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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
Telematics and primary care network
Regulatory background on telematics in Germany
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
Role of IT in Primary Care Contracts Software: Practice IT-Sysem
Telematics and primary care network
Regulatory background on telematics in Germany
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
Role of IT in Primary Care Contracts Software: Practice IT-Sysem
Telematics and primary care network
Regulatory background on telematics in Germany
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
Role of IT in Primary Care Contracts Software: Practice IT-Sysem
Telematics and primary care network
Regulatory background on telematics in Germany
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
Regulatory background on telematics in Germany
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