TI obligation for care: bureaucracy & waiting times slow down digitalization

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As of today, Tuesday, the legal obligation to connect all outpatient and inpatient care facilities to the telematics infrastructure (TI), which is intended for the secure exchange of health data, came into force. The aim is to enable digital communication between nursing care, doctors, pharmacies and other players in the healthcare system, thereby simplifying work processes, reducing bureaucracy and improving patient care. But there is still a long way to go.

“Members report that the connection to the TI was sometimes associated with considerable organizational effort – especially in connection with the application for the necessary components such as the electronic health professional card (eHBA) or the SMC-B card for care facilities,” explains Bertram Grabert-Naß, Deputy Managing Director of the German Professional Association for Nursing Professions (DBfK) Northwest heise online on request. Experience has shown “that the processing times for the trust service providers and the electronic health professions register (eGBR) have varied significantly, which has had a noticeable impact on planning and implementation,” says Grabert-Naß.

Little benefit so far

From the perspective of many care facilities, there has so far been “little concrete benefit in day-to-day care”. In principle, the KIM communication service, which has now been existing for five years, offers “great potential – for the secure exchange of information and documents”, but in practice the system is not yet widely usable, “as many potential communication partners in the healthcare sector are either not yet connected or are not yet actively using KIM despite the existing connection”, says Grabert-Naß.

A survey conducted by the Federal Association of Independent Welfare (BAGFW) among 1,460 facilities shows a clear discrepancy between desire and reality: according to the survey, almost 90 percent of facilities have applied for the SMC-B required for a TI connection, but only a small proportion are actually connected. According to the BAGFW, the main reasons for this are overloaded software companies, long waiting times for the electronic health professional card (eHBA), which is a prerequisite for applying for SMC-B. The bureaucratic procedures are also complex.

Software providers not yet ready

The capacities of the software companies are exhausted, and waiting times until the TI connection is installed are the rule. According to Grabert-Naß, “some industry software providers were not prepared for the TI connection at an early stage”. According to the BAGFW, there is often a lack of an informative contact person in support in the event of technical problems. There is also a lack of transparency when it comes to costs: the offers for the TI connection are difficult to understand for many facilities and are often higher than the amounts that can be refinanced. In the future, however, the costs should be covered by the TI flat rate, promised Prof. Dr. Dietmar Wolff from the Association for Information Technology in the Social Economy and Social Administration (Finsoz) at a Gematik information event.

In addition, according to the BAGFW, the entire process – from the application to the Postident procedure to invoicing – is confusing, involves a high administrative burden and ties up additional time and personnel, which puts further pressure on the already tight staffing ratio. Many facilities report waiting months to receive the necessary institutional cards.

Care calls for simplified access

The BAGFW is therefore calling for centralized, digital access to all TI components via an online portal with one-time registration (“once only”). The care associations emphasize that digitalization and the TI connection can offer real added value for care. However, more areas of application, simplified access and better support during implementation are urgently needed to maintain the high level of motivation among facilities.

According to Gematik, around 60 percent of care facilities have already applied for the necessary access cards. However, there is still room for improvement in the actual use of digital TI services such as KIM. Anyone who has already applied for an electronic healthcare professional card can apply for any number of SMC-B cards, institution cards for connecting facilities to the TI.

For now, there will be no legal pressure on either software providers or care providers. Brenya Adjei, Managing Director of Gematik, emphasized at the information event that the obligation comes from the legislator. Gematik provides care facilities with information, training and practical materials such as videos and checklists. In various Gematik recordings, 9 providers present which modules they and some of their partners have already implemented in the care software.

The possibility of giving nursing staff longer access to the electronic patient file to simplify processes is also being considered, as Lena Dimde, product manager for the ePA at Gematik, said when presenting the status quo. Apart from questions about the financing of the TI, deadlines and implementation, the security of the ePA was also asked about. Adjei stated that the security researchers' attack scenarios were merely theoretical. However, the ePA has had to be regularly improved to date, as security gaps have been pointed out time and again. In some cases, security flaws were not taken seriously in the past.

Care associations had already pointed out months ago that the goal of connecting all care facilities to the TI by the beginning of July was illusory. The association alliance Digitalization in Care had called for more reliability and a plan for the future due to previous postponed deadlines relating to state digitalization. Digitalization in the care sector also needs sustainable funding.

Need for improvements to the e-prescription

Bernd Meurer, President of the Federal Association of Private Social Service Providers (Bpa), told Ärztenachrichtendienst that a “fully integrated e-prescription solution for all care-related medicines and aids”, an easy-to-use electronic patient file (ePA) with nursing writing rights and digital billing procedures are still needed. This has been demanded for years, but is set to change soon. “More efficient processes through the digital exchange of documents, prescriptions, and orders” are important. Until now, practices have had to pass on e-prescriptions “usually in printed form” so that they “somehow reach the home, where they are then taken to the pharmacy.” Communication between doctors and nursing staff via the KIM service, for example when exchanging information about patients, could make many things easier.

(mack)