Digitalization: What does the digital “age” bring for patients?

In the future, millions of insured people will be able to have important health data such as findings, laboratory values ​​and medication available digitally – in electronic patient files (ePA), which are now starting to be used on a mass scale. Federal Health Minister Karl Lauterbach (SPD) said that more than 20 years after the original idea, this is finally becoming a reality. “The electronic patient record is secure and makes better treatment and research possible.” Doctors and patient representatives called for uncomplicated everyday use and further precautions for data security.

Controlled start in three regions

All legally insured people who have not objected will now gradually have an ePA set up by their health insurance company. The ministry said this would likely take two to four weeks. It is expected that there will be more than 70 million e-files. The concrete deployment also started on Wednesday – but not everywhere, but in three model regions. In Hamburg and the surrounding area, Franconia and parts of North Rhine-Westphalia, around 300 practices, pharmacies and clinics are to get started and upload data. The aim is to test uploading and interaction with standard practice systems.

If the system works stably in the test regions, the “go” should follow for all of Germany. According to evaluations, this should only become clear after four weeks at the earliest. The ePA is expected to start nationwide in March or April, as Lauterbach announced. The technical connection in 150,000 health facilities across the country must then be ready to start. There are different ways to ensure that insured people find out that their health insurance company has set up the ePA for them, as the umbrella association said – for example as a push message in the health insurance app or with information on the homepage.

More insights for insured people

For patients, the e-file brings new transparency about treatment data. In this way, you become a “responsible patient” and can have findings explained to you by other doctors, said Lauterbach. The following applies: You can look at your ePA and enter data, but you don’t have to. The e-file can be viewed via a cash register app on smartphones, tablets or laptops. What doctors can set and who can access what can be determined in each case. If you change health insurance, you can take the data with you. In general, the ePA remains voluntary; you can still object later and have it deleted.

Important documents bundled

The core goal is to bring together scattered data and thus enable better treatment. In practices it is often the case that documents from previous treatments are missing or there is nothing at all, explained the National Association of Statutory Health Insurance Physicians (KBV). In the future, important information should be available at a glance and multiple examinations and drug interactions should be better avoided. With a view to drug intolerance alone, tens of thousands of lives could be saved every year, said Lauterbach.

The start of the “ePA for all” should now be the “beginning of a new era of digitalization” of the health system, as Lauterbach called it. E-files were introduced in 2021 as an optional offer that had to be actively taken care of. But they were hardly used: at the beginning of the year there were 1.9 million out of more than 74 million people with statutory health insurance. A law from the traffic light coalition reversed the principle: now everyone gets an ePA unless you actively object (opt-out). The objection rate is now an average of five percent. Private insurance companies can also offer ePAs.

Right of access for doctors for 90 days

If you insert your insurance card into the practice, doctors are given access to read and fill out the ePA. By default it is valid for 90 days; you can shorten and extend the period via the app. Patients can decide during the consultation if a finding should not be included in the file. In the case of sensitive data, you must also be expressly informed of this right to object. The consumer advice centers insist on uncomplicated settings as to which doctors can see what. “Otherwise the dentist’s office will end up finding out about the psychotherapy treatment.”

Gradually more content

Doctors are now obliged to include important documents in the e-file. Right from the start, a list of medications should also be included, which is automatically created from the now common e-prescriptions. From the summer onwards, a medication plan with additional information about dosages of medicines will be added. The KBV points out that the ePA, as an “insured-managed” file, does not replace the doctors’ own documentation in their respective practice system. Direct communication between practices also remains important, especially since insured people can delete data.

Protection of sensitive health data

Lauterbach assured: “Citizens’ data is safe from hackers.” The Chaos Computer Club had previously warned of possible attacks. The majority federally owned digital company Gematik announced solutions to prevent such scenarios. The minister made it clear that they were already being implemented for the federal launch. According to the ministry, the data is stored on domestic servers within the protected healthcare data highway. Every access to the ePA is logged with date and time. Only file formats that do not transmit viruses can be uploaded.

There are also security requirements for insured people when they first log in to the ePA app. An electronic identity card with a secret number (PIN) is needed – or the electronic health card with a PIN, which you can get from your health insurance company upon request. For later use of the app, you can then set your own identification methods on your smartphone, for example using facial recognition. If you don’t want to use the app yourself, you can entrust it to relatives, for example. Children also receive an ePA if their parents do not object; from the age of 15 they can decide for themselves.

Data also for research

The e-file should also provide a boost for research. It is planned that from July 2025 data from the ePAs will be forwarded to a central location for research purposes. The data is used pseudonymously, as the ministry explains – i.e. without directly personal information such as name and address. However, insured persons can also object to this use in the app or at an ombudsman’s office of the health insurance company. Lauterbach sees enormous opportunities for research with large data sets.