"It is not a good idea to store information on thousands of patients in one place." Klaus Bittmann, head of NAV Virchow

Recent reports about incidents of data loss in the British healthcare system have alarmed medical doctors in other European countries.

In Germany, the national association of doctors in private practice (NAV Virchow Bund) has adopted a stance advocating the complete abandonment of all concepts of central data storage in the German national health IT project.

The doctors’ body is now calling for the German Ministry of Health to halt all plans for centrally-stored shared electronic patient records, due to the potential risks to patient confidentiality. NAV Virchow represents around 20,000 doctors in private practice.

In an exclusive interview with E-Health Europe, Klaus Bittmann, head of NAV Virchow, made reference to a series of recent incidents with lost computer discs at several NHS trusts in England. Some of the incidents were initially reported by E-Health Insider.

One particular incident that helped trigger the new NAV Virchow statement was the reported loss of 160,000 notes about patients at London City Hackney Primary Care Trust.

“We are absolutely not against using modern technology, but what we witness again and again is that it is not a good idea to store information on thousands of patients in one place. We are calling for the national ministry of health to stop all plans for server-based concepts for shared electronic patient records immediately,” said Bittmann.

Officially, though, there are no national plans for electronic patient records in Germany. But Bittmann says, in his opinion, the national smartcard project is leading towards that direction.

As an alternative, the German private doctors’ body is suggesting the use of encrypted USB-sticks. These could be handed over to patients and would carry all relevant patient data, including digital images such as radiographs or CT-scans.

“What is needed in addition is a health IT infrastructure that collects only references about the institutions where the documents were generated. In case of loss or destruction of the USB-stick, the EPR could then be re-established by contacting the individual doctors,” said Bittmann.

He criticized both the German Ministry of Health and the German national health IT organisation, gematik, for being unwilling to even consider a decentralized USB solution. “We are currently trying to bring together a number of doctors for making our own project”, said Bittmann.

He also revealed that plans are being drawn up to let professional hackers try to crack the USB system in order to prove that it can be made safe: “When you are honest about making patient data accessible for other doctors, about giving complete medication histories to improve drug safety and about avoiding unnecessary diagnostics, you will come to the conclusion that all this can be done with USB sticks as well. You do not need central data storage.”

Critics are likely to point to some inconsistencies in the arguments of NAV Virchow. There are, for instance, a number of regional care networks in Germany that already use shared electronic patient records with central data storage.

In these settings, patients rarely are made aware what is actually stored about them and where. Ironically, these networks tend to be driven by doctors in private practice. But this does not seem to be what Bittmann and his colleagues are talking about when they criticise data storage on servers.

When talking to E-Health Europe, Bittmann was not able to say under which circumstances exactly he considers data storage to be ‘central’ and thus to be condemned. Instead he gave the impression that NAV Virchow’s main objection stems not from records held on centralised servers but the fact that they will, in the future, be part of a government controlled infrastructure.

Recent years have seen Germany legalising wiretap operations as part of anti-terrorist measures and in 2007 an EU-directive on storing telecommunication data was implemented. All connectivity data on phone and internet communication have to be stored for six months by the provider, which is also true for the communication data of doctors.

“After these experiences, we simply do not trust the government any more”, said Bittmann.

However, some leading experts for data protection tend to take a less alarmist approach than the doctors when it comes to patient data on central servers. “We have a good legislation for health IT in Germany. There is a lot of irrational fear when it comes to server-based data storage”, said Thilo Weichert from the Independent Centre for Data Protection in Schleswig-Holstein recently at November’s Medica trade fair.

But he too admitted that possible changes in legislation in the future could easily make a national health-IT network become a nightmare from a data protection perspective.


Philipp Grätzel