In Germany this week doctors and civil rights activists joined forces to organise a boycott of the German smartcard programme, attracting huge media interest, including national TV.
The new alliance went public last Friday with a joint press conference at which it proclaimed the explicit goal of halting the smartcard health programme and move to centralised systems, citing privacy worries.
The alliance’s opposition extends to all efforts to digitally communicate in the German healthcare system on a supra-regional level.
“We do not need a national communication infrastructure for the healthcare system”, said Silke Lüder, a Hamburg-based GP and one of the speakers of the alliance.
“We are fed up with feeding industry with money just for prestige projects of politicians without any benefit for the patient”, added Martin Grauduszus, head of the doctor’s body ‘Freie Ärzte’ (Free Doctors).
The event made its way through German media on Saturday, Monday and Tuesday. The national news agencies dpa and Reuters reported, as did one of the two main channels of national public television, at least two private channels, a number of national and regional newspapers and a broad spectrum of special interest magazines, including ‘Computerwoche’ (Computer Week), a leading weekly IT title.
The two main issues of criticism are concerns about privacy and about costs. The new alliance claims that smartcards in healthcare are the first step towards a system of national “mega-servers” which contain aggregated patient data in centrally stored shared electronic patient records.
Such a move is unacceptable, said Klaus Bittmann, head of NAV Virchow Bund, an association that represents 20,000 doctors in private practice, because changing legislation in the future might lead to misuse of this data. In reality though, there are no current plans for national megaservers. Instead, a decentralised architecture looks more likely, with a central index to connect the documents.
The alliance also envisages costs of €10bn or more for the whole smartcard programme, as compared to the official number of €1.5bn given by the national ministry of health.
Interestingly, one partner of the new anti-smartcard alliance is the ‘Chaos Computer Club’, an association of hackers that 18-months ago managed to ‘free’ – gain access to – the only independent cost-benefit analysis of the German smartcard project yet carried out.
The analysis predicted costs between €3bn and €7bn for the whole project including electronic patient records. The research was commissioned but not published by the German Ministry for Health.
The key goal of the anti-smartcard alliance is to persuade citizens to boycott the rollout of the new cards by, for example, not sending in the photographs necessary to produce the cards. The start of the national rollout was originally scheduled for spring 2008, but is now unlikely to start before the summer. Despite these delays a number of health insurance companies are planning to give out at least one million cards by the end of the year 2008.
Given the considerable media attention, reactions from official bodies have been muted. “The arguments of the critics do not become better by repeating them again and again”, said a spokeswoman of the German Ministry of Health.
Roland Stahl, spokesman of the Kassenärztliche Bundesvereinigung, the official political representative body of doctors in private practice, told E-Health Europe: “Calls for a boycott are certainly not helpful. It is absolutely necessary, though, that the experiences of doctors in the test regions are taken seriously.”
In fact, the plans for the national roll out are designed in a way that doctors cannot actually prevent. But they could refuse to set up the new smartcard readers and simply continue to use the old patient cards with paper-based prescriptions. This would lead to another delay in the digitalization of the German healthcare system.
Much will depend on the next national assembly of German doctors in May, when the smartcard topic will be high on the agenda.