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Interview with Christian Thomeczek

Dr. Christian Thomeczek is the Director of the German Agency for Quality in Medicine (ÄZQ)

ÄZQ is the joint competence center of the Federal Medical Association and the German Association of Public Health for quality and knowledge in healthcare. Its main focus is on guidelines, patient information, patient safety, and evidence-based medicine. ÄZQ is one organization responsible for maintaining Germany’s Critical Incident Reporting System (CIRS).

Are hospitals in Germany required to implement CIRS systems?

Yes. Hospitals must have an internal CIRS system and must participate in regional cross-institutional systems. Hospitals are also required to use reports to implement safety and quality management.

What is CIRSMedical?

CIRSmedical is a nationwide error reporting and learning system. It was launched in 2005, and in that year, generated 6,500 error reports.

Does learning from CIRS require voluminous reporting?

It’s more about quality than quantity. For example, a small number of reports can have a big impact, while a large number of reports can create an onerous follow-up burden with very little impact.

What role does ÄZQ have in implementing and maintaining internal and external CIRS systems?

In additional to providing educational, implementation and training resources, ÄZQ contracts with hospitals to manage the software and maintenance of their internal CIRS. The contract provides that all reports in the hospital’s internal CIRS will be copied into CIRSmedical, so there is automatic participation in cross-institution reporting.

Where is data from CIRS reports stored?

CIRSmedical is internet-based and hosted in a secure environment at Basel University. The Swiss reporting software erases the IT data once the report is transferred to the server in Basel, so the report cannot be traced to an individual reporter or institution.

Does CIRS use a standard reporting form?

In the beginning of CIRS, the system used common formats. In order for common formats to be successful, the software must have the ability to import and export joint files. Now that the Basel server hosts CIRS, 25 different CIRS systems in the network use an internet-based form that consists of 7 basic questions and allows for some customization.

Can hospitals use the same software to generate CIRS reports as they do to maintain patients’ medical records?

No. CIRS software is separate from the medical records software. CIRS reports should not be contained in a patient’s medical records.

Is there any danger that CIRS data could be used in medical malpractice litigation?

No. First, CIRS reports are anonymous and cannot be traced to an individual patient or provider. Second, the German civil litigation rules forbid a party from getting its evidence from an opponent. Finally, reporters are encouraged to report only near-miss incidents. The only time reporting an injury-causing incident is encouraged is when the claim has already been resolved with insurance.

Can implementation of CIRS expose an institution to additional organizational liability?

Not really. You won’t find reports in CIRS about events that the institution doesn’t already know about, so implementation of CIRS doesn’t expose new errors. Instead, it provides the additional advantage of learning from errors.

CIRS is a voluntary reporting system. Do you think there should be a mandatory reporting system for medical errors?

No. Any requirement to disclose errors or mandatory reporting of harm collides with the right against self-incrimination.

Is there any information about why patients file medical malpractice lawsuits in Germany?

According to the medical arbitration boards, patients file lawsuits because they “had a feeling” that something went wrong and they want to know what happened. There is a generational difference in how doctors respond to medical errors. Generally, older doctors never admit errors while younger doctors are more likely to communicate with the patient. One goal is to teach doctors to “bring patients into the game” to solve conflicts.

How do you feel about a layperson’s ability to decide medical malpractice cases?

No way. Laypeople cannot decide these cases. Without medical expertise, they would only be able to decide emotionally.