Telematics infrastructure
The telematics infrastructure ( TI ) is intended to network all those involved in the healthcare system such as doctors , dentists , psychotherapists , hospitals , pharmacies and health insurance companies . Medical information that is required for treating patients should be available more quickly and easily. An essential core application of the telematics infrastructure to support the medical care of the insured is the electronic patient record .
In Germany, according to the had law for secure digital communication and healthcare applications and amendments to other laws all parties responsible for up to July 1, 2018 Telematics necessary infrastructure set up to carry out the first application, the insured master data management (VSDM). The insured person's master data management concerns the routine data of the insured person (gender, date of birth, home address, insurance status), diagnostic data. ( ICD diagnoses) as well as emergency data or medications can be activated and saved with the consent of the insured. The online check enables the relevant data to be updated in the doctor's patient file and on the eGK . It can also be checked whether the patient is currently a member of his specified health insurance company.
Necessary components
The necessary telematics infrastructure consists of several components. The connector and the card terminal must be approved by gematik and certified by the Federal Office for Information Security (BSI).
Connector
Access to the telematics infrastructure is via a connector . It is similar to a DSL router , but works on a significantly higher level of security. It creates a so-called Virtual Private Network (virtual private network, VPN) for the telematics infrastructure, which enables communication using modern encryption technologies, completely shielded from the Internet .
The connector is connected to the practice's stationary card terminals and the practice management system (PVS) of the practice's computer via a network . It contains the module required for the management of insured persons' master data. The practice administration system must be adapted to enable a connection to the connector and to be able to import the insured person's data from the electronic health card (eGK).
The connector in turn establishes the connection to the telematics infrastructure for the practice management system. In addition, the connector performs other security tasks, such as encrypting and signing medical documents.
The connector transmits personal data , therefore special security requirements apply. The location of the connector should be access-protected.
E-health card terminal
Three types of chip cards are read in the e-health card terminal:
- SMC-B card (Security Module Card-Type B) confirms to the telematics infrastructure that access is via an authorized facility (practice, medical care center, hospital). The SMC-B card is a practice card - a chip card that authenticates the practice for participation in the telematics infrastructure. The practice ID is issued every time the card terminal is switched on, the connector is restarted or This is partly activated by entering a PIN code (personal identification number) when the practice administration system is started and remains in the card terminal.
- The electronic health professional card (eHBA) is a chip card for doctors, dentists, psychotherapists, pharmacists and, in the future, also for members of other health professions who identify themselves with it.
- The electronic health card with which the respective patient identifies himself.
Stationary eHealth card terminals also require a chip card, the gSMC-KT (device-specific security module card for stationary eHealth card terminals), in order to identify themselves as part of the TI to the connector.
VPN access service
For access to the telematics infrastructure, medical practices need a special VPN access service - similar to an Internet provider that provides access to the TI. This is established via the connector and can be set up parallel to the existing network infrastructure as well as serially as the only router for the practice network. Although the serial "series operation" meets higher security requirements, in practice parallel operation is often set up, as it does not hinder other Internet-based services and applications.
Secure network of statutory health insurance associations
The secure network of the Association of Statutory Health Insurance Physicians (SNK) is part of the telematics infrastructure, with which doctors and psychotherapists can, for example, submit the statement online to their Association of Statutory Health Insurance Physicians .
costs
According to the legal requirements, the health insurance companies are obliged to cover the costs for the initial equipment of the practices and the ongoing operation in full. Here over because no agreement was reached, the parties had National Association of Statutory Health Insurance Physicians (KBV) and the Central Federal Association of Health Insurance (SHI Head Association), the Federal Arbitration Office on. According to his decision, the reimbursement amount will be between EUR 1,155 and EUR 2,025 from the 3rd quarter of 2018, depending on the size of the practice. In addition, doctors and psychotherapists receive a one-off starting fee of 900 euros. This primarily reimburses costs related to the technical equipment, for example for the practice failure during the installation of the connector and for the costs of adapting the practice management system. Those who do not order the initial equipment in time will no longer be reimbursed for these costs.
The flat-rate operating cost for the maintenance of the technology and its updates is 248 euros per quarter. In addition, the operating costs for the practice card in the form of the SMC-B smart card in the amount of 23.25 euros / quarter and card and the doctor's card in the form of the HBA smart card in the amount of 11.63 euros / quarter and card are reimbursed.
Sanctions
As a sanction according to § 291 paragraph 2b sentence 14 SGB V, a fee reduction of 1% of the fee turnover is threatened to those practices that do not comply. The sanctions also apply to the public shareholders of the operating company gematik - the National Association of Statutory Health Insurance Physicians (KBV), the dentists' Confederation (KZBV) and the Central Federal Association of Health Insurance (SHI). You must expect budget cuts if deadlines for implementation are not met. However, the legislature had to postpone the date specified in the law because there were delays in the provision of the necessary technology. With the Nursing Staff Strengthening Act , the legislator has decided to extend the deadline to June 30, 2019.
criticism
Criticism, both of the practice-external storage of health data and the connection of practices and hospitals to a telematics infrastructure, is based on numerous data leaks and increasing misuse and feared misuse of health data. There are indications that the TI is not being set up in the practices according to the regulations and that the practice's firewalls are being opened in order to operate the TI properly. It is also aimed at the careless handling of the majority of the population with this sensitive data. The criticism of the electronic health card and the associated connection to the telematics infrastructure is primarily directed against the fact that it will be a gateway for the storage of health data on central servers of the health insurance companies.
literature
- TI Notes 2 , German Hospital Association. Retrieved May 17, 2019.
Web links
Individual evidence
- ↑ Telematics Infrastructure , February 2019. Accessed May 17, 2019.
- ↑ Preliminary remark by the Federal Government on BT-Drs. 19/16228
- ↑ Telematics Infrastructure. Retrieved July 1, 2019 .
- ↑ Information sheet - Technical equipment of a medical facility , gematik, October 1, 2017. Accessed on May 17, 2019.
- ↑ Why the connector is so important , Ärzte Zeitung online, September 1, 2017. Accessed May 17, 2019.
- ↑ Deutscher Ärzteverlag GmbH, editorial office of Deutsches Ärzteblatt: IT security: connector is not the problem. May 3, 2019, accessed July 1, 2019 .
- ↑ Costs for connection to the telematics infrastructure will be reimbursed , National Association of Statutory Health Insurance Physicians, May 4, 2017. Accessed May 18, 2019.
- ↑ Interview with Jens Ernst from June 2019. Retrieved on October 11, 2019
