The security certificates of the first connectors – particularly secure routers for healthcare – expire in September 2022, so that the devices have to be replaced. To date, 31,860 of the approximately 180,000 healthcare connectors have been replaced, such as one Answer to a small request from the AfD parliamentary group (PDF) from the end of March. For all connector certificates whose validity expires in August 2023, a decision was made to exchange the connector. For all newer devices there should also be the option to extend the validity of the certificates by means of a software update.
However, the infrastructure is currently still missing to transfer this update to the connectors via the telematics infrastructure (TI) operated by the national health agency Gematik. The solution required for this should be available in the third quarter, as Gematik announced in response to a request from heise online. Accordingly, the corresponding firmware versions are nearing completion, but still have to be checked.
Until then, doctors and other service providers only have two options: the connector exchange and “TI as a Service” – a connector operated by the service provider in the data center. Accordingly, IT service providers are currently only pointing out these two options to their customers.
Secunet and Rise provide updates
The connector manufacturers Rise and Secunet had prepared the corresponding updates in August 2022, but withdrew them after the decision to replace the connector because the certificate extension was removed from the specifications. The third manufacturer CompuGroup Medical (CGM) had not provided an update at the time, but did not rule out the option of “certificate extension for the future” after the CCC demonstrated that a corresponding update would even be possible for outdated CGM devices.
The devices from the manufacturer CompuGroup Medical (CGM) are primarily affected by the connector exchange. Gematik, which is responsible for the digitization of the healthcare system, and its shareholders had considered the exchange to be the “safest and most economically sensible solution”, although the Federal Office for Information Security had already approved the continued operation of the connectors. While the other two manufacturers had implemented the software update for the certificate extension, CGM did not comply with the specifications of Gematik, the state health agency.
BMG assesses funding
From July 1st, the financing of the TI for medical practices and pharmacies is to run through a monthly TI flat rate from the health insurance companies. Although Gematik assumes that the financing of the software update will also be taken into account in the agreement, the BMG sees no “direct connection between the TI flat rate and the exchange of the connectors”. A spokeswoman for the BMG pointed out that “connectors of the TI (…), like other IT components, (have) a limited lifespan”.
However, the Central Association of Statutory Health Insurance Funds (GKV-Spitzenverband) and the National Association of Statutory Health Insurance Physicians (KBV) were unable to agree on the amount of the flat rate. Therefore, the Federal Ministry of Health (BMG) regulates the financing itself by June 30, 2023 at the latest. as reported by the medical journal. The differences of opinion therefore concern, among other things, the amount of the TI flat rate and the type and scope of the necessary TI components. Therefore, the association asked the BMG to set the flat rate.
Pre-financing burdensome
The Westphalia-Lippe Association of Statutory Health Insurance Dentists is observing the current developments with great concern: “Due to the intended pricing of one-off expenses for the equipment of new TI components in the practice in the monthly TI flat rate”, according to Michael Evelt, the deputy chairman of the KZVWL , which shifts cost pressure to dental and medical practices. Therefore, practices would have to go into a kind of pre-financing, with a term of the components of possibly ten years.
But not only because of the pre-financing the frustration among the doctors is growing, but also because of the current under-financing of current costs of existing TI applications. There were further doubts as to whether the TI flat rate would regulate “the distortion of market conditions”, Evelt continued. So far, the prices of the providers have always been based on the agreed reimbursement rates.
Evelt sees further problems in the “implementation on a specific date” of the TI flat rate. “The exchange of TI components always takes place in consultation with the service provider on site and taking into account the respective practical obligations”. Therefore, a lead time for the practices is necessary. In addition, the legislature is once again interfering with the right to self-government by determining the financing itself.
Letter to Karl Lauterbach
The National Association of Statutory Health Insurance Physicians and the National Association of Statutory Health Insurance Dentists (KZBV) saw no prospect of a joint solution during the negotiations. “The negotiations were just a political fig leaf,” commented KZBV CEO Dr. Karl-Georg Pochhammer the failed negotiation. From the outset, the Federal Ministry of Health had left no opportunity for negotiations.
Medical practices had hoped that digitization would make their work easier, but the “poorly implemented introduction of digital processes and components has shaken confidence in the telematics infrastructure,” says a letter from the KBV and the KZBV to Federal Health Minister Karl Lauterbach. They also demand full compensation for additional financial burdens. So far, the current flat rates have been too tight, which means that the practices are left with the costs.
(mack)
