Health policy: “E-patient records for everyone” – what that means for insured people

Doctor’s letters and findings, blood values, medication plans, dental treatments or even when the last tetanus vaccination was: an electronic patient file (ePA) will soon be automatically created for all those with statutory health insurance who do not actively object. Such data can be gradually stored there. What is the point of this, who decides what is stored there and what concerns are there?

“The electronic patient file will lead to better care. (…) a system that creates important new opportunities for patients, for doctors, but also for researchers.” (Health Minister Karl Lauterbach, SPD, on September 30, 2024)

Where is this file created and what is stored in it?

According to the consumer advice centers, the file and the documents and data it contains are stored and encrypted centrally on servers in Germany. The requirements for data security are very high. Technically, this works via the so-called telematics infrastructure, a self-contained network to which the healthcare players are connected. According to the Ministry of Health, no one other than the insured and those they have authorized access to can read the contents of the e-patient file. The insured persons decide for themselves what exactly is stored in it – also in consultation with their doctors.

How does it work in practice?

Via a smartphone app from the respective health insurance company. Insured persons can use this to store documents in the file themselves, for example scanning and uploading findings or old laboratory results. You can also create self-administered diaries with blood pressure measurements. When you visit the doctor, the doctor fills the file with findings on current treatments using his practice computer. The health insurance companies also upload to the file which services they have been billed for. This makes it clear in black and white when a doctor was visited, what diagnosis was made there or which medication was prescribed and when. The e-patient file for everyone who does not object will start in mid-January 2025.

An example: Pensioner X moves from the city to the country, needs a new family doctor and registers at the new practice. His health insurance card is inserted into the reader, the practice can see his electronic patient file and the new doctor can see which treatments X has already had or which medications he is taking.

This could also be helpful in an emergency if X had to go to the hospital. Doctors could identify previous illnesses in the e-patient file or better rule out interactions when administering medications if they see which medications X otherwise takes regularly.

This means that as soon as my health insurance card is inserted into a reader, I am an open book…

Depending on the settings in the app. There, insured people should be able to determine for themselves which document is visible to whom. This can, for example, be done using confidentiality levels: A document in the e-file is either marked as released for everyone who has access by inserting the chip card, or it is only released for certain doctors or marked as blocked so that only the patient can access it can see it yourself. “You can view, insert, delete or hide content, grant or restrict access rights and file objections at any time,” says the consumer advice centers.

What other advantages are mentioned for the e-patient record?

Transparency and greater informedness for patients because they get an overview of their own health data. The data could also make it easier to obtain second opinions or ask more specific questions from the doctor. It is also stated that duplicate examinations could be avoided. Reference is also made to possibilities in connection with artificial intelligence.

“For example, I can talk to the AI ​​about my own electronic health record. It can give me recommendations, and I can ask it if there were any mistakes made in my treatment.” (Karl Lauterbach in November 2023 in “Spiegel”)

But what if I prefer to stick with the file folder and don’t want an e-file?

If you don’t want the e-file, you have to actively object to it with the health insurance company, then it won’t even be set up. However, it should also be possible later to have a file that has been created deleted again.

There is criticism that controlling the file via a smartphone app could deter older people or people who are not very tech-savvy. In such a case, those affected can appoint a trustworthy person who will take care of the technical support of the file for them. Regardless of this, if the file has not been contradicted, it exists without any action on your part and is then mainly filled out by treating doctors.

Sensitive health data via cell phone and stored somewhere centrally – isn’t that risky?

There is always a risk of data theft and hacker attacks in the digital space, so the use of such technologies always remains a personal consideration. The umbrella association of statutory health insurance companies (GKV) emphasizes that the data processing in the e-patient file takes place “in a technical environment that is security-tested and trustworthy at the highest level”. The apps are also “security tested according to the highest standards”.

However, the Federal Data Protection Commissioner Louisa Specht-Riemenschneider recently criticized the objection solution at a discussion event at her company – that is, that everyone automatically receives an e-file unless they object: This is a political decision, from a data protection perspective one would have been happier with a consent solution. “Then we would have had a self-determined decision for the patients and a legitimacy under data protection law that would have been accepted by the general population.”