Service description for care management provided by the Ambulanzpartner Soziotechnologie APST GmbH and for the use of the APST Care Portal

Published on 1 January 2018

For the sake of better readability, the simultaneous use of masculine and feminine forms has been omitted. All references to persons apply equally to both genders.

Table of Contents

1. Concept description
   1.1. Principles
   1.2. Care Coordination
   1.3. Healthcare research
   1.4. Open platform principle
2. Versorgungsmanagement
   2.1. Provision of medical aids
   2.1.2 The medical aid provision process
   2.2 Provision of medicinal products
   2.2.1 Addressed needs in the provision of medicines
   2.2.2 The process of pharmaceutical care
   2.3 Medication supply
   2.3.1 Addressed needs in the provision of medicines
   2.3.2 Medication supply process
   
   2.4 Ensuring freedom of choice
   
3. cription of services (care management)
   3.1. Care coordination
   3.2. Data management
   3.3. Document management
   3.4. Complaints management
   3.5. Patient reviews
4. Beschreibung des Ambulanzpartner Versorgungsportals (APVP)
   4.1. Nutzerrollen und Berechtigungen
   4.2.Bereitgestellte Daten
5. Prinzip des mehrseitigen Nutzens
   5.1. Nutzen für Patienten
   5.2. Nutzen für medizinische Partner
   5.3. Nutzen für Versorger
   5.4. Gesamtgesellschaftlicher Nutzen
6. Gewährleistung des Datenschutzes und der Datensicherheit
7. Unentgeltiche Bereitstellung und Finanzierung
   

1. Konzeptbeschreibung
   1.1. Grundsätze

1. Concept description
   1.1. Principles
   People with chronic conditions may have significant and complex needs for outpatient care, medical aids, medication and nutritional support. A critical aspect of outpatient treatment is the coordination of the necessary care and the collaboration between the partners involved. APSTaddresses these needs and embodies digitally supported care management. The APST concept (hereinafter “AP concept”) comprises a combination of coordination services with the digital management platform “APST Care Portal” (hereinafter “APCP”).
   
   Ambulanzpartner Soziotechnologie APST GmbH (hereinafter “APST”) offers care management services designed to improve coordination, communication and networking between patients (and their relatives), doctors and medical staff in practices, outpatient clinics and hospitals (referred to as ‘medical partners’), as well as providers of pharmaceutical therapy (pharmacies, manufacturers of medicines and medical devices), nutritional therapy, and medical aids and assistive devices (referred to as ‘care partners’). The APCP internet platform is the communication and management platform that provides digital support for care coordination. It links an electronic care record with digital process control for the purposes of care management and healthcare research.
   
   Through face-to-face, telephone or electronic contact with patients (and their relatives), medical partners (doctors, social services) and care providers, coordinators manage the provision of necessary medicines, medical devices, medical aids and remedies, as well as specialised care. The care management offered by APST comprises services that are not provided, or are provided to a limited extent, within standard care. Standard care provided by doctors and other service providers remains unaffected by the AP concept. The assessment of care needs, including the medical indication for medicines and other medical devices, as well as aids and remedies, remains the sole responsibility of the doctor. The assessment of the appropriateness and cost-effectiveness of care also remains the sole responsibility of the doctor and the funding body. The services and the use of the APCP only come into play once the care decisions have been finalised by the doctor during a doctor-patient consultation. The offer to participate in the AP concept is based on the patient’s wish and voluntary cooperation. The patient retains full rights of participation at all times and is supported only to the extent they wish. The patient is entitled, informed and able to terminate their participation in the APST’s care management at any time and without giving reasons.
   
   The AP concept is offered to patients under the following specific conditions.
   a) for conditions with specific criteria:

• serious illness
• complex chronic illness
• rare illness
  
  b) for care under special conditions:
• significant organisational demands on patient care and medical partners
• a high level of specialisation is required to ensure the quality of care
• A high need for coordination between various medical partners and care providers
  APST – Service Specification for Medical Partners (Version 3.1) – 4 –
• significant need for healthcare research
  
  Due to the specific medical conditions and care needs involved, the AP concept is particularly recommended for patients with the following diagnoses and syndromes
• Amyotrophic lateral sclerosis (ALS)
• Spinal muscular atrophy (SMA)
• Spastic spinal paralysis (SSP)
• Parkinson’s syndrome (severe or unusual course)
• Multiple sclerosis (severe or unusual course)
• Post-stroke deficit syndrome (severe or unusual course)
• Deficit syndrome following traumatic brain injury (severe or unusual course)
• Dementia syndrome (severe or unusual course)
• Tetraparesis
• Hemiparesis
• Spasticity syndrome
• Cachexia syndrome
• Dysphagia syndrome
  
  1.2. Care management
  In the standard care of patients with chronic, severe or rare conditions, the doctor determines, as part of their treatment, the need for aids and therapeutic devices, medication, nutritional therapy or other medical devices. The identification and discussion of treatment needs takes place independently of the AP concept and any potential participation by the patient in APST’s care management. The doctor informs the patient about the option to participate in the AP concept if the patient can benefit from digitally supported care coordination. It is made clear that the doctor receives no remuneration or other benefits for this recommendation. A further reason for providing non-binding information about the possibility of participating in the AP concept is when the patient meets the criteria for participation in a healthcare research study (see 1.3.). The doctor’s recommendation is one of several channels through which the patient can learn about the AP concept. Other channels of information include recommendations from self-help organisations and patient associations, testimonials on blogs and other social media, the APST website, and publications about the AP concept in print and online media as well as scientific publications.
  
  The APST undertakes – provided and to the extent desired by the patient – services on behalf of patients which would otherwise have to be performed by the patient or their relatives themselves, but which cannot be performed, or can only be performed inadequately, due to a lack of resources and skills (e.g. searching for suitable care providers; arranging appointments; providing documents, statements, etc.) . In addition to care coordination, cross-professional digital networking (via the APCP internet portal) is a further service that is not currently provided within standard care.
  
  If the patient wishes to participate in the AP scheme, the necessary documents are provided to the APST. On the basis of informed consent, the patient instructs APST to provide either APST – Service Specification for Medical Partners (Version 3.1) – 5 – comprehensive care management or individual services. To this end, the patient or a legal representative signs a declaration of consent authorising care management by APST and the digitisation of personal data on the APCP internet platform. Once the necessary declarations have been provided, an electronic care file is created and the patient is contacted by a care coordinator from APST or a medical partner. The care process is described in detail in Section 2. The contract is awarded to the care provider regardless of whether the selected care partner utilises APST’s services.

1.3. Healthcare Research
The AP concept follows a dual approach: data generated in the context of care management is used – on the basis of the patients’ informed consent – for a systematic analysis of care. This creates a ‘double effect’: the digitisation of care data on the APCP serves directly to coordinate care and, at the same time, to support healthcare research through the evaluation of ‘routine data’ (data from standard care). All patients who make use of the APST’s care management services are also invited to participate in a registry study in which medical data on medication and nutritional care, the provision of medical aids and remedies, as well as socio-medical data, are scientifically evaluated and published for the purposes of healthcare research. Consent to healthcare research within the AP concept is given on the basis of separate study information and a separate declaration of consent.

1.4. Principle of the open network
Voluntary participation, optional use and the unconditional right to withdraw from the scheme are fundamental principles of the AP concept. Participation does not represent an ‘either/or’ decision. This means that care can be coordinated within the AP concept, whilst – in parallel or at a different time – other care can be provided outside the AP concept. Care partners can access APST services or withdraw from the scheme without any formal barriers. The collective body of participating patients, care partners, medical partners and coordinators is referred to as the care network. The participation of patients, care partners and medical partners in the AP concept is dynamic and functions as an open platform.

2. Care Management
2.1. Provision of medical aids
2.1.1. Identified needs for assistive device provision
For people with chronic neurological conditions, assistive devices for mobility, transfer and communication are a priority. Identifying a suitable care partner is of particular relevance in the case of rare, severe and progressive conditions. For rare and severe conditions, individual care concepts are required in the areas of orthotics, mobility, transfer and communication aids, which demand a high level of professional and technical expertise from the care provider. In the case of progressive conditions, detailed knowledge on the part of the provider regarding the underlying clinical picture is advantageous in order to anticipate the course of the disease and the expected progression of impairments, and to incorporate this into the assistive technology provision plan. The principle of anticipatory assistive technology provision serves to prevent inappropriate provision and requires the provider to possess practical experience in the specific indication. Overall, from the patient’s perspective, there is a legitimate interest in receiving care from service providers who (beyond formal qualifications) possess specific expertise in the underlying condition to be treated and the relevant assistive technology configuration. Identifying and contacting experts in medical aid provision is beneficial in order to ensure the highest level of practical knowledge, quality and efficiency in medical aid treatment and to reduce the risk of inappropriate provision. Through the services of the APST, networking with specialist providers is initiated on behalf of patients and supported throughout the course of care.

2.1.2. Process of medical aid provision
The provision of medical aids is a complex process involving considerable time, organisational and administrative effort. Figure 1 illustrates the necessary sequence of actions between the patient, the provider and the doctor to ensure that a suitable medical aid is submitted to the health insurance fund for cost coverage. The APST’s care management does not alter the structure of the process and adheres to the formal requirements of the healthcare system. However, the service provided by APST consists of taking over, coordinating and digitising certain organisational steps in the communication between the patient, the supplier and the doctor on behalf of the patient and the supplier. This coordination service and the use of the APCP internet platform serve to reduce the burden on patients and care partners.

Fig. 1. Medical aid provision process: The provision of medical aids follows a structured process, which is implemented in the following steps. 1) The doctor issues a prescription for a medical aid; 2) the patient instructs the coordinator to assist with the provision of the medical aid (provision request); 3) the coordinator receives the provision request; 4) the patient confirms the provision request; 5) the coordinator identifies a suitable medical aid provider; 6) The supplier receives and confirms the supply request; 7) The supplier visits the patient and draws up APST – Service Specification for Medical Partners (Version 3.1) – 7 – a supply proposal; 8) The patient confirms the supply proposal; 9) The supplier sends the prescription proposal; 10) The coordinator sends the prescription request to the doctor; 11) The doctor reviews the prescription request; 12) the doctor draws up and sends the medical aid prescription; 13) the coordinator receives and sends the prescription to the supplier; 14) the supplier receives the prescription; 15) the supplier applies for cost coverage.

2.2. Provision of medical products
2.2.1. Identified needs for the supply of medical products
In the case of severe or rare conditions, there is high demand for specialist physiotherapy, occupational therapy and speech and language therapy. Of particular interest are therapy practices that offer specific expertise or treatment options for certain conditions. Specialised therapy practices with qualifications and experience in treating the conditions listed in 1.1 are therefore of particular relevance. Even in the case of common conditions (e.g. stroke), special care requirements may arise (physiotherapy following botulinum toxin treatment for spasticity; combining therapeutic interventions with the provision of assistive devices). A common search criterion is for therapy practices that can provide high-frequency therapy (4–5 times a week) via home visits. Patients with specific requirements regarding therapeutic provision (special forms of therapy; high-frequency therapy, home-based therapy, specific interdisciplinary experience with concomitant pharmacotherapy, orthoses or assistive devices; palliative care focus, etc.) instruct the APST to find a suitable care partner. As treatment progresses, the focus is on organisational support regarding the provision and dispatch of necessary reports and other documents, as well as the coordination of therapy with other healthcare providers (e.g. occupational therapy and speech therapy), assistive device suppliers (e.g. orthopaedic workshops) or care providers (coordination of nursing or therapeutic measures). In the case of severe and chronic conditions, healthcare providers play a central role in the care plan. Particularly where treatment is provided frequently (several times a week), the healthcare provider represents the professional group that implements the medically indicated care plan through direct contact and with the highest level of intensity. Due to the direct interaction between patient and provider, detailed specialist knowledge, practical experience and psychosocial competence that go beyond formal qualifications are required, particularly in the case of progressive illnesses and palliative care objectives. Against this background, there is a legitimate interest from the patient’s perspective in receiving care from a healthcare provider who possesses the therapeutic expertise, the necessary practical experience and the requisite psychosocial competence.

2.2.2. Process of healthcare provision
APST’s care management supports patients in finding and contacting specialist physiotherapists, occupational therapists and speech therapists. In the case of long-term or ongoing therapy, the necessary prescriptions must be obtained; in standard care, the therapist informs the patient of this, who in turn communicates the need for a prescription to the prescribing doctor. Once the indication has been assessed, the patient receives the follow-up prescription and delivers this document to the provider. This administrative process involves significant effort for the patient (particularly for those with mobility and communication barriers, as well as in cases of concurrent use of different therapies) . APST coordinators alleviate this organisational burden – on behalf of the patient – through document management and the use of the APCP internet platform. The upper section of Fig. 2 shows the necessary organisational steps in standard care. The lower part of the diagram illustrates those stages in the care process where patients and healthcare providers receive coordination support.

Fig. 2. Process of therapeutic treatment provision: Fig. 2. Process of therapeutic treatment provision: The provision of therapeutic treatments follows a structured process, which is carried out in the following steps. 1) The doctor determines the indication for therapeutic treatment and issues the prescription; 2) The patient instructs the coordinator to assist with the provision of therapeutic treatment (care request) and sends the prescription to the coordinator; 3) The coordinator receives the prescription; 4) The coordinator identifies a suitable therapist and submits a care request; 5) The therapist accepts the care request; 6) The coordinator suggests a therapist to the patient; the patient confirms the suggested therapist; 7) The therapist receives the care assignment; 8) The therapist receives the prescription; 9) The therapist treats the patient; 10) Upon completion of the therapy, the patient requires further treatment and the necessary prescription; they instruct the therapist to draft a prescription proposal; 11) The therapist sends a prescription proposal for further treatment; 12) the coordinator submits the prescription request to the doctor; 13) the doctor reviews the prescription proposal, determines the indication for continued (or modified) medication supply, prepares and sends the prescription; 14) the coordinator receives and forwards the prescription; 15) the therapist takes over the patient’s further treatment.

2.3. Medication supply
2.3.1. Specific requirements for medication supply
In the case of complex and rare diseases, there may be specific requirements for medication supply relating to the following areas of responsibility for pharmacists:

• Advice on medicines
• Preparation of formulations
• Collaboration with healthcare professionals from other disciplines
  
  2.3.1.1. Advice on medicines
  Advice on effects and side effects, as well as support for the correct use of medicines, forms part of a pharmacist’s regular duties. In the case of complex and rare conditions, however, it is advantageous if the pharmacist possesses specific expertise in these conditions. In this way, practical knowledge of dose-response relationships and side effects can be incorporated into the pharmacist’s advice on the effects and risks of medicines, as well as their proper use. There is a need for specialised advice in cases of an increased risk of adverse drug reactions, as well as in drug therapy involving off-label use or a modified method of administration (offlabel use). Furthermore, a need for specialised advice may arise where there are specific conditions for the use of medicines. The AP concept ‘ ’ coordinates the care of patients who have a particular need for advice, especially due to the following conditions:
• Dysphagia (swallowing disorder)
• Sialorrhoea (uncontrolled salivation)
• Percutaneous endoscopic gastrostomy (tube feeding)
  
  In the case of complex and rare diseases, there may be special circumstances surrounding the consultation, thereby placing specific communicative and psychosocial demands on the pharmacist and other pharmacy staff, as well as on the pharmacy’s technical infrastructure. The AP concept coordinates the care of patients who have a particular need for advice, especially due to the following circumstances:
• Restriction or loss of the patient’s ability to speak during the consultation
• Loss of telephone communication and the necessary use of digital media during the consultation and in the subsequent communication process
• Locked-in syndrome (loss of mobility and communication whilst intellectual functions remain intact)
  
  2.3.1.2. Preparation of compounded medicines
  The preparation of prescriptions is one of the pharmacist’s regular duties. A specialised need arises when rare formulations need to be developed, prepared and stocked. The AP concept specifically coordinates the care of patients who have a particular need for the preparation and timely supply of formulations for the following groups of medicines:
• Anticholinergics for the treatment of sialorrhoea
• Cannabis-based medicines for the treatment of cramps, spasticity and fasciculations
• 4-aminopyridine-containing antispasmodics for the treatment of spasticity
• Medicines containing dextromethorphan for the treatment of motor disinhibition
  
  2.3.1.3. Collaboration with healthcare professionals from other disciplines
  Collaboration with members of other healthcare professions is part of a pharmacist’s regular duties. In the case of complex, rare and chronic conditions, there is a particular need for collaboration to ensure advice on medication risks and the proper use of medicines. The AP concept coordinates the care of patients where there is a particular need for the pharmacist to liaise with healthcare partners:
• PEG tube providers: The administration of medicines via a PEG tube is an interdisciplinary task and requires specialist knowledge from all parties involved, as medical, nursing and pharmaceutical aspects must be taken into account. The optimal approach involves patientspecific data collection, an assessment by the pharmacist of the suitability of medicines for PEG administration, and a final check and prescription by the doctor. Through targeted advice from the pharmacist to nursing and nutritional care providers, the e and professional handling of PEG tubes and medication safety are ensured. The harmful displacement of tubes by medicines can be prevented.
• Medicine suppliers: Information on medicines modified for salivary flow is important for the success of speech and language therapy. At the same time, information from speech and language therapists regarding sialorrhoea is incorporated into the pharmacist’s advice on the proper use of oral medicines. For physiotherapists and occupational therapists, knowledge of sedative, psychotropic or spasmolytic medications is relevant for therapy planning and ensuring the success of therapeutic treatment. Conversely, information provided by physiotherapists and occupational therapists can be significant for the pharmacist’s advice on effects (e.g. improvement of gait disturbances through spasmolytic medicines) and risks (e.g. risk of falls through spasmolytic medicines).
• Assistive technology suppliers: For suppliers of mobility, transfer and communication aids, knowledge of sedative, psychotropic or spasmolytic medications is relevant for testing and assessing the suitability of aids, as well as for preventing incorrect provision.

2.3.2. Medication supply process
Within the APST’s care management system, patients receive support in finding and contacting specialist pharmacists. In the case of long-term or ongoing medication treatment, patients are relieved of organisational tasks by APST coordinators and through the use of the APCP internet platform. Figure 1 shows the organisational process of medication supply and those stages in the care process where patients or pharmacists receive coordination support.

Fig. 3. Medication supply process: The supply of medication follows a structured process, which is carried out in the following steps. 1) The doctor determines the indication for the medication, writes the prescription and hands it to the patient; 2) The patient instructs the coordinator to find a suitable pharmacist (supply request); the coordinator identifies a suitable pharmacist and informs the patient; 3) the patient sends the prescription to the pharmacist; 4) the pharmacist receives the care-related data via the APSTcare portal; 5) the pharmacist contacts, advises and treats the patient; 6) for follow-up medication, the patient asks the pharmacist to submit a proposal regarding the medication requirements; 7) the pharmacist sends their proposal regarding medication requirements to the doctor via the APSTcare portal; 8) the doctor issues the prescription for continued (or modified) medication supply and sends the prescription to the patient; 9) the patient sends the prescription to the pharmacist (continuation of the process).

2.4. Ensuring freedom of choice
The patient’s participation in APST’s care management requires the patient’s informed and documented consent. This requires the patient to acknowledge, consent to or select options and sign the following documents:

• General Terms and Conditions for Patients (GTC)
• Privacy Policy for care management and healthcare research by APST GmbH and the use of the APST Care Portal
• Declaration of consent to participate in care management and healthcare research APST GmbH and to use the APSTcare portal
• Declaration of free choice of pharmacy (if medication supply is required)
• Delivery order for pharmacies (if applicable)
• Waiver of confidentiality for pharmacies (if applicable)
  
  When participating in care management, the patient has complete freedom of choice: they may fill their prescription themselves, or choose a specific provider to be commissioned by the coordinator to provide care, or instruct the APST coordinator to identify a suitable provider and coordinate the care. In the document “Declaration of Free Choice of Pharmacy”, the patient confirms that they have been informed of their right to choose a pharmacy and of these options, and that by signing, they have opted for one of the options listed. As part of care coordination, subject to the legal requirements, it is possible to have medicines delivered by courier or via mail order to the patient’s home or to a doctor’s surgery where the medicine is administered (e.g. injection or infusion therapy). To this end, the patient signs the ‘Delivery Order’ document, APST – Service Specification for Medical Partners (Version 3.1) – 11 – thereby authorising a pharmacy or a logistics company commissioned by the pharmacy to deliver the medication by courier or via mail order.

3. Description of the services
The services facilitate communication and networking between the patient, doctor and care partners and can be utilised as a whole or in individual components. The modular AP service architecture consists of the following components:

3.1. Care Coordination
Care coordination is a service provided by non-medical coordinators at APST. It involves organisational tasks relating to the provision of medical aids, remedies, medicines and medical devices. Care coordination comprises the following services:

• Receipt of care requests by email, fax, post or online
• Digital recording of the care request
• Contacting the patient, relatives or legal representative by telephone to confirm and clarify the care request
• Identification of a suitable care provider on behalf of the patient
• Submitting the care request to a suitable provider on behalf of the patient
• Provision of a telephone service for patients, medical partners and care partners
• Monitoring and reminder service for unprocessed care requests to care partners

3.2. Data management
Data management is a service provided by coordinators and data managers. It involves obtaining medical information and care data, as well as digitising and making this available to patients, care partners and medical partners. Data management comprises the following services:

Contacting patients, relatives or legal representatives by telephone to collect master data,
medical data and care data

• Digitisation of master data, medical data and care data in the APCP’s electronic care record
• Extracting information from doctors’ reports and other medical documents to record and digitise diagnostic data in accordance with ICD-10
• Extracting information from doctors’ letters and other medical documents to record and digitise care data

3.3. Document management
Document management is a service provided by coordinators and data managers. It involves the receipt, recording, archiving and provision of medical documents. Document management comprises the following services:

• Collection and postal dispatch of printed documents (e.g. doctors’ letters, treatment reports, medication plans, care requests, trial protocols) APST – Service Specification for Medical Partners (Version 3.1) – 12 –
• Scanning, indexing, uploading and versioning of documents (e.g. doctors’ letters, treatment reports, medication plans, care requests, trial protocols)
• Creation, circulation and versioning of document templates (e.g. medication plans, care requests, forms)

3.4. Complaints Management
Complaints management is a service provided by coordinators on behalf of patients and care partners. Complaints from patients and medical partners are received via a telephone service as well as via email and post, systematically recorded, investigated, evaluated and communicated to the parties involved (patient, care partner and, where applicable, medical partner). Complaints management comprises the following services:

• Provision and evaluation of complaint forms, as well as the acceptance of complaints by
  telephone, provided that no medical or pharmaceutical issues are involved
• Review and communication of criticised care processes to patients, doctors and care
  providers, provided that no medical or pharmaceutical issues are involved

3.5. Complaints Management
Patients or persons authorised by them also have the opportunity to evaluate medical devices and medical services. Through patient involvement, a significant contribution can be made to improving healthcare, or through targeted suggestions for improvement, the optimisation of future medical devices, treatments and care processes can be achieved. Patient evaluations are conducted by staff trained for this purpose. The assessment involves interviewing patients in person, by telephone or by email.

The patient evaluation comprises the following services:

• Preparation of interview documents (print) and configuration of interview software (online,
  email distribution)
• Conducting telephone surveys, face-to-face interviews and sending out online
  assessments
• Analysis of patient assessments
• Presentation of patient assessments on the APCP and via other communication channels
  (newsletters; print media, publications)

4. Description of the APSTCare Portal (APCP)
The APCP internet platform (https://www.ambulanzpartner.de/) is the digital communication and management platform through which all care management services are documented and managed. It serves as the communication medium between professional coordinators and care partners to facilitate the management of medical aids, therapeutic aids, medication and nutritional care. Use of this platform is not required for patients and medical partners; it is optional and voluntary. Patients can make use of care management services without using the APCP software or any other computer application themselves. Consequently, patients can participate in the AP concept even without technical knowledge or internet access. Patients and medical partners are given the option of obtaining their own access to the APCP internet portal. With this access, patients and healthcare partners are given the option to view the organisational and communication processes between coordinators and care partners. Patient- and care-related data is recorded on the APCP, as outlined in 4.2. Specific access permissions have been defined for accessing personal data, as described in 4.1.

4.1. User roles and permissions
A key feature of data protection is the restriction of access rights to only those data required for the user role. Consequently, not every user of the AP portal can view all the data stored there. The restriction of data access has been specified for the following user groups.

4.1.2. Medical partners and care partners

• All data in the portal relating to patients for whom a treatment or care mandate exists (no data is available for patients for whom no mandate exists)

4.1.3. Coordinator role

• All data in the portal relating to patients for whom a coordination mandate exists (no data is available for patients for whom no coordination mandate exists)

4.1.4. Netzwerk-Manager, Datenmanager und Administratorenrolle

Complete dataset of all patient- and care-related data

• Complete dataset of all medical partners and care partners
• Complete data on patient evaluations (survey management) and participant groups
  (participant management)

4.2. Data provided

Extensive patient- and care-related data is recorded and stored on the AP internet portal via a systematic menu navigation using free text or drop-down lists, based on the patient’s detailed consent. The data fields should be understood as input options that are not recorded for every patient and every care process.

5. Principle of multi-sided benefits
The AP concept is based on the fundamental principle of a multi-sided platform. Within the platform structure, various partners make different contributions to the platform and generate role-specific benefits.

5.1. Benefits for patients

For patients and their relatives, the focus is on support in finding suitable healthcare providers and reducing the organisational burden associated with long-term medication management.
For patients and relatives participating in care management, the following benefits arise – depending on the use of the APCP by the respective care partners:

• Support in finding specialised and suitable healthcare providers
• Relief through a single point of contact for all care-related queries
• Relief through organisational and administrative support in the collection, dispatch and storage of necessary statements, reports and other documents
• Relief through a point of contact for complaints regarding care (complaints management by the coordinators)
• Strengthening of autonomy through the Electronic Care Record (EVA), including a medication plan on the APCP (“empowerment”)
• Strengthening of autonomy through status updates on medical aid provision (“Where is the medical aid in the approval process?”) on the APCP (“Care tracking”) APST – Service Specification for Medical Partners (Version 3.1) – 18 –
• Strengthening the active role of patients through invitations to provide patient reviews of medicines, medical aids and remedies, medical devices, medical services and care providers

Für Patienten und ihre Angehörigen steht die Unterstützung bei der Suche geeigneter Versorger und die Entlastung in den organisatorischen Aufwendungen in der dauerhaften Medikamentenversorgung im Vordergrund. Für Patienten und Angehörige, die am Versorgungsmanagement teilnehmen, entsteht – abhängig von der Nutzung des APVP durch die jeweiligen Versorgungspartner – der folgende Nutzen:

5.2. Benefits for medical partners
Medical partners participating in APST’s care management derive the following benefits:

• Improved quality through a referral option to specialised non-medical care for complex, rare and chronic conditions (based on documented patient preference)
• Strengthening of their own expertise through patient feedback on care (patient reviews)
• Strengthening of their own capabilities through the receipt of monthly statistics via email on care arranged (care arranged and provided)
• Promotion of healthcare research projects (gaining knowledge; supporting innovation in healthcare)

5.3. Benefits for healthcare providers
For providers of pharmaceutical care, there are significant time and efficiency gains in data collection. Furthermore, there are various benefits in quality management and the strengthening of differentiating features. For providers participating in care management, the following benefits arise:

• Time and efficiency savings, as well as improved quality of care, through structured information on diagnoses, specific care objectives and medical indications for treatment
• Time and efficiency savings in the delivery of care through the digital provision of patient and care-related data, including logistics data
• Improved quality of care through the digital provision of patient- and care-relevant data regarding specific conditions of use
• Improved quality of care through the digital provision of patient- and care-relevant data regarding specific consultation circumstances
• Time and efficiency savings, as well as improved quality, through digital support for collaboration between the healthcare provider and members of other healthcare professions
• Quality control through structured patient evaluations (satisfaction surveys regarding the provider’s services; benchmarking against other providers)
• Reducing the risk of inefficient or inappropriate care (through insight into existing and planned care for the same patient)
• Strengthening of the provider’s profile and their own specialisation (through patient evaluations and numerical display of previous care on the APCP)
• Participation in healthcare research projects (enhanced reputation; optimisation of care processes)

5.4. Benefits to society as a whole
The overall perspective describes the benefits of care management that extend beyond the perspective of a specific participant group (patients, doctors, care providers). The focus is on APST – Service Specification for Medical Partners (Version 3.1) – 19 – supporting and alleviating the burden on patients with severe and chronic conditions through an innovative service architecture, as well as on improving the efficiency of care processes through digitalisation. From a broader perspective, digitally supported healthcare management generates the following benefits:

• Providing support for patients and their families in cases of complex, rare and chronic conditions
• Strengthening patient empowerment through patient assessments and coordination services on behalf of the patient
• Strengthening specialisation and differentiation processes in non-medical service provision (neurologically specialised or sub-specialised therapy centres, medical supply shops and pharmacies)
• Increased efficiency for all stakeholders in complex care through coordination services and an online platform (one-off collection of patient and care-related data, but multi-party use of the same data)
• Efficiency gains through digital transformation in care processes (digital support for data and document management)
• Collection of ‘routine data’ for the purposes of optimising care and conducting healthcare research (data spanning different payers and service providers)

6. Ensuring data protection and data security

The APCP internet platform is administered by APST, whilst patient-related data is stored in a secure database. APST ensures that data protection requirements are met. To this end, there is a partnership between APST and Charité – Universitätsmedizin Berlin. Charité has taken on the hosting of personal data. The data is stored within Charité’s data security architecture. In stark contrast to any form of open internet application, the APCP is strictly confidential and accessible only to authorised users. The patient has expressly consented to the use of their data for the purposes of their outpatient care. APST works exclusively with medical and healthcare partners who have agreed to the use of patient data for the purposes of healthcare research and to strict compliance with data protection regulations. The terms of data protection are set out in a separate data protection statement. Consent to data protection by healthcare partners is a prerequisite for the use of the APCP internet platform.

7. Provision free of charge and funding

The services and software of the APCP are provided free of charge to patients and their relatives, as the collection of fees is prohibited for psychosocial reasons. The services of the APST are financed for patients from the fees paid by the care partners as well as from other sources of revenue (third-party funding of the APST). APST services are also made available to medical partners free of charge, as these partners incur additional costs without a corresponding economic benefit. Patients and medical partners contribute to the financing of the AP concept by consenting to the collection and use of healthcare research data (on the basis of informed consent), which is utilised scientifically and economically by the APST (APST third-party funded projects). For healthcare partners, the use of healthcare management services and the APCP software is subject to a fee. Overall, the financing of the AP concept follows the ‘shared value concept’, in which APST’s revenues (from fees paid by healthcare APST – Service Specification for Medical Partners (Version 3.1) – 20 – partners and third-party funding) are used to create social added value (provision free of charge to patients).