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The German Appointment Service and Supply Act, which comes into effect in early 2019, requires health funds to offer policyholders electronic health records (EHRs) by 1 January 2021 at the latest. Although large sections of the act’s wording are still the subject of controversy, there has been little opposition to the introduction of electronic health records in general.
The records are being conceptualised by gematik Gesellschaft für Telematikanwendungen der Gesundheitskarte mbH. The company is expected to pave the way for patient data to be made available in electronic records, independently of cases and institutions.
In April, as part of a pilot project, Germany’s biggest health insurance fund Techniker Krankenkasse (TK) started providing its policyholders with electronic health records through its app TK-Safe. Data was added to the solution in advance. In mid-September 2018, 16 German health insurers launched the joint app Vivy in which policyholders enter their own data. Since then, the number of companies participating in the app has grown to over 20. A small number of other solutions are already available and further health funds can be expected to launch their version before 2021.
EHRs are a central storage point for all relevant information about the health of a patient, with the policyholder and the physicians having round-the-clock access. In the future, it will be possible for the database to remind patients of vaccination and prescription appointments and make findings and medical histories available to subsequent physicians. In an emergency, vital information such as blood groups and intolerances would be available immediately and adverse interactions of prescribed medication could be avoided.
According to a survey, three quarters of German people feel positive about EHRs. This figure increases to 80% for younger respondents as holistic, centralised data storage saves time and can make everyday life easier.
In light of the largely positive resonance amongst doctors and patients, significant numbers of people are expected to use EHRs , which will become increasingly established in the health field. Likewise, electronic health records will open new doors for life insurance - the acceptance of applications, and underwriting in particular, which are often time-consuming and protracted. The health of the applicant must be clarified comprehensively before a valid risk assessment can be carried out. This requires numerous health-related questions that result in equally numerous and complex answers.
Additionally, human error in the traditional application process could be avoided where today the policyholder has to disclose previous medical appointments, diagnoses, treatments, medication and any period they were unable to work. However, policyholders often do not have such information and are rarely able to remember all of the details completely and accurately. As a result, inaccuracies have been unfortunately part and parcel of the application process, sometimes resulting in claims not being paid due to non-disclosure.
EHRs allow an applicant to access and use his or her data to complete a health questionnaire. The policyholder is then able to see the generated answers and either confirm them or add more information. If the applicant discloses the data in their EHR at the outset, the information can be used to carry out a risk assessment and the traditional, extensive health-related questions won’t be necessary.
One of the objectives of data processing should be to distinguish relevant from irrelevant information. In its entirety, the data can, for example, indicate whether an illness is trivial, whether there is only a suspicion of disease, or a definite diagnosis.
Extensive data analysis, random samples and the close monitoring of losses should be used to verify the accuracy of all data. This would then enable the insurer to focus on single, specific pieces of information in manual underwriting and address them specifically in a dialogue with the applicant.
In cases where diagnoses and medical measures are still being sorted out manually, it cannot be ruled out completely that the policyholder may breach his or her pre-contractual duty of disclosure. However, it is less likely as the matter can be specified and cleared up quickly. Forgetfulness or inaccurate information can only be expected to occur rarely.
In the long term, it is expected that with the electronic process an evaluation of the data contained in an electronic health record will be automated in the first step and only in a small proportion of cases will an underwriter intervene in the second step. The underwriter can then focus on the facts in question and make a final clarification and case decision on the basis of the evaluation results already available.
As exciting and beneficial as EHRs sound, before they are introduced and used all over Germany, several technical and legal questions have to be answered. They can only be integrated into the application process after the final structure of the solution has been considered and following a careful examination of insurance policy and data protection regulations.
In other countries, EHRs are already helping to simplify processes in life insurance and improve the quality of risk assessments.
Given its potential, it is worth keeping a close eye on the future development of electronic health records. They might prove to be one of the most exciting health innovations of the next few years.
