eHealth: Dispute over connector replacement threatens to escalate
Medical associations are calling for the telematics infrastructure to be stopped because it is unclear whether the connectors really need to be exchanged for a secure connection to the TI.
Due to crypto certificates expiring after five years, the shareholders of Gematik GmbH, which is responsible for the digitization of the healthcare system in Germany, have decided that around 130,000 connectors for connecting to the telematics infrastructure must be replaced. More and more doctors and other experts from the healthcare sector are critical of the exchange. The medical association MEDI has now spoken out in favor of stopping the exchange campaign. The Bavarian Association of Statutory Health Insurance Physicians (KVB) is even threatening to withdraw from the telematics infrastructure.
The reason for this was an analysis by c’t, which showed that there are no technical obstacles to replacing the crypto certificates with a set of new device-specific security module cards (gSMC-K cards). Accordingly, millions could be saved in the three-digit range. Gematik and BMG did not name us a request from the beginning of July technical Reasons for the allegedly unavoidable hardware replacement. In addition, a software update to extend the crypto certificates is also possible without any problems for another two years, as confirmed by the connector manufacturer RISE. The Federal Office for Information Security had no objection to this.
Instead of a complete exchange of the connectors, MEDI advocates an exchange of the crypto certificates. However, Gematik had stated that an exchange was not possible for security reasons. However, Gematik boss Leyck-Dieken told Ehealthcom in April 2022 that there was nothing to be said against “an extension of the previous connector” – at least where possible.
KVB: “Digitization of the healthcare system on the verge of extinction”
The KVB is also dissatisfied with the planned connector exchange. According to the board of directors, Dr. Wolfgang Krombholz, Dr. Pedro Schmelz and Dr. Claudia Ritter-Rupp, together: “The dissatisfaction of the resident doctors and psychotherapists in Bavaria with bankruptcies, bad luck and breakdowns in the development of a functioning telematics infrastructure is enormous. The measure is full. The connector replacement that is now planned not only produces masses of electronic waste, but also high costs for everyone involved and hinders the usual practice processes.” The KVB sees the Federal Ministry of Health as having a duty to “ensure order” because it has a majority share of 51 percent of Gematik. Either there must be “significantly more money for the equipment of the practices”, or the further expansion of the TI must be nationalized. If this does not happen, the digitization of the health care system is on the verge of collapse.
Statutory health insurance physicians are calling for the alternatives to be examined
The National Association of Statutory Health Insurance Physicians (KBV) is also demanding clarification from Gematik – until the next shareholders’ meeting in August. Among other things, there should be answers as to whether the alternatives to replacing the connector were examined before the decisive shareholders’ meeting on February 28, 2022, and whether the facts presented to the Gematik shareholders during the shareholders’ meeting were complete.
KBV: Flat rates for connector exchange too low
In addition, Dr. Thomas Kriedel from the KBV said that the lump sum of 2300 euros set by the arbitration board for the exchange of the connectors did not cover the costs and rejected the arbitration award. Negotiations between the central association of health insurance companies and the KBV had previously led to the fact that both statutory and private health insurance companies should reimburse doctors for the costs of replacing the connector, totaling 400 million euros. According to the KBV, however, that would not be enough – so far, practices would have had to pay an average of 9,000 euros in addition to the reimbursement for the TI connection.
Exchange a political issue
When asked by Deutsches Ärzteblatt, Georgios Raptis, Professor of Computer Science and eHealth at the Ostbayerische Technische Hochschule Regensburg, confirmed that, from a technical point of view, nothing speaks against a physical exchange of the gSMC-K cards: “Theoretically, it would be conceivable that – if no technical Measures against replacing the gSMC-K have been implemented – the manufacturer (or their service provider) opens the housing, replaces the gSMC-K, reseals the connector and then considers it a ‘new’ connector in terms of the Protection Profile”.
