ePa, ISiK, AI Act: We connect you to the future

The growing interconnectivity across sectors, institutions, and borders is one of the key topics in health IT. Connecting to the ePA is one of the many requirements that hospitals must currently implement. The GFO network uses our JiveX Healthcare Content Management system for this purpose.

Needless to say, Jo Knappstein is well aware that the term “IT training” can elicit frowns and puzzled looks from medical staff. At the present, the prevailing reaction tends to be more of a grin. This is because, in the GFO network’s most recent IT project - which encompasses its 19 hospital locations in Rhineland-Palatinate and North Rhine-Westphalia - the training requirements for doctors remained well within manageable limits. If it had been up to the project manager of the “ePA for All”, it might even have been possible to do without training altogether.

The reason being that the Catholic nonprofit organization has taken a unique approach to complying with the legal requirement to enter treatment data into electronic patient medical records. Unlike the majority of German hospitals, they did not expand a hospital information system (HIS) to handle data transfer. Instead, they employ an interface provided by us via the JiveX Healthcare Content Management (HCM). “And this works very intuitively with just a few clicks,” says a delighted Jo Knappstein.

Since the beginning of this year at the latest, the latest development stage of the “ePA for All” has kept the management and IT departments at German hospitals on their toes. The reason being that April 1 marked the expiry of the legal deadline for the active use of the ePA in hospitals. Since then, institutions that are unable to use the “ePA 1.0” module have faced a 50 percent reduction in their telematics infrastructure allowance.

However, the ePA is not the only challenge facing the healthcare sector at present and in the coming years. Hospitals and doctors' offices are therefore faced with the increasingly urgent issue regarding the future viability of their IT systems. The immediate priority is to avoid further complicating a system that is already severely overburdened by bureaucracy. The long-term goal is to use meaningful data to create added value for patients as well as for the healthcare institutions themselves.

A benefit or just an extra burden?

This is likely to be most evident in the case of the DIX-Standard (DIN/TS 19455), which the health IT industry has agreed upon: At a time when CDs have become primarily a medium for music lovers, the new standard for digital image data exchange is likely to be perceived as a clear benefit for everyone involved. We contributed to this effort through Dr. Marc Kämmerer, as well as to IHE AIRA, the new standard for AI validation and distribution workflows. This standard complies with the requirements of the EU AI Act.

When it comes to other regulatory requirements, it is advisable not to make exaggerated promises to doctors in the initial phase. For example, the European Health Data Space (EHDS), which came into effect in March 2025, "does not actually help reduce bureaucracy at first," says Elena Fomin, Business Development Manager at CGM Clinical. And in the case of ePA integration, the potential benefits are offset by what feels like an added burden - though that impression may fade when one considers how doctors’ letters and other documents have been transmitted in the past.

JiveX HCM as central data platform

Nevertheless, the top priority when implementing new standards and regulations must be to avoid “unnecessary additional burdens.” The GFO network is very satisfied with the implementation of the ePA interface in this regard. But why use JiveX HCM for integration instead of a hospital information system? The answer lies in the past. “Following several acquisitions, the GFO hospitals still use two different hospital information systems,” reports Stefan Napiletzki, Team Leader for Clinical Platforms and System Integration at the GFO. “However, we decided that all systems relating to the hospital information system would be selected from a single vendor based on the best-of-breed concept."

Based on this criterion, JiveX HCM was identified as being the best solution for document management. “Thus the ePA process now works the same way in all of our facilities.” And because JiveX HCM is integrated into both hospital information systems, users don’t have to switch to a new environment; instead, they can navigate with the utmost ease. Simply select the documents for upload or download, click once - and that's it. For this reason there is no need for time-consuming training programs, merely some documentation and a few presentation sessions.

In addition, Napiletzki emphasizes that the GFO JiveX HCM is not merely an archive. “For us, it is the central hub at the heart of the treatment process.” The ePA link is just another logical step in the strategically defined roadmap. In the future, JiveX HCM will also incorporate data from external laboratories and the numerous radiology practices with which the network collaborates. And because GFO has recently felt once again that “VISUS understands our needs and concerns as customers,” they are optimistic about the future.

How to master system diversity

As far as the fundamental challenge is concerned, the GFO is by no means an isolated case. The reason being that the consolidation and merger trends in the German hospital sector are likely to lead to a significant increase in the diversity of systems and the need for cross-sectoral collaboration. The auditing firm Curacon referred to the “highest level of transformation to date” in the edition of the bkw-Curacon-Merger Radar published at the beginning of April. With 167 reported transactions, 2024 was the second record year in the German hospital market after 2023 (158 reports) - a clear result of the hospital reform, according to the authors of the Radar.

“From the perspective of process efficiency, it makes even more sense in this situation to establish a single point of truth for medical data, instead of first transferring documents to a hospital information system and then to a document management system,” explains our product manager, Lena Taprogge. In addition, it may be more cost-effective in the long run to simply retrofit a single HCM system rather than license add-ons for multiple hospital information systems.

Here is how you can benefit from ISiK Level 3 

In our company, Lena Taprogge is not only responsible for implementing the ePA feature on the product side, but also for document exchange via the ISiK interface. To recap: ISiK, the Standard for Information Technology Systems in Hospitals, is intended to establish a binding standardized, cross-vendor “language” for the transfer of health data for IT systems there. Unlike with the ePA, the ISiK Level 3 requirements currently apply only to system providers. "For that reason alone, it is not immediately clear to customers what benefits this offers at this stage", explains Lena Taprogge. Most importantly, however, compliance with ISiK Level 3 is not sufficient in practice.

So we went one better. Specifically, this means that starting with version 5.8 of JiveX, ISiK queries are designed such that users can only search for relevant parameters and their combinations. Should large sets of results be generated despite this, pagination ensures optimal performance when returning the results. And if multiple systems are in use, for example, at different locations, then it is possible to perform a cross-location query. “This way we made ISiK workflow-ready for everyday clinical practice.”

By the way: An optionally available license also simplifies data exchange with the ePA, at least for institutions that use MEDICO, the CGM Group’s hospital information system. The license ensures that MEDICO only retrieves documents from JiveX HCM via the ISiK interface for upload to the ePA and only returns data that are not already available in the MEDICO hospital information system. This avoids duplicate data storage and display. After all, even data that matter are only needed once.