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Comment by mhd | Hacker News Reader

As mentioned in the article, the German health services already adopted Matrix for their "TI-Messenger", which is supposed to make secure communication between health care professionals easier. Or, well, possible at all. Right now this is a morass of "don't mention anything private" emails, letters and faxes. I'm surprised that ticker tape isn't involved somehow.

But don't worry, if German health services doing something right is triggering your "the end is nigh!" response: As far as I know, the rollout for patients is still a long way coming and they still don't even have a date set for video chat (right now a cottage industry of anyone involved in HC doing their own WebRTC thing).

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And we still have to walk to the doctor's office to get that prescription for the same Asthma medicine you always get every three months. Instead of just getting it electronically to the nearest pharmacy. Now we have to queue up in the doctor's office with sick people, wait for them to print and sign a red piece of paper and then walk to the pharmacy.

Maybe this changes too in the future?

> Maybe this changes too in the future?

E-Rezept was supposed to launch in 2022 but has been postponed until mid 2023. Some regions already tested it. It didn't work out well, so some regions dropped out of the testing phase. I'm pretty sure it won't work well at launch and we will have to rely on printed prescriptions for quite some time until all pharmacies and doctors use the new system.

Greetings from Poland, e-Recepta here launched in 2019.

And was given prime time thanks to covid, same as remote call with doctor, which allowed getting electronically recipe without coming into doctors office.

Covid accelerated a lot of remote services.

It is always puzzling to me with how Germany has many cultural similarities with us Nordics and is an advanced science nation, yet is always so much slower in adopting new technologies. In Norway we have used electronic receipts since 2013. That is like a decade.

But I suspect it is a difference in attitude. I think in Scandinavia we are generally far more enthusiastic about new things.

Germans have diffuse fears of new technology. Many of us are skeptical whenever it comes to new gadgets, especially if the risk of being tracked or spied on plays a role. Eventually most people level out and get it anyway, like the cell phone, the smart phone, credit cards, Google/Apple pay, etc. Not sure if our history has something to do with it so that many feel uneasy about giving away too much control about our personal data, but maybe it does.

> Not sure if our history has something to do with it so that many feel uneasy about giving away too much control about our personal data, but maybe it does.

Germany has seen two dictatorships in the last century. The first one was more brutal, but the second one maintained a gigantic spying apparatus on its citizens, that took a large fraction of the state's budget.

Germany is not unique in this regard. The entire central Europe shared the same fate.

What's your level of comparison here? Japan? New economies?

If you contrast it with the US, you'll find some technologies earlier in use in Germany, like texting, and some stuff that just went different (credit vs. debit cards). And talk to someone from the US or even the UK about mandatory ID cards, and you'll hear different things about privacy.

I think this specifically is mostly to blame on bureaucracy and the federal system, not a reflection of general German luddism. Nobody really wants fax machines.

Germany has a different history with surveillance and authoritarian state control.

Not only did the nazis use the resident register to find undesirables, but also the soviet union used any and all avenues to spy and control people.

Privacy and scepticism of making the sate a mandatory middleman is deeply entrenched for historic reasons.

Specifically this cryptographically tight identification, electronic-only payment etc. are very contentious for this reason I believe.

But overall your point is still correct, there is a strong bias towards the status quo and the new thing has a lot of proving itself to do before being accepted.

That's the main reason but not the only one, federalism is the other (unless you consider that also a consequence of certain 20th century events, which in part it absolutely is and in others it absolutely isn't). The ID is clearly federal, but almost everything you might want to implement on top of it is not. The Nordics are small enough to country-wide standards easy.

>The Nordics are small enough to country-wide standards easy.

Size of a country has nothing to do with this. Neighbouring Austria is tiny and is also federalized, with each state having several degrees of autonomy and potentially causing various bureocratic nightmares depending on what you want to do.

Same with Switzerland and its cantons.

True, but I'd expect that those smaller units still have it much easier to pragmatically standardize procedure even when those are formally below federal than in larger units.

Me reading the comments... So that's how Sweden must have felt a decade ago.

«With the examples of surveillance discussed above, we now know why contemporary Germans so highly value privacy and limits on state surveillance. They are reluctant to go back down that road again.»

Source: https://www.wondriumdaily.com/germanys-surveillance-system-i...

You can’t call in advance and pick up the receipt an hour later?

You can but they'll likely only starting preparing the Rezept when you arrive, and you'll still need to wait 30 minutes. At least that's how my Hausarzt works

You should change your Hausarzt. They can be so careless only because enough people tolerate such behaviour.

I just send an email what I need, they reply to me the same day or tomorrow that it's ready to be picked up. I got there, and get it in 2 min.

It's not like they are competing for patients.

In most places it is hard enough to even get an Hausarzt to being with. You might just be lucky to live in a bigger city where you have the ability to choose.

>You should change your Hausarzt. They can be so careless only because enough people tolerate such behaviour.

LoL ok, just that GPs have no shortage of patients, but the other way around so since they're on such high demand and in low supply they can get away with many things. The market is in their favor by far.

Yes you can.

Already exists: https://www.apotheken-umschau.de/e-health/e-rezept/e-rezept-...

Currently was supposed to be in a pilot phase in two regions, but both of them cancelled it due to privacy concerns: https://www1.wdr.de/nachrichten/erezept-kelber-medizin-westf...

I did have a video call with my doc the other day and he mailed me a prescription. Which then got scanned by my digital mail box (caya), then it got forwarded in physical form to my house and now I can finally in person go to the pharmacy with the actual paper and get it... LOL.

I wonder how much this is solely technical. Sure, if it's something like asthma medication or insulin, its' completely superfluous. But if I remember correctly, doctors have a few incentives for this. Part of them rather good, like a fear of over-medication, part of them related to budgets with the insurance companies etc.

The health industry is very weird from top to bottom. True for most countries, but Germany certainly adds a few cherries on top. Or at least massively diluted cherry essences…

Usually in the German health sector the use of existing standards is only there for marking off a checklist I have the feeling. In practice things are so heavily adapted that you often cannot use existing libraries.

Just look at the authentication of the E-Rezept (electronic prescription) service: https://github.com/gematik/api-erp/blob/master/docs/authenti... This is supposed to be standard OpenID.

I fully expect the matrix protocol to suffer the same treatment under the hand of the Gematik.

If you want to know how things end up such a chaos take a look at the definitions of the payload data: https://github.com/gematik/api-erp/blob/master/docs/erp_fhir...

6 different sets of definitions by 5 different regulating bodies, with the organizing company Gematik GmbH owned by 9 different stakeholders: https://www.gematik.de/ueber-uns/struktur

Last time I lived in Berlin (until early 2020) my Hausarzt still used Telegram in her practice. Mostly to communicate between the front desk and the examination rooms.

I wonder how kosher it was.

Meanwhile the E-Arztbrief which was supposed to replace FAX is a complete mess. The directory for mail addresses have not been strictly regulated. It's pretty much useless everywhere where big index databases of medical professionals already exist since find the proper mail address is a pain.

A friend working at a big radiology attempted to manage that since there are issues with FAX systems since ISDN technology has been boxed and the E-Arztbrief would have been a good solution. But when he started out comparing their database, he found awful problems. For example there are whole names in the surname field or names of a Doctor's office. You can't properly search and even if you do, you are never sure you got the right one.

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