The 130th German Doctors’ Day in Hanover passed several resolutions on the planned law for data and digital innovation in healthcare (GeDIG) with a large majority. Federal Health Minister Nina Warken (CDU) defended the reform plans at the opening of the Doctors’ Day, but still signaled a willingness to talk – the Doctors’ Day’s answer was still clear: digitalization, yes, but not at the expense of patients’ rights, medical independence and access to care.
Read more after the ad
Detecting health risks is the task of doctors
A central theme ran like a common thread through all resolutions: the growing role of statutory health insurance companies in medical care. The Health Data Use Act (GDNG), which came into force in 2024, allows health insurance companies to individually evaluate the billing data of their insured persons, identify health risks and contact those affected independently – without involving the treating doctors. The GeDIG draft is now intended to massively expand these powers: to ePA content, third-party data and so-called “real-world laboratories”. For the medical profession, this is a clear breach of a taboo: the identification of individual health risks is originally a medical task and must take place in the context of treatment – according to a resolution adopted with 185 votes to 3.
Criticism of cash register access to ePA data
In another motion, delegates voted for “clear boundaries and data protection” due to the growing use of health data by health insurance companies. They are therefore calling for a fundamental revision of the GeDIG draft and warning of a gradual paradigm shift in the role of health insurance companies, which is moving from being a pure cost provider towards service provision and case management. The criticism of the planned consent solution for health insurance access to ePA data was particularly sharp – according to another resolution passed by the board of the German Medical Association with a large majority: “The planned consent solution does not adequately protect patients and insured persons because those affected as individuals are fundamentally in a weaker position compared to their health insurance company. It is also unreasonable to always have to keep an eye on whether consent, once given, should be revoked due to the occurrence of new illnesses.”
Medical decisions must remain medical decisions
With the broadest majority of all resolutions on the GeDIG, with 189 votes to 7 in favor of a motion for a resolution, the Doctors’ Day reaffirmed the principle of clear separation of roles: Medical decisions about whether, how and to what extent patients are treated must be made free of health insurance influences. Health insurance companies are not allowed to operate digital instruments for patient management that prepare or influence care decisions without independent medical responsibility. The Doctors’ Association also sees a clear conflict of interest in second opinion procedures: health insurance companies should “not be allowed to offer second opinion procedures for reasons of conflict of interest. Such procedures should be medically developed in the future.”
Read more after the ad
The planned digital initial assessment via the ePA app as a preliminary hurdle before visiting the doctor as well as the health insurance-controlled appointment allocation are seen as hardly compatible with the right to health. The members of the Doctors’ Association clearly warned: “This strategy can exclude patients from necessary treatment. It infringes unacceptably deeply into the freedom of organization of medical institutions and into the patient-doctor relationship.”
No digital obligation
Another resolution was directed against a creeping digital imperative in the healthcare system and the plans to further develop the electronic patient file (ePA) into a central “platform for initial assessment, control, referral and appointment scheduling”. “Health as an essential fundamental right of all people must be possible for everyone as part of public services, even without the use of digital technologies or certain apps,” it says. Vulnerable groups would be particularly affected: older and sick people, people with disabilities, people with low income or a lack of language skills. But precaution is also necessary from a society-wide perspective: “Crises or war situations also require offline options for public services, participation in social life and the use of public infrastructure.”
A motion based on this was referred to the board for further decision, which rejects the “system-changing overload of the ‘ePA for all’”. The ePA is already not fulfilling its original promises, according to the delegates. They suffer from a lack of high availability, incorrect prioritization and a lack of trust among patients and doctors. The previous basic mistake was “to declare an insured file at the same time as an emergency file, patient copy, communication solution in medicine, research data delivery and data collection for patients”.
A motion is also being sent to the board that aims at a conflict with confidentiality regarding the reform plans. “Doctors experience a blatant contradiction between their duty of confidentiality and the legal requirement to forward all data about their patients to the ePA and thus also to the research data center at the Federal Institute for Drugs and Medical Devices (BfArM). Most people in Germany do not know that in the future the entire contents of their files will be collected there and made available to third parties for commercial analysis.” The applications also showed that doctors are not against the digitalization of the healthcare system and are already well positioned digitally in many areas. However, added value must be recognizable. AI can also help, but it should only be a tool.
(mack)
