Discharge Letter Automation
A possible setup for automated discharge letter creation: HIS integration, AI-assisted draft, mandatory physician approval, and dispatch via the German telematics infrastructure (KIM). Target: roughly 5 instead of 30–45 minutes per letter.
- Time Saved
- -89%
- Industry
- Healthcare
- Implementation
- 10–12 weeks
At a glance
- It starts with
- Discharge Triggered
- The machine handles
- 13 of 15 steps
- A person keeps
- Doctor Review · QES Signature
- Bottom line
- -89%Time Saved
The problem
Real talk: nobody likes dictating discharge letters. You spend the day seeing patients, evening rolls in, the stack is still untouched, and the medical review board is asking again.
Twenty minutes per letter on average. A clinic with thirty discharges a day means ten hours of dictation time — every day, spread across doctors who should be seeing patients instead.
The uncomfortable part: letters go out two weeks late, referring colleagues call, the patient waits for rehab — all because there's no pipeline between dictation and dispatch.
Here's the pipeline.
Discharge letters are critical for continuity of care, but the manual process is extremely time-consuming: 30–45 minutes per letter, copy-paste between 5–7 systems (HIS, LIS, RIS, pharmacy, OR documentation). With 100+ discharges daily, that's 50–75 physician hours per day. A significant share of letters miss the typical 24-hour deadline for dispatch to the general practitioner. Quality issues from missing information and inconsistent wording endanger patient safety.
How the process runs — step by step
Scroll through. The diagram stays put and highlights the step you are on.
- 01
Discharge Triggered
HIS Trigger
A discharge is documented in the HIS and automatically triggers the letter creation process.
- 02
Data Collection
FHIR/HL7
The system collects all relevant patient data from the HIS via FHIR R4 and HL7 v2 interfaces.
- 03
Parallel
Data collection is split into parallel paths for optimal processing speed.
- 04
Diagnoses
ICD-10-GM
Diagnoses are extracted with ICD-10-GM codes from the system and prepared for the letter.
- 05
Medication
ATC Codes
Medication data with ATC codes is compiled from the patient's home medication and inpatient prescriptions.
- 06
Join
All data collected in parallel is merged into a complete dataset.
- 07
AI Structuring
LLM (local or EU cloud)
The AI structures all data according to department-specific templates and generates medically accurate wording.
- 08
Draft Generated
Template-based
A complete letter draft is generated, including all relevant sections and recommendations.
- 09Human decides
Doctor Review
2-3 Min
The responsible physician reviews the draft and makes adjustments if needed – typically in 2-3 minutes.
- 10Branch
Approved?
Gateway: Was the letter approved by the physician or are corrections required?
- 11
Corrections
Adjustments
If changes are requested, corrections are incorporated and the letter is resubmitted for review.
- 12Human decides
QES Signature
D-Trust
The approved letter is signed with a qualified electronic signature (QES) via D-Trust, making it legally valid.
- 13
KIM Dispatch
To GP
The signed letter is automatically sent via KIM (gematik) E2E encrypted to the general practitioner.
- 14
Archiving
Patient Record
The letter is archived in the electronic patient record and stored for future reference.
- 15
Complete
Letter Delivered
The process is complete. The GP has received the signed letter, delivery is confirmed.
Our Solution
Automated data aggregation from all relevant systems via FHIR R4 and HL7 v2 (SAP IS-H, Orbis, iMedOne, Medico). AI-assisted draft using department-specific templates – either with locally hosted open-source models (Llama, Mistral) or via DPA-compliant EU endpoints of commercial LLMs. The physician reviews and approves in roughly 2–3 instead of 30–45 minutes. The signed letter is then dispatched to the general practitioner via the telematics infrastructure (KIM) with end-to-end encryption and delivery confirmation, after a qualified electronic signature (QES, eIDAS-compliant) via D-Trust. Physician approval is always required – the AI does not replace clinical judgment.
- Deep HIS Integration
- FHIR R4/HL7 v2 connection to all common German HIS: SAP IS-H, Orbis, iMedOne, Medico. Automatic aggregation of ICD-10-GM, OPS, medication, and lab data.
- AI-Assisted Letter Draft
- Modern LLMs (locally hosted open-source models such as Llama/Mistral, or commercial models such as Claude or GPT) with department-specific templates. Consistent structure and clinically appropriate wording – final approval is always done by the responsible physician.
- QES-Compliant Signature
- D-Trust integration for qualified electronic signatures. Legally valid under eIDAS, fully integrated into the workflow.
- Automatic KIM Dispatch
- Direct dispatch via gematik KIM to the general practitioner. E2E encrypted, with delivery confirmation, fully automatic address resolution.
What comes out of it
Possible setup, not a packaged product
The figures shown are target values and expected magnitudes for a possible setup – based on industry benchmarks, public studies of comparable setups, and our own tests on a real stack. They are not measured outcomes from a specific customer project; actual results depend on company size, process maturity, and integration depth. We do not offer this setup as a packaged product. We help teams design, automate, and run such processes themselves – through architecture consulting, workshops, and implementation support with n8n. For regulated third-party systems with certification or license requirements (e.g. HIS, gematik, DATEV-certified), we partner with specialized providers.
- ~5 Min
- Time per Letter (target)
- ~-89%
- Time Saved (target)
- 150+
- Letters/Day (with approval)
- ≥ 95%
- On-time Rate (target)
Expected magnitude: roughly 89% less time per letter, materially improved on-time rate, 150+ letters per day with physician approval
Before vs. After
| Aspekt | Before | After |
|---|---|---|
| Time per Letter | 30–45 minutes | ~5 minutes (with physician approval) |
| Data Sources | Manual copy-paste from 5–7 systems | Automatic aggregation via FHIR/HL7 |
| 24h On-Time Rate | Often below 70% | Target ≥ 95% |
| Signature | Handwritten or without qualified signature | QES (legally valid under eIDAS) |
| Dispatch to GP | Fax, mail, or unencrypted email | KIM (E2E encrypted, with delivery confirmation) |
Technical facts
Technology Stack
Integrations
Seamless connection to your existing infrastructure
SAP IS-H
HISComplete integration via SAP interfaces for patient data, diagnoses, and medication
Orbis (Dedalus)
HISNative FHIR R4 connection for real-time data retrieval
D-Trust
SignatureQualified electronic signature for legally valid documents
KIM (gematik)
CommunicationSecure dispatch via telematics infrastructure to general practitioners
Security & Compliance
Enterprise-ready with highest security standards
GDPR Compliant
Full compliance with EU General Data Protection Regulation. Data processing in Germany.
ISO 27001
Data processing in ISO 27001 certified data centers.
KIM Encryption
End-to-end encryption via gematik's telematics infrastructure.
On-Premise Option
Optional operation in your own infrastructure without external data transfer.
Frequently Asked Questions
Does this look like your setup?
If this workflow resembles yours, we will look at it together — and tell you honestly whether automating it pays off.
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