Practice Management Software Requirements for Germany

Acceptance

Most doctors are willing to pay a reasonable inital amount and reasonable maintenance fees if:

someone can be taken under contract for maintenance

a revenue source of open source companies

the system meets certain minimum functional requirements

often measured against their former system, if any

is easily customizable in any desired way

open source does deliver on that
many doctors will in fact not care too much about that point "as long as it does what they want"

will allow them to reuse their existing hardware

open source/protocols allow that more easily

is up to date with legal requirements

this does cost money and they are willing to pay for it

I have a list of doctors who are either

interested in a practice management system under Linux
use Linux in some way already
are computer-savvy

Those I could contact and ask for help, encouragement, funding.

Requirements

1^st priority - Absolute requirements - must haves before deployment in Germany

minimum EMR:

demographic patient data (BDT [BehandlungsDatenTräger], ...)
diagnoses handling (current problems, permanent/long term problems)
ICD 10 (in Germany) (entity coding)
EBM (Einheitlicher BewertungsMaßstab) - billing patients insured by government regulated companies
GOÄ (GebührenOrdnung für Ärzte) - billing of privately insured patients

disk based billing:

official data format KVDT (Kassenärztliche-Vereinigung-DatenTräger)

mandatory

KVDT conformance validator (KVDT Prüfmodul)

C source available
disk with billing data must successfully pass validator before submitting

system must pass conformance tests by KBV¹ before accreditation

maybe workaround by using old TurboMed source ?

unalterable saving of "KVK² read" flag for current quartal

requirement by KBV to allow billing via disk w/o handing in forms

ICD 10 coding of diagnoses

required by law
crosswalk: plain text diagnoses -> ICD 10 code
for crosswalk creation: create master database by harvesting old KVDT and BDT disks

interfacing KVK-Reader - stationary, mobile

protocol/data format available
all but one connect to the serial port
the one is integrated with a keyboard made by Cherry
for the Cherry keyboard there is source available from the company

official databases:

EBM
GOÄ
SVDT (SozialVersichererDatenTräger) - official list of health insurance companies

forms

prescription (official and private)
referral
off work
official billing form (replacement for disk based billing)
LaTeX templates with placeholders + ghostscript
must be Courier 10 pt (it's the law, you know)

Browser- or DOS-Client for proof of concept
BDT import

2^nd priority - required to increase acceptance - implement as quickly as possible

interfacing to drug database(s)

doctors must be able to track their "spending" of public money by prescribing drugs because they may get fined (!) for exceeding their "budget"

LDT import (LaborDatenTräger) - standard data format for importing lab data
bills for private patients - interface with 3^rd party financial app
Bonner Modell - another, considered to be obsolete, standard data format for importing lab data
BDT based EMR export
native Linux/DOS/Win-Clients
PAD (PrivatAbrechnungsDatenträger) - standard data format for disk based billing when billing privately insured patients through clearing houses and not directly
other necessary forms

3^rd priority - partially wish list, partially must haves for wide acceptance

stored procedures - e.g. KVDT conformance validator so clients do not have to worry about it but only submit and check return codes
Mac-Client (?)
Blankoformulare (= Postscript) - printing forms on blank paper, including data, template and a barcode

available from KBV

GDT (GeräteDatenTräger) - standard data format for interfacing with electronic medical equipment
email gateway, KDT - standard for handling medical email
fax gateway
clinical calculators (body mass index, body surface area, ...)
messaging API - jabber ? = gateway between outsider's choice of contact (phone, fax, mail, pager, ...) and practice management app
remote work stations (is network function, not app)
EMR with trigger events
"standard office procedure" database - trigger batches of actions
auto reminder for planning
auto TODO
patient appointment manager (Bestellsystem)
patient tracking on office contact
intelligent daily contact list
picture handling - interface with 3^rd party image database (photoseek ?)
link handling - interface with browser
gecko based client (!= browser client !)
gnome client
qt client
ncurses client
inventory - link with dispensing (eg. in progress notes: wound dressing -> triggers prompting of material used -> triggers inventory update -> triggers update of "to purchase" list)
LAN based phone system (interfacing 3^rd party apps !!)

Potential Partners

GNUmed - excellent basic design of system (network) architecture
FreeMed, FreePM - good HTML-Client implementations, database layout valuable, advanced
Dr. Vergil Slee - suggestions on how to do diagnosis coding the Right Way(tm)
KBV - extensive, detailed data definitions + tables, validators, forms
LinuxMedNews - good source of links and news
TurboMed - agreed to make DOS source available after discontinuing support (end of 2001), but licensing issues may prevent us from using it; also they were innovative in their early development
Res Medicinae - aims to build a (German) practice management system
OIO - concept of forms based display of EMR data
many EMR standards definitions, e.g. GEHR, HL7, ...
3^rd party billing software (linuxkontor, open accounting) for billing privately insured patients
HCPP (Health Care Professional Protocol) - might become official standard in Germany for doctor's smartcard IDs
photoseek - image database
Quick Quack Medical Manager - excellent implementation ideas
any of the small practice management software companies - do they want a stable, free, open server base to build on ? - they could provide services, clients and maintenance
Duria - Genossenschaft, practice management system kind of run as a commune
MAP - was an innovative practice management system when it started
TurboMed - was an innovative practice management system when it started
APW - started by one doctor/practice
ImageMagick - displays DICOM encoded images
medical websites for travel medicine, etc.
drug databases (IFAP, AMIS, ABDA, Rote Liste, Gelbe Liste, web based, PDC, ...)

General thoughts

xDT handling should be unified architecture
Prüfmodul should be able to validate "sections" like single lines, records or patients instead of only complete files
Prüfmodul should be engine/UI separated
IPv6 ? (security)
coding with online access ?

¹ KBV = Kassenärztliche Bundesvereinigung - This organisation is responsible at the federal level for administrative tasks concerning all private practices. It's counterpart on the state level is the KV (Kassenärztliche Vereinigung).

² KVK = KrankenVersichertenKarte - A standardized chip card holding the patient's name, address and insurance company in mandatory use in Germany. Not a smart card !