mr. Bönig, thank you for the interview. <

The interview was conducted by MVF editor-in-chief Peter Stegmaier