The city of Bottrop, North Rhine Westphalia, has launched a private electronic patient record project that utilises the new German healthcare smartcard for patient identification.

Knappschaft, one of the biggest health insurance companies in Germany, is co-ordinating the project which will run for three years with a budget of €5.6m. If successful, it will be extended to more cities in the region.

The participants in the project include 50 doctors from private practice and one hospital. The project is not a part of the national smartcard programme, but it does comply with technology standards laid down by gematik, the national health IT organisation in Germany.

This includes smartcards for patients and doctors as well as smartcard readers – provided by SCM Microsystems – and so called ‘Konnektoren’ – provided by Siemens. These are router-like devices that have been developed by gematik in recent months. They are installed in the offices of doctors and build up a virtual private network (VPN) for secure digital communication.

“More than 10,000 patients have already consented,” says Christian Bauer, Knappschaft‘s project manager. The patients will make available digital documents like, for example, referral letters or diagnostic findings in a central electronic patient record.

The central electronic patient record is provided by T-Systems, a subsidiary of Deutsche Telekom. The company is also responsible for the VPN connection and for the broadband access.

“What is different from other projects and in particular from the national project is the way of access to personal data,” said Bauer. In order to get access to the patient’s documents, doctors need to ask the patient for his smartcard. The patient then has to enter a PIN-code.

Up to this point, the project follows what is envisioned for the national smartcard project. However, in Bottrop, the patient does not have to use his smartcard and PIN every single time.

Instead, there will be a time slot concept. This means that, once the PIN was entered, the patient file remains open to doctors for a pre-specified period of time. It is hoped that introducing this feature will make the smartcard handling less time consuming for doctors.

It is somewhat typical of the German health IT landscape that Ulla Schmidt undertook the day trip to Bottrop, even though Bottrop is not ‘her’ project at all.

After the failure of electronic prescriptions and electronic emergency data sets in the national smartcard programme, Ulla Schmidt’s ministry has been pushing behind the scenes for a realignment of the project.

This realignment was announced by gematik three weeks ago. Under the new ‘online first’ concept, gematik wants to bring doctors online so that they can exchange electronic referral letters, and insurance details. More difficult applications, like electronic prescriptions, are to be skipped for the time being. In Germany this is referred to as the ‘Austrian approach’, as it mirrors the approach that Austria took with its e-card.

The announcement of ‘online first’ three weeks ago has led the German smartcard project into its biggest crisis to date.

Doctors are revolting, because many of them dislike the whole concept of central electronic architectures. They prefer USB sticks as carrier medium for patient data. With ‘online first’, they now fear that all ideas of decentralised USB solutions will be abandoned.

Unsurprising then that Ulla Schmidt was happy to launch a project that largely realises the ‘online first’ scenario. “Such projects can contribute to make discussions more objective,” the minister said.

She also heavily criticised parts of the medical establishment for their opposition to the national project: “The security of the systems has been shown and communicated, and it is backed by national and federal data protection agencies Germany wide.”


Gematik (German language)