What is CardLink and why is it so important?

Germany has been working on making healthcare more digital. Starting from January 1, 2024, all medicines that doctors prescribe must be done digitally (although it is important to note that BtM-Rezepte and T-rezepts still need to be written on paper). The digitization process also extends to other areas of healthcare, such as medical records, teleconsultation, and information exchange between specialists.

Toward the end of last year, Gematik, the company responsible for overseeing the entire process, announced the release of specifications for a technology known as CardLink. 

On March 19 of this year, the long-awaited specification was finally released and is available at this link.

This technology enables the use of the electronic patient card (eGK) via a smartphone equipped with an NFC module. This means that patients can manage their digital prescriptions by simply tapping their smartphone on a card. 

But CardLink can be used for more than just managing digital prescriptions.

E-prescription in Germany

In this article, we have explained how electronic prescriptions work in Germany. Similarly, in this article, we have discussed the difficulties that arise from such a system. Let’s briefly recap:

In Germany, e-prescriptions are generated digitally in VOS and practice management systems (PVS) and verified with a physician’s certificate. These prescriptions are then securely transmitted to a central system. There are three methods through which a prescription can be fulfilled:

  • Using a special smartphone app provided by Gematik, the patient can select the pharmacy to process the order.
  • Upon request, the physician can provide a paper printout with a special data matrix code that can then be read by the smartphone application of a specific pharmacy (e.g., an online pharmacy).
  • Alternatively, patients can use their electronic health card (eGK) to pick up their medication. To do this, they must be physically present at the pharmacy and insert the card into a reader, giving the pharmacist access to their prescriptions stored in the central system.

Once the medication is dispensed, a document is signed within the central system, which can then be used for reimbursement by the health insurance company.

Where is the problem?

The most popular and convenient way to obtain a prescription is by using the patient’s card (eGK) directly at the pharmacy. This option has been available since July 2023. However, difficulties arise when patients are unable or unwilling to visit the pharmacy in person.

To address the issue of physical presence at the pharmacy, patients can potentially use Gematik’s E-rezept app and select an online pharmacy to fill their prescription. However, the app itself has received poor reviews and a low number of downloads (2.2 / 5 at the time of writing), which raises concerns among users. In addition, patients must request a PIN code from their health plan to use the card, which can also present challenges.

A potential solution to this problem could be applications developed by pharmacies themselves. Such applications include the ability to fill an e-prescription based on a Data Matrix standard token received from the doctor. The user scans the code and the application allows them to purchase the appropriate medication. Doctors, however, do not print out e-prescriptions every time (what would be the point of e-prescriptions?), but only when the patient requests it.

In other words, what’s missing is a fully digital, convenient way to process e-prescriptions.

It would be much more convenient from the patient’s perspective if pharmacies themselves had the technology to read the e-prescription over the phone, as the Gematik app does. They could then implement this solution in their own mobile apps or websites.

This would be an excellent solution for patients who, for example, have a disability that makes it difficult for them to physically visit a pharmacy and would prefer to fill a prescription online.

Online pharmacies would certainly benefit from such a solution, but so would local pharmacies, which have the advantage of being able to fulfill same-day medication orders.

That’s why Gematik decided to develop and eventually publish a specification for CardLink technology that would provide a convenient and fully digital way for patients to fill e-prescriptions.

What is CardLink?

The Health-CardLink (eH-CL) system establishes a secure connection between the client and the connector, acting as a gateway between the two, despite their different transmission protocols. With eH-CL, it is possible to use a mobile device with an NFC module as part of a telematics infrastructure (TI) to authorize an electronic health card (eHC) without having to enter a PIN. This facilitates communication between different transmission protocols.

As part of the process, the patient’s app connects to the pharmacy, which then communicates with the connector to verify the eGK and access e-prescriptions.

The technology ensures that the data received from the remotely connected eGK actually comes from the same card, ensuring security and data integrity in mobile health scenarios.

In simple terms, CardLink technology enables patients to use their electronic health card (eHC) without entering a PIN via the corresponding e-prescription viewing and fulfillment application.

They no longer need to insert their electronic health card into a stationary terminal, but simply hold it up to a smartphone equipped with an NFC module. The device at the pharmacy then reads the relevant patient data from the Gematik server and the prescription can be filled.

CardLink makes the entire e-prescription redemption process simpler and easier.

Already, most mail-order pharmacies, such as DocMorris and Gesund.de, have a notice on their websites stating that e-prescriptions can currently be filled by scanning a QR code, but “in the future” it will be possible to fill e-prescriptions based on the use of an electronic patient card.

The future

However, the use of this technology is not limited to e-prescribing – it can solve other potential problems.

An example?
  • If the patient has not been to the clinic in a given quarter and has not scanned the card, the healthcare professional cannot even issue an e-prescription. They can only do that if the patient physically shows up at the clinic and “check” the card. The CardLink process could add real value here by allowing this activity to be performed entirely remotely.
  • The technology could also be used to arrange video consultations or home visits. In the case of telemedicine, swiping a card on a phone could authorize access to electronic medical records. It would also be needed to bill the health insurance company for the visit.

According to the developers, talks are already underway with software providers for offices, nursing homes, and insurance companies to further develop the CardLink technology.

Overall, Gematik’s CardLink technology represents a milestone in the digitization of the German healthcare system. By combining the convenience of e-prescribing with the simplicity of NFC technology, CardLink is expected to transform the patient experience and improve healthcare delivery.

As Germany continues to develop digital health solutions, the future of healthcare looks brighter and brighter.

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