Skip to main content

The Case for mHealth Standardization for Electronic Health Records in the German Healthcare System

  • Conference paper
  • First Online:
Information Systems (EMCIS 2019)

Part of the book series: Lecture Notes in Business Information Processing ((LNBIP,volume 381))

  • 2248 Accesses

Abstract

New impulses for the development of an electronic health record in Germany were given with passing the Terminservice- und Verordnungsgesetz. Looking into adjacent legislative work, we find that the existent international standard for Fast Healthcare Interoperability Resources (FHIR) is not sufficient and consequently, German FHIR objects (gFR) are mandatory. Therefore, we investigate the necessity and capability of this German format and evaluate the interaction with current health interfaces. Hence, an app prototype was developed to assess the ability for mobile use and integration with Apple HealthKit. We find, the use of gFRs and electronic health records prevents media discontinuity and has the potential to improve patient care and empowerment. We recommend that developing gFRs according to FHIR should be done in the following order: Medication, Clinical, Diagnostics, Workflow, Finance. Proceeding with clinical and diagnostic gFRs according to population prevalence, has best chances for quick, yet sustainable, success.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bundesministerium für Gesundheit: Bedeutung der Gesundheitswirtschaft. https://www.bundesgesundheitsministerium.de/themen/gesundheitswesen/gesundheitswirtschaft/bedeutung-der-gesundheitswirtschaft.html. Accessed 30 July 2019

  2. Statistisches Bundesamt (Destatis): Einrichtungen, Betten und Patientenbewegung. www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Gesundheit/Krankenhaeuser/Tabellen/gd-krankenhaeuser-jahre.html. Accessed 30 July 2019

  3. Weber, V., Bloom, F., Pierdon, S., Wood, C.: Employing the electronic health record to improve diabetes care: a multifaceted intervention in an integrated delivery system. J. Gen. Intern. Med. 23, 379–382 (2008). https://doi.org/10.1007/s11606-007-0439-2

    Article  Google Scholar 

  4. Benson, T., Grieve, G.: Principles of Health Interoperability: SNOMED CT, HL7 and FHIR. Springer, New York (2016). https://doi.org/10.1007/978-3-319-30370-3

    Book  Google Scholar 

  5. Health Level Seven International (HL7): HL7 FHIR, https://www.hl7.org/fhir/. Accessed 23 July 2019

  6. Haas, P.: Einrichtungsübergreifende elektronische patientenakten. In: Fischer, F., Krämer, A. (eds.) eHealth in Deutschland, pp. 183–201. Springer, Heidelberg (2016). https://doi.org/10.1007/978-3-662-49504-9_9

    Chapter  Google Scholar 

  7. Bundesministerium für Gesundheit: TSVG - Terminservice- und Versorgungsgesetz. In: Bundesgesetzblatt, pp. 646–691 (2019)

    Google Scholar 

  8. Bundesministerium der Justiz und für Verbraucherschutz: § 291a SGB V - Elektronische Gesundheitskarte und Telematikinfrastruktur, www.gesetze-im-internet.de/sgb_5/291a.html. Accessed 01 Aug 2019

  9. Statista: Marktanteile von Android und iOS am Absatz in Deutschland. www.statista.com/statistik/daten/studie/256790/umfrage/marktanteile-von-android-und-ios-am-smartphone-absatz-in-deutschland/. Accessed 01 Aug 2019

  10. Hevner, A.R.: A three cycle view of design science research. Scand. J. Inf. Syst. 19, 4 (2007)

    Google Scholar 

  11. Hevner, A.R., March, S.T., Park, J., Ram, S.: Design science in information systems research. MIS Q. 28, 75–105 (2004)

    Article  Google Scholar 

  12. Peffers, K., Tuunanen, T., Rothenberger, M.A., Chatterjee, S.: A design science research methodology for information systems research. J. Manag. Inf. Syst. 24, 45–77 (2007). https://doi.org/10.2753/MIS0742-1222240302

    Article  Google Scholar 

  13. Busse, R., Blümel, M., Spranger, A.: Das deutsche Gesundheitssystem: Akteure, Daten. Analysen. Medizin. Wissenschaftliche Verlagsgesellschaft, Berlin (2017)

    Book  Google Scholar 

  14. Braunstein, M.L.: Health Informatics on FHIR: How HL7’s New API is Transforming Healthcare. Springer, Heidelberg (2018). https://doi.org/10.1007/978-3-319-93414-3

    Book  Google Scholar 

  15. Fischer, F., Aust, V., Krämer, A.: eHealth: hintergrund und begriffsbestimmung. In: Fischer, F., Krämer, A. (eds.) eHealth in Deutschland, pp. 3–23. Springer, Heidelberg (2016). https://doi.org/10.1007/978-3-662-49504-9_1

    Chapter  Google Scholar 

  16. The Commonwealth Fund: Electronic Health Records: International Health Care System Profiles. https://international.commonwealthfund.org/features/ehrs/. Accessed 01 Aug 2019

  17. Fielding, R.T.: REST: architectural styles and the design of network-based software architectures (2000)

    Google Scholar 

  18. Fielding, R.T., et al.: Reflections on the REST architectural style and principled design of the modern web architecture. In: Proceedings of the 2017 11th Joint Meeting on Foundations of Software Engineering, pp. 4–14. ACM (2017)

    Google Scholar 

  19. Shaver, D.: How Widely Adopted Is HL7?. http://healthstandards.com/blog/2007/08/30/how-widely-adopted-is-hl7/. Accessed 02 Agu 2019

  20. Posnack, S., Barker, W.: Heat Wave: The U.S. is Poised to Catch FHIR in 2019 | Health IT Buzz. www.healthit.gov/buzz-blog/interoperability/heat-wave-the-u-s-is-poised-to-catch-fhir-in-2019. Accessed 02 Aug 2019

  21. Totten, A.M., et al.: Telehealth: mapping the evidence for patient outcomes from systematic reviews. Agency for Healthcare Research and Quality (US), Rockville (MD) (2016)

    Google Scholar 

  22. Marceglia, S., Fontelo, P., Rossi, E., Ackerman, M.J.: A standards-based architecture proposal for integrating patient mHealth apps to electronic health record systems. Appl. Clin. Inform. 06, 488–505 (2015). https://doi.org/10.4338/ACI-2014-12-RA-0115

    Article  Google Scholar 

  23. North, F., Chaudhry, R.: Apple HealthKit and health app: patient uptake and barriers in primary care. Telemedicine e-Health 22, 608–613 (2016). https://doi.org/10.1089/tmj.2015.0106

    Article  Google Scholar 

  24. Parker, S.J., Jessel, S., Richardson, J.E., Reid, M.C.: Older adults are mobile too! Identifying the barriers and facilitators to older adults’ use of mHealth for pain management. BMC Geriatr. 13, 43 (2013). https://doi.org/10.1186/1471-2318-13-43

    Article  Google Scholar 

  25. Kumar, R.B., Goren, N.D., Stark, D.E., Wall, D.P., Longhurst, C.A.: Automated integration of continuous glucose monitor data in the electronic health record using consumer technology. J. Am. Med. Inf. Assoc. 23, 532–537 (2016). https://doi.org/10.1093/jamia/ocv206

    Article  Google Scholar 

  26. Gay, V., Leijdekkers, P.: Bringing health and fitness data together for connected health care: mobile apps as enablers of interoperability. J. Med. Internet Res. 17, e260 (2015). https://doi.org/10.2196/jmir.5094

    Article  Google Scholar 

  27. Coons, J.C., Patel, R., Coley, K.C., Empey, P.E.: Design and testing of Medivate, a mobile app to achieve medication list portability via Fast Healthcare Interoperability Resources. J. Am. Pharm. Assoc. 59, 78–85 (2019). https://doi.org/10.1016/j.japh.2019.01.001

    Article  Google Scholar 

  28. Bloomfield, R.A., Polo-Wood, F., Mandel, J.C., Mandl, K.D.: Opening the Duke electronic health record to apps: implementing SMART on FHIR. Int. J. Med. Inform. 99, 1–10 (2017). https://doi.org/10.1016/j.ijmedinf.2016.12.005

    Article  Google Scholar 

  29. Bundesministerium der Justiz und für Verbraucherschutz: IfSG - Gesetz zur Verhütung und Bekämpfung von Infektionskrankheiten beim Menschen. www.gesetze-im-internet.de/ifsg/. Accessed 02 Aug 2019

  30. GitHub Repository: FHIR Swift Classes. https://github.com/smart-on-fhir/Swift-FHIR. Accessed 06 Aug 2019

  31. Hibbard, J.H., Greene, J.: What the evidence shows about patient activation: better health outcomes and care experiences. Fewer Data Costs. Health Affairs. 32, 207–214 (2013). https://doi.org/10.1377/hlthaff.2012.1061

    Article  Google Scholar 

  32. Health Level Seven International (HL7): Level 1 to 5 Implementation Roadmap. www.hl7.org/fhir/index.html. Accessed 02 Aug 2019

  33. Bundesministerium für Gesundheit: Entwurf eines Gesetzes für mehr Sicherheit in der Arzneimittelversorg. www.bundesgesundheitsministerium.de/fileadmin/Da-teien/3_Downloads/Gesetze_und_Verordnungen/GuV/G/GSAV_Bundestag.pdf. Accessed 02 Aug 2019

  34. Kassenärztliche Bundesereinigung: Die häufigsten Krankenheiten in deutschen Arztpraxen. https://www.presseportal.de/pm/34021/3446781. Accessed 12 Aug 2019

  35. Kassenärztliche Vereinigung Nordrhein: Die 100 häufigsten ICD-10-Schlüssel und Kurztexte (2019). https://www.kvno.de/downloads/verordnungen/100icd_19–1.pdf

  36. Kim, S.H., Kwon, J.: How Do EHRs and a meaningful use initiative affect breaches of patient information? Inf. Syst. Res. (2019). https://doi.org/10.1287/isre.2019.0858

  37. Thranberend, T.: Weisse Liste - For patients, for quality. https://www.bertelsmann-stiftung.de/en/our-projects/weisse-liste/weisse-liste-project-description/. Accessed 15 Nov 2019

  38. Health Level Seven International (HL7): HL7 Argonaut Project Wiki. https://argonautwiki.hl7.org, www.fhir.org/guides/argonaut/. Accessed 31 July 2019

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Max-Marcel Theilig .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this paper

Check for updates. Verify currency and authenticity via CrossMark

Cite this paper

Theilig, MM., Werner, J., Schoffke, F., Zarnekow, R. (2020). The Case for mHealth Standardization for Electronic Health Records in the German Healthcare System. In: Themistocleous, M., Papadaki, M. (eds) Information Systems. EMCIS 2019. Lecture Notes in Business Information Processing, vol 381. Springer, Cham. https://doi.org/10.1007/978-3-030-44322-1_24

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-44322-1_24

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-44321-4

  • Online ISBN: 978-3-030-44322-1

  • eBook Packages: Computer ScienceComputer Science (R0)

Publish with us

Policies and ethics