1. Digital Strategy: Health Insurance Funds Want More Access to Data, Doctors Warn

• Health insurance funds as "digital navigators"
• Doctors see confidentiality at risk
• More and more data for the funds?

The umbrella organization of statutory health insurance funds is calling for a comprehensive digital strategy for future-oriented healthcare. In its position paper "Digital Strategy for Future-Oriented Healthcare," the association advocates for a patient-centered approach, expanding the electronic patient record (ePA) to become the core of a digital ecosystem and health insurance funds taking on a more active role as "digital navigators."

A central concern of the association (PDF) for the planned update of the digital strategy in healthcare is to develop the ePA from a mere document repository into an interactive platform. "The electronic patient record (ePA) must become the heart of digitally transformed care and the basis of a healthcare ecosystem," it states in the paper (PDF). It is to be supplemented using artificial intelligence (AI), telemedicine, and individual value-added applications from the health insurance funds.

Furthermore, the association criticizes the role of Gematik: "Gematik should concentrate on its core tasks as a licensing, specification, and supervisory authority and reduce its role as an operational developer of digital applications." Instead of central control, more competitive leeway is needed for the funds.

To facilitate access to digital health services, the association is pushing for the rapid introduction of Telematics Infrastructure 2.0 – the further development of the predecessor to the health data highway – as well as a cross-departmental strategy for uniform digital identities.

Health insurance funds as "digital navigators"

However, the GKV-Spitzenverband also wants significantly more scope for health insurance funds. "Health insurance funds must be able to act as digital navigators and be allowed to develop and offer their own digital services and health solutions based on the ePA – especially in the areas of prevention, e.g., by expanding data-driven early detection of diseases," according to one of the core demands. Examples given include vaccination reminders, AI-supported analyses of health data, or personalized prevention offers. Thanks to access to routine data, diseases are to be detected earlier.

Another focus is on the use of care data. "Health insurance funds must receive and be allowed to use up-to-date care data to develop and offer personalized prevention and care services," it states. At the same time, AI and automation are to help streamline administrative processes and reduce bureaucracy, creating more time for patient care.

Doctors see confidentiality at risk

The plans are meeting with strong resistance from the medical profession, for example from the Kassenärztliche Vereinigung Niedersachsen (KVN). "The health insurance funds want to take over parts of patient treatment bypassing the established outpatient care structures. They see themselves as therapy providers and service providers in the future. That is not their job!" criticizes KVN board member Nicole Löhr. This development calls into question "the principle of joint self-governance that has been in place for decades" and leads to a "health insurance fund-dominated system" with the sole aim of cost savings. "Personalized patient data does not belong in the hands of health insurance funds," says Löhr, referring to patient confidentiality and medical secrecy.

More and more data for the funds?

In the past, there has already been criticism of Paragraph 25b, which allows health insurance funds to make recommendations based on billing data. "While health insurance funds will have access to care data in the future and will even be allowed to develop their own algorithms, doctors remain largely excluded from the same data and are not allowed to co-develop the algorithms," said medical informatician Sylvia Thun to the Ärzte Zeitung.

(mack)

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This article was originally published in German. It was translated with technical assistance and editorially reviewed before publication.