EFMI Representative, University of Leipzig Medical Faculty
Before 1990, primary care in the eastern part of Germany was organised in so-called "polyclinics". These polyclinics were mainly located in factories (including primary care as well as hospital medicine), and there were few independent practitioners, using their own consulting rooms, often with limited facilities. The number of private practices was very low.
A few polyclinics began to work with computers in the 1980s, but these computers were only used in administration and for very simple documentation. Since then, more useful clinical applications have begun to be used, such as the measurement and monitoring of diabetes care and antenatal care. A further important area of the use of computers was the design of clinical records by physicians with the help of text processors. Simple statistical software has been used. The polyclinics have supported important medical registers such as the cancer register. Useful databases were created, for example of medical literature and poisons.
Very often hospitals and polyclinics were accommodated in the same building, and there were compulsory trials of a shared patient record. However, clearing information was not an object of medical informatics.
After the reunification of Germany, during 1990 to 1993, 95% of the polyclinics were closed. Now, physicians practise independently, financed from their own resources, and very often in the old consulting rooms. Co-operation between the experts has continued only seldom in terms of common use of rooms or equipment. Co-operation with hospital medicine, as with the shared medical record, has almost completely disappeared.
With the privatisation of primary health care, there is no doubt that increased productivity was produced by:
Something quite new for primary care physicians was the necessity of analysing the cost-effectiveness of their activities; many physicians had no experience of the fundamental principles of management of a practice. Some of the older physicians were bankrupted by their lack of basic knowledge of management.
The elimination of polyclinics at first meant a step backwards for medical informatics, though the great majority of primary care physicians were extremely interested in using computers. They were also responsive to the use of ICD-9 and other classifications.
Today, primary health care in the eastern part of Germany is better equipped with computers than, for example, Bavaria.
The aims of medical informatics in primary care have changed:
A very important area of progress in the use of computers was caused by the introduction of chip-cards by the health insurers. In primary health care informatics, the significance of computers as an economical tool will increase in the future.