CD var/Inc:The contribution of medical emergency data in use of the electronic health card in the German health care system

'Abstract The trend of the medical treatment costs in the German health service has caused the legislation to look for ways to increase the efficiency of the health service achievements and to determine saving potentials. The outcome of this process was the legally imposed digitization of all data in the German health service. The digitization of all medical data is supposed to optimize the processes of the health service and to avoid redundant data acquisition and collection and is thus crucial to cost reduction. The use of networked information technology across the boundaries of medical institutions and sectors is a potential opportunity for such digitization and saving potentials. It creates numerous possibilities such as improved communication between health care providers and patients, smoother transfer of information across electronic boundaries, lower costs and improved treatment quality and safety. An essential step towards the implementation of this system will be the introduction of a microprocessor smart card for patients in Germany, the so called electronic health card. The introduction of the Electronic Health Card is based on the law of modernization of the German health care system. The functions and regulations of the electronic Health Card are defined in 291a and 291b of the 5th book of code of social law. The electronic Health Card possesses two different types of functions. On one hand the mandatory functions, like the administrative data of the insurant and the electronic prescription. On the other hand there are the voluntary medical functions, like the electronic emergency record and an electronic patient record. The electronic emergency record includes medical information, such as allergies or cardiac pacemakers for instance. The electronic Health Card will be mandatory for every German, who has a statutory health insurance. The testing of the electronic Health Card has been taking place in seven selected test regions in Germany since 2006. In these test regions a total number of 190 physicians and doctors, of 11 pharmacies and of 11 hospitals and of 63,000 health insured were involved in the testing projects. During the testing period the acceptance of the utilization of the new equipment and technology and the resulting processes worsened considerably, particularly among established physicians. Due to the high lack of transparency, the estimated cost-benefit ratio was poor and the significant organizational and financial efforts high. Also many doctors expressed their skepticism about the actual data security of personal data and about the privacy functions of the electronic Health Card and the Telematic infrastructure in general. And today the health service providers openly reject the electronic Health Card in the currently-planned form. Moreover, from the perspective of the health service providers unsolved technical problems still exist, for example the problem of system compatibility. Nevertheless, all statutory insured in Germany were equipped with a new electronic Health Card until the end of 2013. And since January 1st 2014 only electronic Health Cards are accepted as proof of insurance. Due to the significant problem of acceptance by the health institutions providing the service and the high general importance of the electronic Health Card project for Germany, the card contains only basic data of the insured as well as information about the insurance status. The implementation of additional medical information such as the emergency record, the safety of medical treatment or the cross-facility electronic health record, is being delayed further. So far, there have been no studies to analyze the insufficient acceptance among German physicians. Therefore, it is the objective of this research to address the complexity of acceptance problems holistically and to identify the specific acceptance factors, which in turn lead to a higher acceptance and thus a successful implementation of the electronic Health Card. Based on the Technology Acceptance Model the essential factors which have an impact on the acceptance and ultimately the utilization of the electronic Health Card, were conceptualized and summarized in a research model. The empirical analysis using the partial least squares analysis method was carried out as part of a survey within the group of health care providers that participated in the testing of the electronic Health Card in the test region Wolfsburg in Lower Saxony, Germany. From December 2011 to March 2012 every test participant was interviewed and a total of 109 questionnaires for the evaluation of the acceptance were completed and returned. The empirical results indicate that especially the trust in the new technology, a balanced costs and benefits ratio as well as the compatibility to existing systems increases the acceptance for the usage of the electronic Health Card and the electronic emergency record. However, the productivity expectation does not cause a significant increase in the perceived ease of use of the new card or of the electronic emergency record for the German health care providers. Keywords: eHealth, Telematic infrastructure, electronic Health Card (eHC), electronic emergency recordb (eer), Acceptance Research, Technology Acceptance Model (TAM)'

1 INTRODUCTION

2 Research Issue

4 Research Delimitation

5 Research Structure

8 CURRENT STATE OF RESEARCH

11 TECHNIC AL COMPONENT AND PROCESSES

11 Health Insurance Card

15 Paper-Based Emergency Records

15 Processes

20 Conclusion

22 Electronic Health Card

24 Components of the Telematic Infrastructure

28 Encryption and Digital Signatures

33 Electronics and Emergency Road

35 Processes

45 Identification of Factors

46 ACCEPTANCE

48 Technology Acceptance Model

49 Perceived Usefulness

50 Perceived Ease of use

51 External Factors

55 RESEARCH METHODOLOGY

56 Hypotheses

57 Data Collection

59 DATA ANALYSIS

59 Representativeness of the Sample

60 Construct Reliability

61 Significance Analysis

63 Indicator Reliability

63 Hypotheses Testing

71 INTERPRETATION OF RESULTS

71 Influencing Factors on Perceived Usefulness

73 Influencing Factors on Perceived Ease of Use

73 Influencing Factors on Attitude towards Using

74 Influencing Factors on Behavioral Intention to Use

74 Influencing Factors on Actual System Use

75 CONCLUSIONS

77 Implications for Science

78 Implications for Practice

80 Questionnaire

82 Collected Data

XV GLOSSARY

XXVI INDEX