The Introduction of the Electronic Health Insurance Card

Dr. med. Franz-Joseph Bartmann, Chairman of the Telematics Committee of the German Medical Association, comments in the following interview on the status quo of the electronic health insurance card. Only recently, State Secretary of Federal Ministry of Health, Klaus Theo Schroeder, Made waves with his statement to introduce the card without so called 100,000 tests. This met vehement criticism from the medical fraternity. At MEDICA 2007 the electronic health insurance card makes up an important part of the Special Show MEDICA MEDIA.

In your state Schleswig-Holstein one of nationwide seven pilot projects concerning the electronic health insurance card takes place. How is the actual state of affairs?
Dr. med. Franz-Joseph Bartmann
: Right now, there are no tests of the original functions of the electronic health insurance card (eGK) taking place at all. In Schleswig-Holstein and elsewhere, a kind of pretests is in progress instead. Latter are supposed to prove that the new card is able to take over the functions of the old one. In the end of August, the Federal Ministry of Health already announced that the electronic health insurance card will be released to the insurants in this form.

Do you agree?
Dr. med. Bartmann
: The presently tested eGK is in fact able to take over the basic functions without additional inspection. However, a card in this form would be no alteration compared to the old one except the picture of the insurant. These cards have been tested only offline so far. Further functions would be not included.

Wouldn´t it be relatively unsatisfying to only distribute the first version of the card and then later on distribute another one with in fact more functions available?
Dr. med. Bartmann
: Of course, the innovators of this card take thusly the risk that in subsequent functional checks the malfunction of the eGK becomes apparent and new cards have to be handed out.

Do you think that the legislator actually takes this chance?
Dr. med. Bartmann
: Yes. Several years will still pass till the additional functions can be really implemented. The legislator, however, has put itself on the spot and does not want to wait that long. Thusly, a card will be handed out next year which features more functions than the old card but whose functions cannot be used to the time of release since they have not been tested yet. For this purpose the 100,000 tests are essential.

Severe demands among doctors just recently led as far as to the exit of the medical fraternity. How do you assess this circumstance against the background of the latest development?
Dr. med. Bartmann
: Decisive for me is the resolution of the previous German Medical Assembly. Not the exit of gematik, the operating company of eGK, was put down but the call of the medical fraternity for a new concept of the card.

But a new concept is not in sight…
Dr. med. Bartmann
: I would not say it like that. From my point-of-view the storage on a central server is not an issue in the foreseeable future at least. Today, already more than a dozen of electronic patient records exist in Germany. Strange to say, doctors seem to have fewer reservations regarding industrial offers like the one from Barmer Ersatzkasse than with projects concerning self-administration.

At least partially, the apprehension can be qualified whereby practical sequences might be interfered with a card which is not working yet. The comfort signature is on the brink of its accreditation and contains – compared to previous handwritten signatures – no time disadvantages anymore. In this respect the practical sequences will thusly presumably not be interfered anymore.

Participation in an electronic safeguarding of the pharmacotherapy might be the medical benefit. This part, however, remains controversial. Beyond controversy is the benefit of a secured point-to-point communication with the aid of the new telematics infrastructure. The general benefit of the electronic patient records is incontrovertibly as well but as already mentioned largely dependent on the definite conception and realization.

It was also eventually feared that due to the introduction of eGK doctors might be prompted to expenses which do not comply with the appropriate benefit. The corresponding negotiations have not been conducted yet but I assume that basic equipment – namely the necessary readers – will be provided like the previous card release in 1995. The exposure to subsequent acquisitions which will perhaps need to be done due to additional options already have to take place in advance.

You look upon the project eGK pretty favorably then…
Dr. med. Bartmann
: Yes and no. eGK has large potential, both in positive as well as negative respects. The most important point for us as medical fraternity is the following: Nobody can be forced to participate when online systems are introduced. Voluntariness of patients has been pointed out so far. We are demanding the same for doctors, too. Commitment has to be a consequence of an act from conviction that online systems are useful to the operator and its patients. In general use it should be clear that a date abuse will not occur in the foreseeable future. The voluntariness will also be a central claim at the coming German Medical Assembly in Ulm. There are currently many doctors who are afraid in this regard. You will not win them over under duress. Far from it. Coercion will lead to solidarity among previously indecisive colleagues. From our point-of-view, voluntariness of the participation in online systems is a must.

The electronic ID for healthcare professions (Hba) meets much less resistance…
Dr. med. Bartmann
: The electronic ID for health professions shall amongst others increase the safety of the communication among colleagues. Doctors have obviously no objections against that. There exist, however, problems from the industrial side. The Hba without immediate connection to eGK apparently features no attractive business model for the industry. If it would be clear that a highly demanded safe tele-communication is also without a functioning eGK only possible with the aid of the electronic ID for healthcare professionals, this could change quickly. First signals in this direction are noticeable. The eGK itself will be not a self-runner till it has not only supplied evidence of efficiency in principle but also removed doubts of potential users in practice.