Electronic patient record | Rumbling digitalization

A family doctor loads documents into an electronic patient file in his practice. Photo: dpa/Daniel Karmann Currently only around eight percent of those with statutory health insurance actively use their electronic patient record (ePA). That would be around 5.85 million of a total of around 73 million insured people with an ePA created. According to this, a million people with statutory health insurance can manage without the app, but it is not known whether this group even tries to use healthcare services and, if so, how they do so. The use of ePA has been mandatory for all practices, hospitals and pharmacies since October 1, 2025.

If you remember the introduction of the ePA (although it took over 20 years for this to happen), it is surprising that politicians remain silent about the low rate of independent use by the insured. There was also a certain surprise effect when it was introduced - very few insured people did not take part. Others tried in vain and at great expense to get their data. However, health insurance companies do little to make access easier for their insured persons.

"I find PDF files there like on a digital clothesline, even with meaningless file names, and there is no search function."

In a survey by the Federal Commissioner for Data Protection and Freedom of Information, eleven percent of participants said that the app was too complicated and cumbersome for them, that it did not work or that they did not have a suitable smartphone. The largest proportion of those interviewed resolved the topic for themselves by saying that they had no need because the cases of illness were too rare (42 percent). Others had not yet had time for it (26 percent) or lacked information and knowledge (nine percent).

The ePA has now arrived in practice, even if the majority of those insured are reluctant to actively use it or are unable to cope with it. However, the ePA is not yet the perfect instrument for doctors, therapists and other providers. Although it is easier to access reports from other doctors, this does not apply in every case. “I find PDF files there like on a digital clothesline,” even with meaningless file names, “and there is no search function. That's annoying with three doctor's letters, but with 80 it's a catastrophe," comments Stefan Streit, a general practitioner from Cologne.

He belongs to an alliance of doctors, therapists and patient rights activists who see an urgent need for improvement, and not just in the ePA. The initiative is called “Better digitize health” (Gebedi) and aims to ensure that the ePA is completely overhauled with a clear concept. Some representatives presented their ideas on Thursday in Berlin.

It is currently not clear what the file should be first: patient- or practitioner-managed, collection of copies of findings, communication channel in the healthcare system, emergency file or data source for research. All these aspects are still mixed. In addition, the existing solution is not technically reliable. The alliance points out another difficulty: Is all the existing and required data actually already in the file? And couldn't medical confidentiality be violated if highly sensitive patient data ends up being viewed by too many people?

Finally, the insured persons were deprived of the opportunity to decide who should have access to it, depending on the document. According to Gematik, which is supposed to organize digitalization in the health sector on a legal basis, the “cure” could be that individual documents can be completely deleted in the future. But that would bring a new dilemma: those treating the patient would never know whether they were seeing the complete data.

But Gebedi has ideas on how weak points could be overcome. She wants a modern link to existing decentralized medical documentation. This would make findings and treatment results available in real time if patients consent. Emergency files with vital information would also be possible, for example in the event of unresponsive patients. In 95 theses, Gebedi also poses questions that urgently need to be clarified in public debate, including the benefits of the ePA for the care of sick people. How can patients' self-determination be maintained? Or how would the area of ​​trust between treating physicians and patients, including the protection of confidentiality, be maintained?

One of the goals for EHR use is to enable research to use collected data. And from January 2027, health data should be able to be automatically extracted from the electronic patient files (ePA) of all those insured by statutory health insurance for research purposes, provided they do not contradict this. The Gebedi alliance is not calling for an emergency brake on ongoing digitalization, but is calling for a public review of central state projects and solutions. There could be more concrete discussions about medical professional associations such as those for consumer and patient protection.

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