Digitalization: Why nursing demands more say

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Nursing has finally “arrived” politically, says Thomas Meißner from the German Nursing Council in an interview with heise online. However, there are still massive deficits in digitalization, self-governance, and financing. Meißner, a trained nursing professional and for years one of the most prominent voices on digitalization in nursing, therefore calls for a dedicated nursing informatics initiative, reliable investments, and more say for the profession.

He is particularly critical of current political considerations to limit nursing services and the slow implementation of digital infrastructure. He also warns against making professional decisions increasingly based on financial situation.

“Nursing has finally become visible”

We spoke about a year ago, at that time mainly about the Nursing Competence Act and the digitalization plans for nursing. A lot has happened since then. What is your interim assessment?

Overall, one must draw a positive balance for nursing. Nursing is gaining more public attention and political awareness. Many demands that we have made over the years are now being met, at least step by step. Of course, there is still much room for improvement, but it must be said clearly: Nursing has arrived politically.

The German Nursing Council is also taken seriously now and legally recognized as a key organization. Behind it is the expertise of many member associations and thus very broad specialist knowledge from practice, science, and training. That is progress.

“We have many digital highways”

At the same time, one still hears a lot of frustration from the field about digitalization.

Digitalization is fundamentally well-intentioned. We are much further along than five years ago. But we still have too many isolated solutions. The connection between systems does not work properly.

I like to describe it with an image: We have built many digital highways, many bridges to them – but everyone drives their car around the edge somewhere and doesn't get onto the highway at all. That is precisely the problem of missing interoperability.

But that doesn't just affect nursing.

No, of course not. However in nursing, the consequences are felt particularly strongly. The telematics infrastructure is technically there, many facilities now have KIM addresses. Only: If nobody uses them, it's of little use.

If a nursing service wants to communicate digitally with a doctor's practice and the practice says: “We don't do that,” then it fails. Or a hospital wants to exchange data digitally and the outpatient service says: “Too complicated.” In addition, there are outdated connectors, long processing times for financing, or technical problems. The result is: An actually good idea is not consistently used in practice.

Where do you see the biggest structural problems?

We still have no nursing informatics initiative. I consider that a big mistake. We need standardized norms for nursing data, for documentation, data exchange, and evaluation. Artificial intelligence will also only be as good as the data basis behind it. Bad data leads to bad AI.

Nursing has its own very specific requirements. Cybersecurity in a hospital is different from that in a small outpatient service or a stationary long-term care facility. These specifics are currently considered too little.

Doctors had their own IT initiatives early on. We need exactly the same thing in nursing.

You also looked at the current draft bill for the Digital Health Act (GeDIG). What is missing from a nursing perspective?

Much in the GeDIG is still strongly conceived from the logic of medical care. From my perspective, nursing-specific requirements are still too little considered. For example, we finally need a nursing informatics initiative, i.e., clear standards for how nursing data is collected, structured, and exchanged between systems.

Especially in nursing, we have very different working realities than in a doctor's practice or a hospital. An outpatient nursing service works mobile, often under time pressure and with very different technical prerequisites. This must also be reflected in the legal framework.

Furthermore, the GeDIG lacks binding statements on financing from our perspective. Digitalization is not just about a one-time purchase. Facilities need ongoing funds for maintenance, software, cybersecurity, and training. If digitalization is truly desired politically, then these investments must also be secured.

“Fax machines are still part of everyday life”

Despite all the digitalization laws, reality typically still seems very analog?

Absolutely. I was just at a digitalization panel at the nursing congress “Because we care” in Augsburg. When asked in a panel who still uses fax machines, three-quarters of those present raised their hands.

Politically, the impression is typically created that fax is long gone. The reality is different.

We constantly experience media breaks: data is recorded digitally, then printed, signed, and sent again by fax. That is not real digitalization. That is just an analog process on a screen.

The electronic health professional card (eHBA) continues to be a topic of discussion not only among doctors and pharmacists but also in nursing. How do you assess the current situation?

The eHBA is fundamentally important and necessary. If nursing professionals are to sign e-prescriptions or digital orders independently in the future, then of course a secure digital identity is also needed. The electronic health professional card is the basis for this.

But the reality is still complicated. The issuance of health professional cards and institutional cards is not yet widespread in many places. Many facilities report long processing times, complicated application procedures, and high costs. In some cases, reimbursement takes several months while the technology has already been further developed.

Digitalization must not fail due to bureaucracy. If people wait weeks or months for cards, authorizations, or reimbursements, it creates frustration instead of acceptance. The eHBA must not become an additional obstacle, but must actually make everyday work easier.

Would a mandatory use of services like KIM (Communication in the Medical Field) be sensible from your point of view?

I am fundamentally not a fan of simply obligating people to do something. I want to convince. Digitalization must work in practice and be tangible – otherwise, you lose people.

Once nursing staff use good digital documentation, most of them no longer want to work with a pen. But as long as everything has to be printed out in the end, you lose acceptance.

Many facilities complain about high costs and lack of funding.

The problem is real. Digitalization costs money – not just once for hardware and software, but permanently for maintenance, updates, cybersecurity, and support.

That's why we need secure financing models. Investment costs must be refinanced, as well as ongoing operating expenses.

And I say this very clearly: One should no longer discuss the necessity of digitalization. If we want to remain competitive internationally as a healthcare system, we must invest.

It's similar to infrastructure or defense policy: One can discuss how to invest – but no longer whether to invest.

“Politics interferes in professional decisions”

Do you view the current considerations regarding nursing insurance critically?

Yes, because in my opinion a line is being crossed here. There are considerations to change the criteria for nursing care levels so that fewer people receive benefits or upward reclassifications become more difficult. This is direct political interference in professional assessments.

Imagine if doctors were told not to make certain diagnoses anymore because the therapies are too expensive. There would be an outcry across the country. In nursing, such things appear to be more readily accepted. I consider that wrong.

What would be the concrete consequences?

Of course, there would be restrictions for insured people. But for me, it's primarily about the fundamental question: Is need for care assessed professionally or based on financial situation? If financial considerations determine the professional assessment, then we have a problem.

Why hasn't nursing managed to build up political pressure as strongly as, for example, medical associations?

Because the structures are wholly different. Doctors have had strong chambers, full-time staff, and large administrative apparatuses for decades.

In nursing, an extreme amount is done on a voluntary basis. Many are involved alongside their actual work. The people involved achieve amazing things under these conditions – but of course, it is more difficult to organize sustained political pressure under such circumstances.

Nevertheless, nursing has achieved an enormous amount recently. Twenty years ago, many of these discussions would have been unthinkable.

Still sounds like a long way to go.

Of course. Other professions had a hundred years for that. Nursing is now catching up on many developments in a few decades. But we are here. We are becoming more visible. We are being consulted. And we will continue to get involved.

(mack)