Doctors’ day against Gematik as a state health agency
The Doctors’ Day votes against the decision of the Federal Ministry of Health (BMG) to completely nationalize Gematik, which is responsible for digitization. This would “thwart” the BMG’s digital strategy. She calls on the Federal Ministry of Health to continue to “let the payer and service provider organizations participate in the processes” as shareholders of Gematik. With a share of 51 percent, the BMG previously had the majority share in Gematik, “a complete nationalization” is therefore unnecessary and would completely exclude “the users of digital processes in the health care system”.
According to the delegates of the Doctors’ Day, the “implementation of the announced participatory digitization strategy geared to the well-being of patients […] fail without adequate participation and decision-making rights for the “German Medical Association”. In addition, the doctors voted for a strengthening of self-government, with politicians only providing framework specifications.
decision by consensus?
According to Federal Minister of Health Karl Lauterbach, the decision to make Gematik the national health agency was a mutual one. He said so in April during a meeting of the Digital Committee. But even at that point, various shareholders, such as the central association of social health insurance companies, were surprised by the decision. The National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) also felt it was unfair to continue having to take on a significant part – 93 percent – of the financing of Gematik.
Practical digitization required
Overall, doctors seem dissatisfied with the current lack of added value in the digitization of the healthcare system. Mere announcements would not suffice. Deadlines should also be set realistically. This is also evident from various resolutions of the Medical Association. Germany brings up the rear in Europe when it comes to digitization. “Despite several years of introductory phases, useful applications such as the emergency data record (NFD), the electronic patient file (ePA), electronic medication plans and the electronic prescription (e-prescription) are still far from being widely used by doctors”.
Usually they are not available or the applications are poorly implemented – “with completely inadequate usability” – or are actively slowed down “by hardly implementable interpretations of the European legal framework by national data protection authorities”. The manufacturers of the products should therefore be committed to better usability for the users. Likewise, software manufacturers are to be legally obliged to comply with IT standards so that processes in practice are reduced in bureaucracy and, for example, make double data entry obsolete. In hospital and practice management systems, the standards are to be implemented in such a way that, for example, processes are digitally automated and data within a system does not have to be re-entered and subsystems can use interfaces.
The electronic identity (eID) “as an alternative to the electronic health card” (eGK) should also help. However, the current implementation with “repeated requests for login information” via the electronic ID card or the eGK with PIN would reduce acceptance. Therefore, single sign-on options and biometric procedures for registration are important. After appropriate clarification, according to the delegates of the Doctors’ Day, insured persons should be able to decide “on their own responsibility and after individual consideration” about procedures with a lower level of data protection.
Strengthen the digital competence of the insured
The insured would also have to be informed about the digital applications by the health insurance companies – “who benefit from the enormous savings potential when using the TI”. A “broad public campaign” is required for this. Until now, a large part of the population knew nothing about the applications of the telematics infrastructure (TI) – the electronic certificate of incapacity for work (eAU), the e-prescription, the NFD, the electronic medication plan (eMP) and the ePA. It is also important that possible restrictions on vulnerable groups are given greater consideration when using digital applications.
Especially older and multimorbid people with cognitive disorders are overwhelmed with it. Doctors would not have time to help patients use it. In addition, not everyone would have smartphones, tablets or computers or be able to use them “to the extent required”. An increased “need for advice and support is already noticeable”. Even in the case of digitally affine patients, ePA information is “very time-consuming”. Therefore, “the main beneficiaries” should offer their insured information material and training.
Legally review the use of AI products
In addition, the board of the German Medical Association should also legally examine the use of artificial intelligence (AI) and write an opinion on it. The German Ethics Council had already issued a statement on this. Similar statements would have to be made for the safety of patients as for the approval of medical devices or pharmaceuticals. They are therefore calling for a legal regulation according to which the effectiveness of the various “AI products” must be proven. It must also be checked who is subsequently liable.
“We need answers to the question of how we can make digital applications and artificial intelligence in the sense of doctor-supporting applications really practical and safe for patient care,” said Klaus Reinhardt, President of the German Medical Association, at the opening of the German Doctors’ Day.
(mack)
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