eDoctor's letters: mandatory readiness to receive from 30.06.2024

The doctor's letter is basically used for the targeted exchange of information between the doctors providing treatment or continuing treatment. As a result of the Act to Accelerate Digitalization in the Healthcare System (Digital-Gesetz DigiG), all doctors and facilities participating in SHI-accredited medical care are now obliged to be able to receive electronic doctor's letters (eDoctors' letters) by 30 June 2024 at the latest.

In addition to the electronic certificate of incapacity for work and the electronic prescription (ePrescription), this is another obligation to be implemented by registered contract doctors and MVZs. In addition to an electronic health professional card (eHBA), doctors need a card terminal, a KIM service (communication in the medical sector) and a KIM address for the eArztbrief - similar to the electronic certificate of incapacity for work. To ensure that the eArztbriefe can be sent securely, a secure transmission procedure is required that uses suitable state-of-the-art technical measures to prevent unauthorized access.

Deadline: 30.06.2024

In accordance with Section 295 (1c) SGB V, doctors, medical care centers (MVZ) and authorized doctors - as participants in SHI-accredited medical care - are obliged to establish digital readiness to receive by 30.06.2024 and to sign electronic letters electronically with a qualified electronic health professional card (eHBA) before sending them in accordance with the "Guideline on the determination of electronic letters in SHI-accredited medical care in accordance with Section 383 SGB V" (Electronic Letter Guideline) of the National Association of Statutory Health Insurance Physicians (KBV). However, there are currently no corresponding regulations for the inpatient sector or for hospitals.

Reduction of the TI flat rate

Since July 1, 2023, practices have received a monthly telematics infrastructure (TI) flat rate, which varies depending on the size of the practice, the level of equipment, the time of initial equipment and the time of connector replacement. This flat rate is intended to cover all costs incurred by the TI, including the costs for the eArztbrief. Practices without the eArztbrief module must expect reductions in this TI financing lump sum, unless their software provider has not yet provided the module.

The connection and operating costs for the TI connection will increase accordingly by a flat rate per transmission of an electronic letter, cf. section 383 SGB V. The Berlin-Brandenburg Regional Social Court has ruled that the Federal Ministry of Health's decision on TI from September 1, 2023 has not repealed this regulation, but that it is still valid. As a result, doctors will continue to receive both the TI flat rate and the transmission flat rate for the transmission of individual e-physician letters. Sending an eDoctor's letter will be reimbursed at 28 cents (GOP 86900) and receiving it at 27 cents (GOP 86901) - up to a maximum value of EUR 23.40 per quarter and doctor. This is regulated by the Federal Coverage Agreement.

In summary, the introduction of doctor's letters from 30 June 2024 represents an important step towards digitalization in the healthcare sector. The DigiG obliges registered doctors and facilities to be ready to receive and securely send e-physician letters digitally. The associated technical requirements and costs are to be supported by the TI lump sum and reductions in this TI lump sum are to create clear incentives for implementation. Corresponding mandatory regulations are not yet in place for hospitals. In the long term, this would be another important building block for the implementation of digitization in the entire healthcare system.

Date: 9. Jul 2024