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Germany embraces CDA eReferral document specification

Publication date: May 02, 2008

At the conhIT (the German software-in-healthcare conference) it was announced that the German national healthcare infrastructure will create a CDA implementation guide for referral and discharge letters. The implementation guide will be based on an existing one created by the VHitG, the German vendor organization of software applications in healthcare. This column contains an interview with a representative of Siemens, one of the vendors involved in the national infrastructure as well as in VHiTG.

The German conhIT is a mixture of a conference (lectures; workshops) and a trade show. HL7 Germany had its own booth. The conference was well attended, and will be even bigger next year given that it will be combined with another conference.

On the first day of the conference, Gematik (the organization responsible for the creation of a healthcare IT infrastructure) announced that it would create a specification for the discharge letter and referral based on the Clinical Document Architecture (CDA, a HL7 version 3 standard). The focus of Gematik has been mainly on the creation of a secure transmission infrastructure, and on chipcards. The use of chipcards (for patients as well as providers) is mandated by law, as is the use of the infrastructure for the exchange of electronic prescriptions. The exchange of discharge letters and referrals (known as Arztbrief in German) are mentioned in the very same law as an additional (though optional) workflow supported by the infrastructure.

About 1.5 years prior to this announcement the VHitG, the German vendor organization of software applications in healthcare, had already created a CDA implementation guide for discharge letters. A number of vendors have already implemented that specification. The decision of Gematik to base their specification on the VHiTG specification is therefore a very pragmatic one which will help the adoption of the new Gematik implementation guide.

Georg Heidenreich, the "standardization evangelist" with Siemens Healthcare in Erlangen, Germany, has been involved in the development of the national infrastructure and knows the various players present on the german market. His comments:

A more cynical comment was made by another source: Gematik has been rather unsuccesful in rolling out the national infrastructure, so their decision to use CDA should be seen as a "quick win", as "picking low hanging fruit".

Whatever the case may be, the fact that they embraced CDA as a standard will surely have a positive effect on the amount of implementations of CDA within Germany.


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Ringholm bv is a group of European experts in the field of messaging standards and systems integration in healthcare IT. We provide the industry's most advanced training courses and consulting on healthcare information exchange standards.
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Rene's Column (English) Rene is the Tutor-in-chief of Ringholm.