Die elektronische Gesundheitskarte soll 2014 endlich wirksam werden

Die meisten Patienten kennen schon die neue elektronische Gesundheitskarte mit Passbild. Doch es gibt immer noch Mitglieder der gesetzlichen Krankenkasse, die an ihrer alten Gesundheitskarte ohne Passbild festhalten wollen. Der Spitzenverband der Krankenkassen möchte nun 2014 die neue Gesundheitskarte mit Passbild endlich wirksam machen und die alte Gesundheitskarte verdrängen. Doch dieses Vorhaben bleibt umstritten.

Die elektronische Gesundheitskarte soll 2014 endlich wirksam werden
Die elektronische Gesundheitskarte soll 2014 endlich wirksam werden

Wie man bereits früher verdeutlichen konnte, bringt die neue elektronische Gesundheitskarte zunächst nur wenige Vorteile für die Patienten. Erst sehr langfristig könnte durch bessere Datenanbindungen gesichert werden, dass man mit der neuen elektronischen Gesundheitskarte schneller und flexibler auf die Gesundheitsdaten der Patienten zugreifen kann. Das kann für medizinische Behandlungen wichtig werden, wirft aber Probleme beim Datenschutz auf.

Nun wollen die Krankenkassen sicherstellen, dass die neue elektronische Gesundheitskarte ab 2014 verpflichtend wird: Alte Gesundheitskarten sollen nicht mehr vom Arzt akzeptiert werden. Versicherte, die noch keine neue Gesundheitskarte haben, werden dann ab 2014 auf den umständlichen Weg des Ersatzverfahrens geschickt, um die ärztlichen Leistungen nicht aus der eigenen Tasche bezahlen zu müssen. Möglicherweise gehen die Krankenkassen davon aus, dass dieser Druck die restlichen Patienten motiviert, endlich ein Passbild bei ihnen einzureichen, damit schnellstmöglich eine neue Gesundheitskarte noch vor 2014 erstellt werden kann.

Dieses Vorgehen hat nicht überall Beifall gefunden, wie das Handelsblatt zur neuen elektronischen Gesundheitskarte berichtete: Der Spitzenverband der Ärzte habe ausgesagt, dass die alte Karte noch lange im Jahre 2014 von den Ärzten akzeptiert würde.

Was bei dem Streit nicht untersucht wird: Worin besteht eigentlich der Nutzen der Patienten durch die neue elektronische Gesundheitskarte? Haben allein die Krankenkassen den Vorteil, dass wegen des Passbildes es vermieden werden kann, dass Patienten sich mit einer nicht ihnen zugeordneten Gesundheitskarte behandeln lassen? Die teure Umstellung auf die neue Gesundheitskarte allein wegen des Passbildes lässt sich wohl kaum rechtfertigen.

Bildnachweis: © Zerbor – Fotolia.com

526 Antworten auf „Die elektronische Gesundheitskarte soll 2014 endlich wirksam werden“

  1. Auch wenn das aufgebrachte Passfoto augenscheinlich der größte Unterschied zwischen der elektronischen Gesundheitskarte (eGK) und der alten Versicherungskarte ist, so ist sie bei weitem nicht nur deswegen umstritten. So geht es vielmehr um die mit der Einführung der eGK einher gehenden Einführung der Gematik Infrastruktur, über die die meisten Versicherten so gut wie nichts wissen. Aktuell ist die einzige Anwendung der eGK der Stammdatenabgleich, künftig sollen aber eine Vielzahl anderer Anwendungen auf diese Infrastruktur aufsetzen, so zum Beispiel die elektronische Krankenakte. Und an diesen potenziellen Anwendungen erregen sich die Gemüter – Sie erwähnen ja aufgeworfene „Probleme beim Datenschutz“.

    Nur mal exemplarisch am Beispiel „elektronische Krankenakte“ diskutiert: Die Krankendaten der Versicherten sollen zentral in einer Datenbank gespeichert, verschlüsselt mit den dem auf der eGK gespeicherten Schlüssel des Versicherten. Der Arzt kann auf diese Daten nur mit seinem Heilberufsausweis und dem auf der eGK gespeicherten Schlüssel des Versicherten zugreifen – soweit, so gut. Das Verfahren suggeriert, dass ein Zugriff auf die Krankendaten nur mit dem auf der eGK gespeicherten Schlüssel und somit nur mit der eGK möglich ist. Wie kann aber dann die Versicherung eine Ersatzkarte ausgeben, ohne dass die zentral gespeicherten Daten verloren sind, wenn doch für deren Entschlüsselung auf jeden Fall nur die auf der eGK gespeicherten privaten Schlüssel notwendig sind? Dies lässt eigentlich nur zwei Schlüsse zu: entweder werden die Krankendaten für mindestens einen weiteren Schlüssel verschlüsselt – oder die Krankenkasse verfügt über eine Kopie des auf der eGK gespeicherten Schlüssels. In beiden Fällen hätte sie aber Zugriff auf die Daten, suggeriert wird aber, dass der Zugriff auf die Krankendaten nur mit der eGK möglich sei.

    Ein weiterer Kritikpunkt ist die Befürchtung, dass die ärztliche Schweigepflicht durch die „elektronische Krankenakte“ entweder geschwächt oder das Vertrauensverhältnis zwischen Arzt und Patient nachhaltig gestört werden könnte. Als Patient hätte man künftig entweder die Möglichkeit dem Arzt vollen Zugriff auf seine Krankendaten zu gewähren – oder sie komplett zu verwehren. Würde sich der Patient aber nicht komplett offenbaren wollen, zum Beispiel weil er eine psychiatrische Behandlung vor seinem Zahnarzt verschweigen möchte, so blieben ihm nur die beiden genannten Möglichkeiten: Verweigerung mit Vertrauensverlust oder Komplett-Offenbarung mit der Umgehung der ärztlichen Schweigepflicht.

    Der Vollständigkeit halber sollte erwähnt werden, dass die elektronische Krankenakte als Anwendung auf der Gematik Infrastruktur aktuell aus der konkreten Planung herausgenommen wurde. Sie wird aber sicher wieder eingeplant werden, weil dies eine naheliegende Anwendung ist, die man als Versicherter von der eGK auch irgendwie erwartet. Aber man sollte sich auch mal überlegen wie praktikabel eine solche Anwendung sein wird, selbst wenn man künftig darüber entscheiden könnte, welche Daten man seinem Arzt übergibt und welche nicht. Wie soll dies geschehen? Vorab beim Arzt an einem Terminal?

    Es gibt noch weitere Kritikpunkte an der eGK und der Infrastruktur die durchaus kontrovers diskutiert werden. Ich hoffe das aufgeführte Beispiel hat aber verdeutlicht, dass es im Wesentlichen nicht nur um das Passbild auf der eGK geht. Das Passbild ist für die Versicherungen lediglich eine unangenehme Hürde bei der Einführung der eGK, weil hier einige Versicherte auch ohne die Gematik Infrastruktur zu kennen und abzulehnen, sich der eGK versperren.

    Es geht bei der Kritik an der eGK nicht nur um Technik, sondern vor allem darum, wie sie auf die Ausübung unseres Rechts auf informelle Selbstbestimmung wirkt: Heute kann ich sehr einfach entscheiden, was ich meinem Arzt mitteile und was nicht. Im Rahmen der informellen Selbstbestimmung sollten mündigen Bürger aber stets darauf achten, dass für sie nachvollziehbar bleibt was mit ihren Daten geschieht. Mit der eGK leidet diese Nachvollziehbarkeit meiner Erfahrung nach, da die Krankenkassen auch auf Nachfrage nicht aufklären können oder wollen. Zumindest die von meiner Versicherung ausgehändigten Informationsblätter zur eGK und gegebenen Antworten auf meine Fragen klären m. E. nicht auf, sondern beschwichtigen vollkommen unkritisch. Das mag aus Sicht einer GKV legitim sein, schafft aber – zumindest bei mir – bezüglich der eGK kein Vertrauen.

    Zu meiner Person: Ich schreibe hier als Privatperson, arbeite aber selbst in der IT einer großen Versicherung (wenn auch keine GKV) und bin dort mit Architekturen und Sicherheit von zentralen Anwendungen betraut. Versichert bin ich bei einer GKV.

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