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Povinné elektronické zdravotné karty v Nemecku od januára 2014


 | 30.1.2014 | komentárov: 450

Od januára 2014 sa v Nemecku zaviedli povinné elektronické zdravotné karty. Ako prebieha a bude pokračovať zavádzanie nového systému? Kde sú podľa odborníkov jeho silné stránky a kde naopak nedostatky? Bude skutočne znamenať výrazne vylepšenie, alebo bude prechod na elektronické karty skôr drahým komplikovaným a nedostatočne funkčným balíčkom?

Obrazok Prečo sa systém zavádza a na čom je postavený

Idea za zavedením nového systému je zvýšenie kvality poskytovania zdravotných služieb a zároveň zníženie celkových nákladov. Popritom by sa malo posilniť postavenie pacienta pri rozhodovaní o tom, kto a v akej miere bude môcť nakladať s jeho údajmi. Pri dnešných závratnou rýchlosťou rastúcich možnostiach v oblasti medicíny, sa rýchly prístup k informáciám o zdravotnom stave pacienta stáva kľúčovou otázkou úspechu alebo neúspechu liečby.
Od 1.1.2014 sa v Nemecku zavádzajú povinné nové elektronické zdravotné karty. Každý pacient, ktorý vlastný elektronickú kartu, sa touto kartou musí preukázať pri návšteve lekára. Podľa štatistík viac ako 90 percent zákonných poistencov už novú elektronickú kartu vlastní. Všetci ostatní by ich mali do konca septembra 2014 nasledovať. Vtedy totiž uplynie lehota na výmenu. Stará karta stratí platnosť bez ohľadu na dátum platnosti na nej uvedený hneď po výmene alebo po septembri 2014.
Cesta k zavedeniu elektronických kariet nebola vonkoncom jednoduchá. Pôvodne mala byť elektronická karta povinne v peňaženke každého Nemca už v roku 2006. Avšak diskusie okolo bezpečnosti dát, oneskorenia pri budovaní celkovej informačnej infraštruktúry ako aj odpor nemeckých lekárov spôsobili výrazne posunutie konečného termínu. A ako všetky tieto okolnosti nakoniec ovplyvnili konečnú verziu systému? Pozrime sa na to zblízka.

Akým spôsob sa systém zavádza v praxi

Zavedenie prebieha v niekoľkých krokoch. Najprv sa na kartu uložia osobné administratívne dáta poistenca, ako napríklad meno, dátum narodenia, a následne pridelené dáta od poisťovne, ako číslo zdravotného poistenia a status poistenca. Každá elektronická karta, okrem špeciálnych výnimiek ako sú napríklad deti vo veku nižšom ako 15 rokov, obsahuje osobnú fotografiu, ktorá ma zabrániť možným zámenám kariet a zneužívaniu systému požadovaním neadekvátnych  služieb.
Akonáhle sa karty s uloženými údajmi dostanú k poistencom, pristúpi sa k ďalšiemu kroku. Údaje na karte sa porovnajú s aktuálnymi údajmi poistenca v registroch zdravotnej poisťovne. To umožní, že akákoľvek zmena údajov, ktorú nahlási poistenec poisťovne, sa automaticky pri najbližšej návšteve lekára aktualizuje aj na elektronickej karte. Tým pádom pri zmene osobných údajov nebude musieť zdravotná poisťovňa vydávať novú kartu. Na aktuálnu zdravotnú kartu sa budú ukladať všetky údaje zo zdravotnej praxe, či už od praktických lekárov, zubárov, ošetrujúcich lekárov v nemocniciach alebo lekárnikov.

Ako je zabezpečená bezpečnosť dát

Cirkulácia informácii je zabezpečená pomocou na tento účel špeciálne vytvoreného systému. Tento sa nedá porovnať s verejným internetovým zdieľaním informácií. Sprístupniť údaje je možné len za súčasného vloženia elektronickej karty a preukazu profesionálneho poskytovateľa zdravotných služieb (preukaz) do čítačky elektronických kariet pridelenej od zdravotnej poisťovne. Navyše musí svoj súhlas so sprístupnením údajov pacient potvrdiť zadaním PIN kódu. Toto však neplatí pre akútne prípady ohrozenia života. Vtedy je možné sprístupniť niektoré údaje, ako napríklad krvnú skupinu alebo alergie, čisto použitím elektronickej karty bez preukazu lekára a bez zadania kódu pacientom.
Aké sú ale skutočné zákutia celého systému?

Identifikačná fotografia

Fotografia na karte má slúžiť zabráneniu zneužívaniu tak, aby mal prístup k zdravotným službám len ten, kto je skutočne poistený. Identita sa overuje porovnaním fotografie s výzorom pacienta. Faktom však je, že väčšina zdravotných poisťovní si nechala zaslať fotografie od poistencov poštou bez toho, aby si nejakým spôsobom overila, či je osoba na fotografie skutočne poistencom. Ošetrujúci lekár si môže vypýtať občiansky preukaz na overenie totožnosti, no ani toto nemusí by úplnou zárukou proti zneužitiam.

Nemožnosť odmietnuť vstup do systému ako takého

Ako negatívum možno vnímať fakt, že okolo vstupu do systému nie sú prípustné žiadne výhrady. Zákonodarca totižto zdravotné poisťovne zaviazal nimi vybaviť svojich poistencov. Kto by sa napríklad zdráhal zaslať poisťovni vzorovú fotografiu, ocitne sa v nebezpečenstve, že mu lekár po ošetrení vystaví účet, ktorý bude musieť vzdorujúci poistenec uhradiť z vlastného vrecka. Žaloba proti povinnosti vlastniť elektronickú kartu by bola Berlínskych súdom pre sociálne záležitosti automaticky odmietnutá. Všeobecná povinnosť má ale zabezpečiť funkčnosť systému, preto je jej zavedenie z istého pohľadu obhájiteľné.    

Jedno registračné číslo na celý život

Za pozitívum možno považovať byrokratické odbremenenie od výmeny karty pri zmene poisťovne. S každou novou elektronickou kartou dostane poistenec nové registračné číslo poistenca, ktoré zostane rovnaké do konca života. Toto číslo si ponechá, i keby sa rozhodol zmeniť zdravotnú poisťovňu. V tomto prípade by sa vymenila len karta a jej PIN kód. Toto výrazne pomôže pri výmene údajov medzi poisťovňami. Jediný prípad, kedy sa registračné číslo poistenca môže zmeniť je, keď poistenec prestúpi zo zákonnej do súkromnej poisťovne.

Všetko na jednom mieste

Plánov, čo všetko bude EZK v budúcnosti obsahovať, majú jej tvorcovia mnoho. Neostávajú len pri dôležitých zdravotných údajoch, ale zamýšľajú na čip uložiť napríklad aj údaje o súhlase s darcovstvom orgánov. Karta by mala neskôr slúžiť aj ako elektronický recept. Preto ak v budúcnosti lekár predpíše pacientovi napríklad sirup proti kašľu, recept uloží na čip, tento si lekárnik pomocou čítačky kariet načíta a predá pacientovi presne to, čo lekár predpísal. Idea je chvályhodná. No ak  bude chcieť príbuzný vybrať liek z lekárne, nedostane sa k nemu bez elektronickej karty pacienta. Navyše praktická funkčnosť tohto systému ešte nie je odskúšaná. K testu online synchronizácie údajov zdravotných poisťovní a údajov z elektronických kariet by malo dôjsť až v októbri tohto roka.
Ak sa ale systém ukáže funkčných, nebudú si už musieť Nemci pred návštevou lekára nastavovať pripomienku, aby nezabudli zobrať röntgenové snímky a lekársku správu od internistu. Jednoducho im postačí vytiahnuť elektronickú kartu z peňaženky. Táto bude totiž obsahovať informácie ako lekárske nálezy, zoznamy liekov, správy z operácií, diagnózy a iné laboratórne vyšetrenia. Týmto by sa malo zamedziť opakovaným vyšetreniam a ušetriť nadbytočné náklady a tiež napomôcť lepšej starostlivosti vďaka výmene informácií medzi jednotlivými lekármi. No len čas preverí, ako to v skutočnosti bude fungovať.

Súkromné poisťovne ostávajú mimo

Súkromné poisťovne zatiaľ nie sú zapojené do programu elektronických zdravotných kariet a pre ich poistencov ostáva všetko po starom. Či už to ich poistenci vnímajú ako pozitívum alebo ako negatívum, pre efektívnosť systému by bolo vhodnejšie, aby sa v priebehu času povinnosť vzťahovala aj na ne.

Možnosť odmietnuť uloženie jednotlivých informácií

Pacient musí udeliť súhlas s uložením všetkých údajov na kartu. To znamená, že predtým, ako lekár uloží informácie na čip, musí si vyžiadať súhlas pacienta. Je však otázne, či sa bude v praxi skutočne vyžadovať súhlas k uloženie informácie o každom predpísanom lieku, vykonanom vyšetrení či zistenej diagnóze. Alebo sa z praktických dôvodov a kvôli ušetreniu času pristúpi skôr k udeľovaniu všeobecného súhlasu k uloženie všetkých alebo žiadnych informácií. Ak by skutočne došlo k udeľovaniu selektívneho súhlasu, mohlo by to viesť k výrazným problémom, kedy by karta ako taká stratila svoj zmysel. Ak by totiž na karte chýbali informácie čo i len o tabletku proti vysokému tlaku alebo o antidepresívach, nebudú sa na ňu môcť lekári v konečnom dôsledku spoľahnúť.

Nejasnosti o možnosti vymazať už uložené dáta

Otáznik visí nad spôsobom vymazávania informácií. Nejasné je doteraz, kedy a za akých okolností bude môcť pacient požiadať o vymazanie informácií z karty, a či tak bude mať možnosť spraviť i bez súhlasu lekára alebo len so súhlasom. Isté je zatiaľ len jedno, základné osobné údaje pacienta ostanú nedotknuteľné.

Praktické spojenie s európskou kartičkou poistenca

Praktickým riešením je umiestnenie európskej kartičky poistenca na druhú stranu karty. Po predložení tejto kartičky je občan Európskej únie štandardne ošetrený vo všetkých 28 krajinách Európskej únie a na Islande, v Lichtenštajnsku, Nórsku a vo Švajčiarsku.

Koľko to celé Nemcov stálo

Vydanie jednej elektronickej zdravotnej karty by malo vyjsť na dve Eurá, čo znamená, že na samotné vydanie všetkých kariet je potrebných 139 miliónov Eur. K tomu treba pripočítať náklady na zaslanie kariet, na vybavenie lekárov čítačkami kariet a na vybudovanie celej infraštruktúry. Konečné odhadované náklady sa pohybujú v rozmedzí od 700 miliónov do 14 miliárd Eur. Ak by sa systém ukázal ako funkčný a efektívny a cieľ znížiť celkové náklady v zdravotníctve by sa naplnil, investícia by sa postupne vrátila a systém by si na seba začal zarábať. Toto však ukáže len čas. A čo viac, hodnota zachránených ľudských životov vďaka rýchlej a systematickej dostupnosti zdravotných údajov, sa nedá vyčísliť v peniazoch.

Spracovala: Lenka Mišová


Zdroje:
Webová stránka nemeckého Spolkového ministerstva zdravotníctva http://www.bmg.bund.de/krankenversicherung/elektronische-gesundheitskarte/allgemeine-informationen-egk.html
Das Infoporatal zur Gesundheitskarte http://www.gesundheitskarte.net/
SPIEGEL ONLINE: Elektronische Gesundheitskarte: Alte Karte hat offiziell ab sofort ausgedient [publikované 2.1.2014]
http://www.spiegel.de/gesundheit/diagnose/elektronische-gesundheitskarte-alte-krankenkarte-ab-sofort-ungueltig-a-941512.html
Frankfuter Algemeine Zeitung: Haben Sie Ihr neues Kärtchen dabei? [publikované 16.12.2013]
http://www.faz.net/aktuell/gesellschaft/gesundheit/elektronische-gesundheitskarte-haben-sie-ihr-neues-kaertchen-dabei-12700080-p3.html

Obrázok: freedigitalphotos.net




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