With the entry into force of the first family doctor-centered care contract according to the new §73b SGB V on July 1, 2008, the development of the eHealth infrastructure in Baden-Württemberg began. Over 1,200 family doctors are already connected online via the highly secure infrastructure.

>> The family doctor-centered care contract (HZV) between AOK Baden-Württemberg, the family doctor contract group (HÄVG) and MEDI Verbund not only guarantees participating doctors fixed euro amounts for their services, it has also ensured that “in the country” there is a highly secure Telematics infrastructure and thus the basis for a secure IT network for doctors is created: In order to keep the administrative costs of the HZV contract as low as possible, participating doctors are obliged to bill the services provided under the contract directly online to the HÄVG data center . In accordance with the recommendations of data protection experts and the German Medical Association, the contractual partners require the use of a secure infrastructure with Gematik-capable connectors for the transmission of sensitive billing data. This secure infrastructure has passed its practical test and can now be further expanded at any time - even beyond the borders of the federal state.
Optimal security
The infrastructure used for the §73b contract takes into account all specifications previously published by gematik for the secure online connection of medical practices. To do this, a so-called connector sets up a hardware-supported VPN connection - a virtual private network - between the doctor's office and the data center for each data transfer. This technology offers the highest possible level of security currently available at a reasonable cost: Hardware-supported virtual private networks are also used by numerous large companies and government agencies to exchange confidential information between their various branches at home and abroad. With current tools, a secure online connection like this can be cracked purely mathematically with around 28 years of computer power. But then only this one attacked connection can be eavesdropped on, which is usually terminated after just a few minutes. In addition, the connector protects the practice network against unauthorized access from outside through an integrated firewall.
High acceptance
Over 1,200 general practitioners in Baden-Württemberg are already connected to the new telematics infrastructure, and another 300 have ordered a connector to use the secure online connection. This means that the majority of doctors participating in the HZV contract have opted for the highly secure infrastructure. What made a decisive contribution to this was that the infrastructure components were only installed and set up on site in the practices by specially certified technicians. After installation, doctors and practice assistants were given detailed instructions on how to use the infrastructure and the applications based on it and can use various training programs. There is also a telephone hotline staffed by IT specialists and a support center for questions and possible problems.
Billing at any time
Thanks to the secure online connection and the HZV's new billing system, doctors no longer have to wait until the end of the quarter to submit their billing: Billing is generally possible at any time - the contractual partners even recommend billing online once or twice a week. Notes that have already been billed can also be changed later if the patient uses further services in the same quarter. In this way, regular night shifts and billing marathons at the end of the quarter are a thing of the past. The first online billing via the new infrastructure went smoothly: The more than 18,000 billing data records from over 200 medical practices were easily transferred to the data center and processed there. Just ten weeks after the end of the quarter, the participating doctors received their final bill and the fee to which they were entitled. This pleases the participating physicians. General practitioner Dr. Walter Franck from Stuttgart, for example, reports: “In 26 years of practical experience, we have never experienced billing that was so easy and quick!”
Additional comfort
With the new telematics infrastructure in Baden-Württemberg, doctors can not only transfer their billing data quickly and easily, it also offers other convenient additional functions: For example, AOK patients who come to the practice with their health insurance card can be queried via a secure connection whether he is already taking part in family doctor-centered care. This reliably avoids double enrollment of patients. Software updates can also be conveniently provided online via the infrastructure: The Hausarzt+ contract software or the pharmaceutical module of the encapsulated Hausarzt+ core, which is used in the HZV modules of other manufacturers, can easily be kept up to date with the click of a mouse. This function is also offered to other IT companies in order to further increase the level of service for doctors.
Maintenance-free technology
Since the status of the connector can be checked at any time via a remote monitoring system, the doctor no longer has to worry about updates or configuration changes after the device has been installed by an IT specialist - the connector is maintained online. In addition, the software in the doctor's practice can be maintained via the connector without a technician having to come to site: After the doctor has agreed to establish a connection to a certified technician, he or she can use the software in the practice via a secure connection via the connector Maintain installed software from your own workstation. This eliminates costly and unproductive travel times.
Other applications
Since the connector is Gematik-capable, it represents a future-proof investment in the practice's IT equipment: If the doctor wants it, the same connector that is used today for billing the family doctor-centered care contract can later also be used for the applications electronic health card can be used. Other applications such as the highly secure exchange of laboratory values or medical information, for example via a doctor's network file, are also possible.
extension of infrastructure
With the rollout in Baden-Württemberg, daily operations and the first online billing, the new telematics infrastructure has proven its practical suitability. The infrastructure is designed in such a way that not only the family doctor contract according to §73b, but also specialist contracts according to §73c and other care models are possible. Doctors, pharmacists and other medical service providers can be networked securely and reliably with a wide range of contractual partners such as health insurance companies, medical associations, statutory health insurance associations or clinic groups.
Neutral operating company
For a further rollout of the telematics infrastructure and its operation, it is advisable to set up a neutral operating company in the form of private-public cooperation. Neutrality is important from two points of view: Firstly, it can ensure that the various contractual partners - i.e. health insurance companies and medical organizations - can use the infrastructure equally and in parallel. Secondly, it can be ensured that the competing software houses for primary systems can connect their applications to this infrastructure on an equal basis. In this way, based on the successful model from Baden-Württemberg, the networking of doctors and the efficient exchange of medical and billing-related information could be implemented nationwide in the shortest possible time.
Other applications
Since the connector is Gematik-capable, it represents a future-proof investment in the practice's IT equipment: If the doctor wants it, the same connector that is used today for billing the family doctor-centered care contract can later also be used for the applications electronic health card can be used. Other applications such as the highly secure exchange of laboratory values or medical information, for example via a doctor's network file, are also possible. <<

by: Peter Reuschel*