Gematik CEO: "Digital Healthcare Too Complex"

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The "enormous complexity" in the digital healthcare sector is a major obstacle, according to Florian Fuhrmann, one of the Gematik managing directors. In the early 1990s, Germany was among the first countries in Europe to have practice, hospital, and pharmacy management systems. "So we were right at the forefront of the digitalization transition of the desktop era, and during that time until today, we have built up an incredible legacy," Fuhrmann said at the Bitkom Digital Health Conference in Berlin on Tuesday. This cannot continue.

The large healthcare market – consisting of more than 100 practice management systems (PVS) from which doctors can choose – is "difficult to navigate" according to Gematik, "because everyone naturally has good arguments for their own system." The complexity is not only on the side of the primary systems but also within the telematics infrastructure. "And this sheer mass of systems naturally makes our work at Gematik more difficult, because the speed, the pace, is defined by the slowest one," Fuhrmann said. Therefore, Gematik's role as a certifying body is particularly important: "Since this year, we have also added conformity assessment as a new certification." From January at the latest, only certified systems will be approved for billing and use.

Genuine Interoperability as a Prerequisite

There was agreement that genuine interoperability is necessary for the next stage of digitalization – both on a syntactic and semantic level. "This must be guaranteed, and Gematik also plays an important role in this, through the Competence Center for Interoperability in Healthcare," Fuhrmann said. He expressed concerns regarding the sometimes unfair competition.

There was also concern that the existing oligopoly among practice management system (PVS) providers significantly restricts the freedom of choice for many doctors. Numerous practices feared the loss of important data when switching systems – a risk that effectively ties many to their current provider. In this context, a question was directed at Jan Wemmel from Compugroup Medical (CGM) – a company formerly known for its walled garden.. It was asked whether CGM intended to make its "dinosaur" fit for the future. Wemmel replied that CGM was by no means a dinosaur, pointing to its "highly modern" offerings in hospitals, pharmacies, and medical practices.

Addressing Florian Fuhrmann from Gematik, he said that competition is good. Different needs require different solutions. Regarding interoperability and data exchange, Wemmel emphasized that there are technical and security-related challenges in implementation.

"Fair Competition, No Protectionism"

Fuhrmann then emphasized that he is "absolutely in favor of competition, but I am in favor of healthy and sensible competition" that is not characterized by protectionism, but rather "by dynamics and innovations, as well as good price levels and also options for switching." He advocated for a healthy market, "which corresponds to the economic ideals of the nation, and it does not currently." This has become possible through a multitude of providers, "because there is a niche for everyone somewhere, where they can find an economic model," Fuhrmann explained. He would even find 1000 practice management systems acceptable – even if it were inefficient – but there must be "healthy competition." With conformity assessment, Gematik wants to improve this.

Bettina Goerner from the cloud-based practice management system provider "Eterno" praised the revised IT security directive of the National Association of Statutory Health Insurance Physicians. This is important for raising "awareness for penetration tests, business continuity, and all these buzzwords" from IT security experts. From her perspective, there is an urgent need for practices to catch up in terms of cybersecurity.

It must run "smoothly"

Volker Dentel from Kv.digital, a subsidiary of the National Association of Statutory Health Insurance Physicians, provided insights into reality. According to him, the exchange between clinics and doctor's offices is still difficult or non-existent. If something doesn't work with the telematics infrastructure, doctors, for example, switch back to fax. He also pointed to Austria, where the fax machine was banned in healthcare. However, as soon as the technology works, it is also accepted in practices. It just has to run "smoothly," said Dentel.

(mack)