Why the digitalization of the Public Health Service is hardly progressing
More could have been achieved with the millions for the digitalization of the Public Health Service. An experience report.
(Image: Moobin/Shutterstock.com)
The digitalization pact for the Public Health Service (Ă–GD) is expiring soon. So one can ask: What has happened for the Ă–GD during this time (and with this money)? As an IT specialist in the Ă–GD, I accompanied the pact for several years. During this time, I encountered several points that are symbolic of the stalled administrative digitalization in Germany.
First: What does the Ă–GD do?
What the ÖGD does varies by federal state, but here are some examples: school entry examinations, health certificates for food handling jobs, examinations for civil servant candidates, drinking and bathing water monitoring, storage of death certificates – and it plays a central role in the event of a pandemic. Health authorities organize contact tracing and quarantine orders. In the pandemic, this only worked to a limited extent: processes remained unchanged, capacities were lacking, so staff was increased, partly with support from the Bundeswehr.
In parallel, private sector solutions such as the Luca app emerged. Things moved on – but not structurally better. The digitalization pact was intended to make the authorities more resilient: more digital, more efficient, more sovereign. Ambitious and necessary goals. But the state of administrative digitalization is well known.
Videos by heise
Municipalities tend to rely on private providers
As part of the Online Access Act (Onlinezugangsgesetz), administrative services are to be made digitally available, such as the infection protection briefing. For this, an EfA service ("One for All") theoretically exists, developed in Lower Saxony. Goal: uniform, reusable solutions. A service description is publicly available. In practice, however, many municipalities rely on private providers such as the Technologiezentrum Glehn, which, according to its own statement, has a significant market share. The briefing is handled entirely there, with a cost of usually around ten euros per process. In some federal states, this represents a considerable portion of the fee.
Identification is done via video-ident-like procedures or AI-based image recognition – i.e., biometrics-based – depending on the provider. The nationwide BundID is intended as an authentication solution but is not consistently used. The Lower Saxony EfA solution was initially procured but later discontinued without much announcement. Municipalities could not continue to operate it independently, as only bodies designated by the state are allowed to apply for EfA services. Since the briefing is subject to the OZG, many places were left with no choice but to go through private providers.
The causes are complex federal structures, bureaucratic procedures, a lack of IT specialists, and changing political priorities. Result: A public, uniform solution exists – but it is not catching on. Procurement channels are confusing, and decisions at the state level can exclude all municipalities. This does not lead to sustainable digital sovereignty.
Efforts towards standardization existed
At the state level, there were efforts to standardize specialized applications, for example through Ă–G-Digital and later GA-Lotse. While Ă–G-Digital was not very convincing, GA-Lotse appeared promising as an open, modern, and technically well-thought-out solution.
In a statewide exchange on preferences, the discussion was heavily moderated from my perspective. Pro and con lists painted a distorted picture. In the end, everything remained the same: the authorities continued to use their existing systems. Furthermore, there was the timing: the initiative effectively only started in the last funding year. Previously, existing systems had been expanded with funding. An immediate switch would have devalued these investments – difficult to justify internally and to taxpayers.
Our office uses OctoWareTN. I was open to GA-Lotse, also for reasons of digital sovereignty. However, the advantages of open solutions were hardly communicated. Instead, the interest in standardized data delivery was often the focus. The authorities would have managed the conversion work without clear added value.
Regardless of the system, a fundamental problem becomes apparent: specialized applications are typically used only as databases, like a complex Excel spreadsheet. Functions such as automated document creation remain unused or unknown. Process changes meet resistance, and a document management system is considered an imposition. Often, time and know-how are lacking, so systems stagnate and serve as a "digital paper file."
Specialized IT professionals are scarce
Structured project management was historically not necessary in many authorities. Smaller IT projects could be improvised. With six-figure funding, this is no longer possible. There is a lack of long-term planning, clear milestones, and success measurement. Priorities change according to urgency, and in the end, everything has priority.
The project managers usually have other tasks, and specialized IT professionals are scarce. New IT positions – for example, according to E9c – often remain unfilled. The support for specialized applications falls to people who "just know computers." Time and expertise for real further development are lacking.
In short: there is a lack of personnel and know-how to effectively implement projects of this magnitude. Additional coordination levels increase inertia.
Legal Basis
Administrative action requires legal foundations, usually at the state level. This leads to a patchwork. For death certificates, for example, the master data is first recorded in the registry office and then again in the health authority – including error-prone transfers. Technically, a digital interface would be possible. In some federal states, the legal basis for this exists, in others it does not. Meaningful work simplifications thus fail due to a lack of legal basis. Changes are not foreseeable.
Project success is measured using a maturity model, with criteria such as citizen-centricity, interoperability, and IT security. There are several levels, and minimum targets have been defined. The authorities regularly report their status. Since repayment is threatened if minimum targets are not met, there is an incentive for benevolent interpretation. Clear, uniform criteria are lacking, and interpretations differ. Not every authority is examined in depth. This significantly weakens the metric's validity.
Conclusion
After several years of the digitalization pact, the impression remains: in many places, the processes are as they were before – just with better hardware. The digitalization initiative is simply not feasible with the current structures in the Public Health Service. There are many problem areas where the ÖGD cannot act independently, and their origins lie at the federal administrative level. Too much manpower is being invested in many different structures without real results.
And that is tragic: the Corona pandemic is still remembered, but as soon as more years pass, the Public Health Service will also be forgotten again. The best time for extensive reforms and modernizations would have been now, because the next pandemic will come at some point. It would be nice to be prepared for it. Instead, there will apparently be solutions like the Luca app again. Ah, how nice it was back then with the Luca app.
(kbe)
