Connection to the healthcare network and co.: What doctors have to deal with

The telematics infrastructure (TI) is intended to securely network practices, pharmacies and clinics, simplify administrative processes and make treatments more efficient. In practice, however, it is clear that there is often a significant gap between aspirations and everyday life. In September alone, there were numerous disruptions that hindered doctors' work.

In the coming weeks, doctors and pharmacists will face another major technical challenge, namely the changeover of cryptographic procedures in the telematics infrastructure from RSA to ECC (Elliptic Curve Cryptography). According to Gematik, the reason for this is “European legal requirements,” which demand that components of the TI—including connectors, health professional cards (eHBA), institution cards (SMC-B), as well as primary systems and KIM client modules—must support the new procedure.

As the time remaining until the changeover is short and numerous cards and connectors still need to be replaced, Gematik and IT service providers are already warning of possible supply bottlenecks and longer processing times. Doctors should therefore contact their IT providers at an early stage to check whether the changeover affects their practice hardware. New eHBAs should ideally be available by 1 December 2025 at the latest to guarantee smooth operation. SMC-Bs and device-specific security module cards (gSMC-KT cards) can still be used for the for now

poke to a doctor in private practice, Dr. Marius Martin, who has been using the TI for years, and to his brother, computer scientist Marcus Dromowicz, who supports him with IT in his practice. In the interview, the two report on the digital processes that are now working well—and where technical hurdles, high costs, and organizational friction losses are still slowing down practice operations.

What are the advantages of the TI?

Marius Martin: The e-prescription – after it worked smoothly – was already a relief, as prescriptions could be issued without patients having to come to the practice in person – This was a great advantage, especially in times of the coronavirus pandemic.

What difficulties have you encountered over time?

Martin: Initially, the biggest problem was that the entire TI was extremely slow. In some cases, it couldn't be operated at all. An additional module for document organization was particularly affected. For example, uploading images no longer responded at all. For a long time, we didn't know whether this was due to the PC, the server, incorrect settings or actually the TI.

Marcus Dromowicz: In 2021, we replaced the server as part of a practice takeover when a colleague left. We invested around 8,000 euros in new hardware and also brought in an external IT service provider. Unfortunately, it turned out that things didn't really improve with the new hardware. The system remained relatively slow.

And how did the connector replacement go?

CGM wanted to replace it because the certificates were expiring. It was going to cost 2800 euros. As we were already dissatisfied, we opted for the “connector in the cloud” alternative. Initially, there were problems because providers were passing the buck to each other. Things are now more stable—also thanks to the switch to a more powerful server.

Have you already converted the TI components in your practice to the new encryption (ECC)?

Our main card is already compatible, and we are hoping to do the same with a second card. We have also ordered new electronic health professional cards (eHBA). Only the gSMC-KT cards in the treatment rooms will expire next year and need to be replaced. I hope that we will be able to carry out the replacement ourselves without causing weeks of disruption again.

Were there any difficulties when replacing the cards?

Dromowicz: Yes, with the SMC-B card (security module card type B). It was registered to the colleague who had left – with his e-mail and even private address, even though we had entered verifiably correct data. As a result, all the activation emails ended up with him. Bundesdruckerei or D-Trust then said that the master data in the database was final and could not be changed. We were only offered on-site activation, which was absurd. We have since canceled the faulty card – despite reminders having already been sent. But these are not the only problems.

Martin: The PVS system also responded very slowly and crashed regularly. Unfortunately, the responsible IT service provider didn't really feel responsible, so we ultimately decided to hire an external third-party company to provide telematics support. The support is much more reliable with them.

E-prescriptions and electronic certificates of incapacity for work could often not be sent. As a result, we had to add numerous examinations in the evening, and patients only received handwritten prescriptions meanwhile. The additional workload was enormous.

With the mobile card readers, for example, not even the switch-on button works reliably. To start the device, you often have to remove the cover on the back and reinsert the eHBA card. In addition, battery consumption has been high – If you leave them in the device, they are actually discharged within two days.

Which ones are still available?

Martin: It was particularly annoying that one of Ingenico's mobile card readers stopped working after an upgrade was installed. To work with new practice ID cards and electronic health professional ID cards, these mobile devices need to be updated. One of our card readers gave a signature error during the flash upgrade and aborted the update. Although it tries to restart the update process after switching on and still recognizes our admin PIN, the same error occurs every time.

Dromowicz: We've just encountered the next problem. A web application from another provider is not working currently, but we need it for the gSMC-KT card exchange. The new cards have to be linked to the readers via this. Time is also gradually running out. There too, responsibility for the issue is being shifted back and forth between the providers since the summer holidays.

Do they crash less frequently now?

Dromowicz: Scanning the insurance cards sometimes took 10 to 20 seconds. It doesn't sound like much, but it adds up enormously for every patient. It also often happened that card readers failed completely. Then all we could do was unplug the device and plug it in again, which always took time. The “Orga Protect” attachments didn't help much either. These difficulties exist everywhere. Many practices struggle with similar problems—long runtimes, incompatibilities, overpriced hardware, or a lack of support. So we are by no means an isolated case.

Is the TI flat rate actually enough to cover all these costs?

Martin: The KV flat rates are generally calculated in such a way that they cover the pure acquisition costs. However, what is not considered is the considerable effort required for installation and maintenance. The technicians usually need considerably more time than planned, and these additional costs are neither reimbursed nor covered.

(mack)