Digitization: What does the “soft start” bring for the e-patient files?

Exam findings, medication, X -ray images: For important health data, there are now electronic patient files (EPA) that went into mass use at the beginning of the year. The new digital memory can accompany patients with all doctors for a lifetime. But most of them probably didn’t notice much. That should change now. A “start-up” should begin on Tuesday so that the e-file gradually becomes standard everywhere in Germany.

What exactly happens now?

Since January 15, 70 million of the 74 million legally insured persons have received an EPA from their health insurance, which can also be rejected for themselves. The concrete use in health facilities that provide data in the e-files and use the technology in everyday life was initially only tested in three regions. Around 300 practices, pharmacies and clinics took part in Hamburg and the surrounding area, Franconia and parts of North Rhine-Westphalia. After completing the trial phase, the nationwide expansion should now follow.

How does the expansion run?

The transition to the entire republic does not come in one fell swoop, but gradually. The National Association of Statutory Health Insurance Physicians (KBV) speaks of a “soft start”: Some practices could use the EPA immediately, others would still have to install a module. Software updates are also used. This process is likely to take several weeks, as the mostly federal digital agency Gematik explains. The facilities can initially use the EPA on a voluntary basis. A legal obligation will then apply from October 1st.

Why do e-files come at all?

For the outgoing Federal Minister of Health Karl Lauterbach (SPD), who was still implementing the major operation, the EPA brings a “turn of time” in digitization. “Patients finally get an overview of their data and findings. Doctors can make better decisions.” The aim is to bring together scattered or missing data and thus enable better treatments. The EPA should also avoid multiple examinations and medication interactions. Lauterbach, in his own words, assumes that broad use will develop very quickly.

What can you do with the EPA?

Patients can look at their EPA, but do not have to. You can see them via an app of the cash register, for example on the smartphone. The head of the Techniker Krankenkasse, Jens Baas, advises insured persons to actively use the EPA. “So you can see which data are stored in your file and are much better informed about your own health.” What doctors can adjust and who can access what can be determined. If you change the cash register, you can also take your stored data with you.

How does the EPA work in the practices?

If you insert the insurance card on the practical reading, doctors receive an access right to read and fill the EPA for 90 days. The range can be shortened and extended via the app. Patients can determine in the consultation if a finding is not to be found in the file. In the case of sensitive data, they must be expressly pointed out to the right. The German Foundation for Patient Protection complained that individual documents only show certain doctors. So an orthopedist could see if a patient is in psychotherapeutic treatment. Instead, only the possibility of refusing him with complete access to the EPA remains.

What comes into the e-file?

From the beginning, a list of medication should be included, which is automatically created from the usual e-recipes. Further content should be added gradually – next a medication plan with information about medicinal doses. In general, doctors are intended to post important treatment data in the e-files. At the same time, the KBV points out that the EPA, as a “insured” file, does not replace the documentation in its own practical systems. Direct communication between practices also remains important, especially since insured data can delete.

What about the protection of the data?

Lauterbach underlines: “Safety always goes.” Additional precautions were implemented during the test phase. So it was possible to solve security problems for mass access to EPAs that the Chaos Computer Club had worked out. According to the ministry, the data is stored on domestic servers within the protected data highway of the healthcare system. Every access to the EPA is logged with the date and time. Uploading are only file formats that do not transmit viruses.

What applies to registering in the app and for children?

For insured persons, there are also security requirements when registering in the EPA app. An electronic ID card with a secret number (PIN) – or the electric health card with PIN, which you get from the cash register at the cash register is needed. If you don’t want to operate the app yourself, you can entrust relatives with it. Children also get an EPA if the parents do not contradict, from 15 they can decide themselves. Certain sensitive information cannot be entered to protect children.

Is there a breakthrough now?

According to Gematik, there are currently up to 60,000 access to EPAs per day. In the future, the nationwide expansion should be much more. E-files were introduced as an offer that you have to take in was introduced after years of delays in 2021. But they were hardly used. A law of the traffic light coalition turns the principle: Now everyone gets an EPA unless you actively contradict. The objection rate was five percent on average. Private health insurance companies can also offer EPAs.

What is planned for data for research?

It is planned in a next expansion stage that data from the EPA will be forwarded to a central point for research purposes. They are used pseudonymized, as the ministry explains – i.e. without directly personal information such as the name and address. Insured persons can also object to this data use in the app or at an ombudal center of the health insurance company. Lauterbach sees enormous opportunities for research with large databases and artificial intelligence.