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An electronic health card from the Techniker Krankenkasse is inserted into a reader

Photo: A9999 Techniker Krankenkasse / dpa

If you want to trigger an emotional heartburn in doctors, all you have to do is drop two letters: TI. The abbreviation stands for "telematics infrastructure" and according to a large part of the medical profession, this is the reason for all kinds of mischief and extra work. Behind this are things like the reading of the electronic health card or the electronic sick note – innovations that are supposed to make the lives of patients easier, but apparently make those of doctors more difficult.

In order to find out whether the lamentations about connectors, practice software and interface technology are justified or just talk to postpone digitization, the Central Institute for Statutory Health Insurance Physicians (Zi) together with the Physicians' Network Berlin has dealt with this in a comprehensive survey in Berlin. The Zi is an institution supported by the Associations of Statutory Health Insurance Physicians that conducts research on questions of outpatient care. The survey took place from the end of March to the beginning of July this year; 385 doctors, psychotherapists and practice employees were surveyed.

Regular problems with technology

The results show that there are significant problems with the digital connection, which often leads to additional work for the practice team.

44 percent reported that problems with the telematics infrastructure occur several times a month – with more than 24 percent even "very frequently". The most common problem is reading the electronic health card, followed by difficulties with classic TI applications such as issuing an electronic certificate of incapacity for work.

Almost 63 percent of the survey participants stated that the use of electronic sick leave made their work more difficult. On the other hand, more respondents perceive the electronic medication plan, in which information on prescribed medication is stored on the health card, as a relief. 32 percent of those surveyed stated that they had already written a doctor's letter electronically; just under eleven percent have used the electronic patient record for their patients. Psychotherapists were not even asked these questions.

Longer waiting times for appointments

The Zi attaches great importance to the fact that the medical profession is not against digitalization as such. However, the problems caused by the shaky telematics infrastructure are viewed critically, because ultimately there is less working time left for patients. Dominik von Stillfried, chairman of the institute's board, says: "Patients will see the technical problems very concretely, for example if the medical assistant at the reception desk is not visible because she crouches under the table to reboot the connector. On the other hand, because practices are losing urgently needed and desperately needed employees, for example because they are moving to hospitals." The practices would then have to reduce consultation hours, which would make waiting times for appointments longer and longer.

Von Stillfried also fears that more and more older doctors are closing their practices "because they simply don't want to be forced to implement a dysfunctional telematics infrastructure that paralyzes practice operations."

Only 2.3 percent of the health insurance practices surveyed still work almost completely analogue in paper form, 66 percent work completely or at least mostly digitally. This is hardly surprising, because the legislator has imposed a certain compulsion here: From January 1, 2024, prescriptions for patients with statutory health insurance may only be created digitally. The electronic certificate of incapacity for work is already mandatory for contract doctors. Private patients are exempt from this: they may continue to receive a prescription handwritten on paper, for example. Many private doctors see this as an immense relief to their everyday work.

Time spent, susceptibility to errors, privacy concerns, costs – there are many reasons why doctors and therapists do not use all TI applications. In order to be able to authenticate themselves in the system, statutory health insurance physicians must use an electronic health professional card.

According to the survey, psychotherapists in particular have so far been unable to do much with this plastic card. More than 65 percent of respondents said that although they had such an ID, they did not use it.