The National Association of Statutory Health Insurance Physicians (KBV) considers it “wishful thinking” on the part of the Federal Ministry of Health (BMG) to want to establish the e-prescription as the standard by 2025. That’s what KBV board member Thomas Kriedel said at the association’s meeting of representatives. Thanks to the BMG’s “well-sounding triad” of participation, care orientation and user perspective, the panel doctors felt they were heard and let them “cautiously hope”. He also demanded that alternatives to connector replacement should not wait until September 2023 to be examined.
For the success of the health network – the telematics infrastructure (TI) – Gematik, which is responsible for the digitization of the health system, needs a “clear mandate and additional competencies”. So they should take responsibility for the TI – the apps, on the other hand, should be developed by the industry because it can do it better. Kriedel thinks it is “little effective” that the e-prescription app may only be implemented by Gematik. There should also have been other options much earlier to redeem the e-prescription via e-mail, SMS and the electronic health card.
Cumbersome registration in the e-prescription app
Access to the e-prescription app is currently difficult for many people, since in addition to an NFC-enabled smartphone with at least Android 7 or iOS14, an electronic health card 2.1 including a PIN is required – the latter only being issued by the health insurance companies after an identification procedure in the health insurance branch is sent. According to Kriedel, less than one percent of the insured have this PIN. “Anyone who wants to establish the e-prescription among people must make access as easy as possible for them,” he emphasized.
The second test region, the Schleswig-Holstein Association of Statutory Health Insurance Physicians (KVSH), ended active participation in the test phase at the end of August. The reason given by the KVSH was, among other things, that the data protection officers of the state of Schleswig-Holstein did not allow “sending the dataless QR code of the e-prescription to patients or pharmacies by e-mail or SMS method”. According to Gematik, these were never intended as “secure ways of redeeming the e-prescription”. However, until then, most e-prescriptions in Schleswig-Holstein had been sent using this method, which was requested by doctors and implemented by a practice management system manufacturer popular in the local region.
The Association of Statutory Health Insurance Physicians of Westphalia-Lippe (KVWL) took Schleswig-Holstein’s “withdrawal” as an opportunity to link its further participation in the test phase to a function with which the e-prescription can also be redeemed via the health card. The KVWL has requested a deadline of the end of November for the implementation of this function. At the same time, Gematik is currently working on an interim solution, according to which the QR code-like 2D code for the e-prescription can be forwarded to the pharmacies without registering in the app.
No more bureaucracy due to digitization
At present, the issuing of e-prescriptions and electronic certificates of incapacity for work (eAU) is still associated with increased paper consumption and time expenditure by practices. This can even be proven with the bureaucracy cost index (BIX). According to the KBV, the eAU alone causes additional time expenditure of more than one million working hours a year in the practices. “We Germans have always had the reputation of being world champions when it comes to bureaucracy. We can easily defend this title if we even increase paper consumption as digitization progresses […] So instead of relieving the practices, the previous digitization policy has demonstrably continued to burden the practices,” said Kriedel. – an independent advisory body to the federal government – to ensure that the bureaucratic effort does not increase when digitizing various projects.
Check connector replacement alternatives earlier
Kriedel demands from the Federal Ministry of Health (BMG) for the connector exchange that they should act quickly. Politicians must provide offers and “establish a balance with the demand side”. Gematik cannot wait until a year to make statements about possible alternatives to replacing connectors. “We want to give the practices the security that they can alternatively connect to connector farms. However, this requires certification of this variant.” These as well as questions about data protection and data security still have to be clarified by Gematik. Although the connection costs less than a new connector, according to Kriedel, there are “rental costs and expenses for a particularly secure VPN connection including a firewall”. That is why a financing agreement is needed for the costs that, according to the central association of health insurance companies, the practices should bear.
In the meantime, Gematik has also included offers for connector hosting – where a connector can be used by several parties in a data center – after a provider had asked for “clarification” in its FAQ on connector exchange. Previously, Gematik had only announced these offers for 2023, although this option has been in use for four years.
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