JMIR Publications

ABSTRACT

Background:

Mandatory notifications of infectious diseases in Germany were paper-based until the implementation of DEMIS (Deutsches Elektronisches Melde- und Informationssystem für den Infektionschutz) – the German Electronic Reporting and Information system in 2020. DEMIS provides the technical infrastructure for electronic reporting of infectious diseases to public health authorities with the goal of improving timeliness and data quality while reducing bureaucratic burden.

Objective:

DEMIS provides FHIR based interfaces for mandatory notification systems that can be accessed by multiple authentication methods for different user groups, such as laboratories, hospitals and public health authorities. In this paper, we will describe DEMIS in terms of its objectives, implementation – from conceptualization to deployment – and the associated challenges.

Methods:

Starting in 2012, initial concepts for DEMIS were developed collaboratively by the Robert Koch Institute, Fraunhofer FOKUS, and the German Federal Ministry of Health. In 2017, it was mandated by the German Infection Protection Act and with support of the gematik – the National Digital Health Agency - implementation accelerated during the COVID-19 pandemic in 2020. DEMIS provides access either directly via a FHIR-based API or through a web portal. API access authorization is primarily verified by a certificate-based method. Web portal authorization mainly uses personal or legal entity accounts of a central identification system provided by the German federal government. DEMIS defines a range of FHIR resource profile packages - from basic information for patients and notifiers to specific diagnostics, clinical data, and epidemiological questionnaires. The use of FHIR interfaces, as well as LOINC- and SNOMED CT-terminologies, enables interoperability with other surveillance systems at both national and international levels

Results:

The first surveillance module was deployed for SARS-CoV-2 notification during the COVID-19 pandemic in 2020. Since 2022 there were 697 laboratories, 1,670 hospitals and 870 other institutions such as private test centres, pharmacies and general practitioners, in Germany that have accessed DEMIS via the direct API. DEMIS has handled roughly 50 million pathogen notifications and 500,000 disease notifications to date, routable to all 376 local public health authorities. For notifiable pathogens, data quality has been routinely reported back to the laboratories. User feedbacks collected through multiple channels have facilitated the improvement of data quality during implementation. Through DEMIS-FHIR implementation challenges in mapping codes between sender and recipient software as well as achieving semantic interoperability between different surveillance systems were observed.

Conclusions:

DEMIS plays a key role in digitizing healthcare. It enables secure data exchange, accelerate data processing, and reduces manual workload as well error rate in public health authorities. Operations have functioned reliably since rollout. Ongoing routine data quality assessment - such as evaluating data completeness and validity – could further enhance DEMIS performance. As DEMIS expands to other surveillance systems, continued discussion on semantic interoperability is necessary.