Health: What are the benefits of e-prescriptions and e-patient records for everyone?

Electronic prescriptions and digital files for important health data are set to become standard for millions of patients. This is provided for by a law passed by the traffic light coalition in the Bundestag. E-prescriptions will be mandatory in practices from the beginning of 2024. At the beginning of 2025, everyone with statutory health insurance should receive e-patient files – unless they reject it.

Minister Karl Lauterbach (SPD) spoke of a “quantum leap” with which Germany, after many delays, is catching up with digitization in the healthcare system. Doctors, health insurance companies and patient advocates also warned of pitfalls.

Lauterbach made it clear that after 20 years of debate it was about catching up. Until now, important data has been distributed on servers in practices and hospitals where patients were treated in the past. For example, when a chronically ill person comes to a new specialist, some of the findings or x-rays are usually not there. The treatment often takes place without the data, but this leads to errors and in any case to “suboptimal therapy”. “It can’t continue to be like this.”

The minister said that the new regulations would have very concrete benefits for patients. The Green health expert Janosch Dahmen said that in the future not only all treating professions would be able to see relevant information in one place, but also patients themselves for the first time. The FDP specialist politician Andrew Ullmann said that data sovereignty remains with the people.

The opposition Union abstained from the vote and called for further digital steps, the AfD voted no. Left-wing MPs expressed data protection concerns.

E-patient records for everyone

Specifically, there is a breakthrough for electronic patient records (ePA) – as a personal data storage that accompanies you throughout your life. The bundled data is also intended to avoid drug interactions and multiple examinations. E-files were introduced as an optional offer in 2021, but so far only around one percent of the 74 million people with statutory health insurance have one at all.

The declared goal is 80 percent by 2025, and the government is switching to the “opt-out” principle: According to the law, the health insurance companies should provide broad information and automatically set up an e-file for everyone by January 15, 2025 – unless you actively contradicts this.

The e-file with certain identification rules should be accessible via cash register apps. You should be able to decide for yourself what doctors can set and who can access what. First, an overview of medications should be available, followed by laboratory findings, among other things. If you change health insurance, you should be able to take your data with you. The ministry explained that people without a smartphone could view their ePA in selected pharmacies. Ombudsman offices of the health insurance companies are intended to support insured people who do not manage the ePA via the app.

E-prescription across the board

For some time now, e-prescriptions have been able to be redeemed using a special app or a printed QR code instead of the usual pink slip. But a larger-scale start was delayed several times due to technical problems. There is now an easier way to redeem it by inserting the insurance card into a reader at the pharmacy. By law, from January 1, 2024, it will be mandatory for doctors to issue prescriptions electronically.

The obligation actually existed from the beginning of 2022. However, the practices should now change because recently the requirements were not yet there everywhere. This includes a connecting device for the protected healthcare information highway. The e-prescriptions are stored on a central server and when the cash register card is inserted, the pharmacy is authorized to retrieve them from there. In the future, the e-prescription app will also be integrated into cash register apps.

Easier data research

Research using health data should also make progress. To this end, a law should make it possible to link data from various sources at a central access point – for example from cancer registries and health insurance companies. Data should be encrypted (pseudonymized).

An opt-out model is again planned for data stored in e-patient files: You should initially have a setting for “data donations” for research purposes, which you can reject. Lauterbach said this was a breakthrough for research to improve care – for example in cancer and dementia studies.

Telemedicine and health apps

Telemedicine offerings such as video consultations are to be expanded – this can also close gaps in rural regions. For this purpose, regulations that previously only ensured that practices received reimbursement from the health insurance companies for a limited range of services should be eliminated. The range of certain health apps that patients can get with a prescription will also be expanded.

The practical implementation

Healthcare associations welcomed the push for e-files – but also pointed out difficulties. To date, the technology works so poorly that it usually takes several minutes before the ePA can even be viewed, according to the Association of General Practitioners. The German Foundation for Patient Protection warned against discrimination against seriously ill people and those in need of care, for example with regard to the current right to a medication plan on paper.

The umbrella association of statutory health insurance companies called the schedule with an introduction at the beginning of 2025 too tight. The short deadline is a right signal to the industry to bring well-developed products to market as quickly as possible. So that insured people have enough time to make an informed decision and the health insurance companies to prepare, the ePA should not come for everyone until July 2025.

Draft law on e-patient files and e-prescriptions Explanations of the regulations Draft law on the use of health data Explanations of the regulations