The electronic patient file (ePA) is a central component of the digitization of the healthcare system. So far, however, it has only been actively used by a few insured persons. On the one hand, this is due to the fact that a multi-step authentication process is required for registration – on the other hand, many doctors are not able to fill it in for technical reasons. The aim of the Federal Ministry of Health (BMG) is for 80 percent of people in Germany to have an electronic patient file by 2025 – but there is still a long way to go. Currently there is 586,196 Electronic Medical Records (as of 01/13/2023). Since only 0.7 percent of the population has an ePA, everyone should get one automatically in the future. In this FAQ we answer initial questions about the ePA.
This FAQ is constantly being expanded.
What is the electronic health record?
The electronic patient file is intended to bundle patient information in one place. It is intended to provide insured persons with convenient access to their diagnoses, laboratory findings, X-rays and other information that doctors have previously provided in the electronic patient file. After approval by the patient, other doctors should also be able to access the data. You can delete or have the documents in the ePA deleted at any time.
When will the electronic patient file come?
The electronic patient file has been available for those with statutory insurance since January 1, 2021. For privately insured people, the e-patient file should come in the course of the year. An opt-out variant of the electronic patient file is being considered for the future. This means that every person registered in Germany gets it and has to object if they don’t want it.
How do I get the electronic patient file?
Electronic patient file in the TK app
If you are legally insured, you must register to access the electronic patient file and identify yourself to your health insurance company. This is usually possible via the Postident procedure or in person. With individual health insurance companies, such as Pronova BKK, an identification process is also possible using the electronic ID card. The videoident procedure was prohibited for security reasons.
Insured persons usually access their electronic ID card via the app of their respective health insurance company. With the many statutory health insurance companies and company health insurance companies, the ePA is integrated into the app of the health insurance company, for example with TK. Others – such as the AOK – have an app with the ePA (OK my life). One detailed list with the corresponding ePA apps of the health insurance companies can be found on the website of Gematik GmbH, which is responsible for the digitization of the healthcare system.
The design, the user experience and the graphic representation of the electronic patient record vary depending on the health insurance company. But the functions are identical everywhere.
Is an electronic patient record possible without a smartphone?
Some health insurance companies, such as Techniker, offer that patients can have an ePA created by their doctor. However, you can then only view the stored data from your doctor. With all health insurance companies, the electronic patient file can also be called up on the desktop for various operating systems – usually with limited options – usually for Mac and Windows. Almost all company health insurance companies, which also belong to the statutory health insurance companies, have them electronic patient file also for Linux. In addition to the electronic health card 2.1 and the associated PIN, a card reader is required to use the desktop app.
Desktop version of the AOK app “Mein Leben”
What is stored in the electronic patient file?
Documents containing information about diagnoses, recently prescribed medication and discharge letters from the doctor are stored in the electronic patient file. Since 2022, the mother and vaccination card, the dental bonus booklet and the U-examination booklet for children can also be saved in the ePA by the doctor from his IT system.
What happens to the data if you change health insurance?
The previous health insurance company makes the data available when you change the selected health insurance company. You can also export the data from your patient file and upload it to the new health insurance company’s ePA app.
How do data and documents get into the ePA?
Data and documents can be uploaded to the ePA by the patient themselves, or a doctor can enter data as medical information objects (MIOs) or documents in the form of PDFs in the file. MIOs are data exchange files defined in XML by the National Association of Statutory Health Insurance Physicians (KBV). Image formats are also permitted in the ePA.
Who is responsible for data protection?
According to Gematik, responsibility for data protection “depends on the responsibility and responsibility for the individual work step”. Accordingly, the doctor is responsible for patient data in the practice and for storing the data on site. Gematik and the connector manufacturers (manufacturers of particularly secure routers in the healthcare sector) are responsible for data transmission in the telematics infrastructure – Gematik alone within the telematics infrastructure.
Responsibility for data protection in the ePA remains with the health insurance companies. An ePA, including its data and documents, is intended to last a lifetime. According to Gematik, the data will therefore not be deleted after ten years, but insured persons can request their health insurance companies to delete the ePA at any time, which according to various health insurance companies is irrevocable.
What happens to the data?
Data downloaded from the file is on the devices of the insured and with the respective doctor, who makes a copy and makes his diagnosis including (laboratory) data and documents available. Patients can, for example, authorize specific doctors for individual documents. An electronic patient file and its data are intended for a lifetime. According to Gematik, the data will therefore not be deleted after ten years, as is usual. However, insured persons can request an irrevocable deletion of the ePA from their health insurance companies at any time. The patient can release data (as MIOs) for research purposes (research release).
A European health data space (EHDS) is planned for the future, in which all data from digital health applications and the electronic patient file can be shared by patients after research approval has been granted. The billing data of those with statutory health insurance are already collected by the National Association of Health Insurance Funds (GKV-Spitzenverband) and forwarded from there to an office based at the Federal Institute for Drugs and Medical Devices (BfArM).
Who owns the patient records?
The data primarily belongs to the patients themselves. The patient can assign the rights to read and download/save the documents via their app. The rights can relate to an institution (a hospital or a medical practice) or other service providers, such as midwives, who have an electronic health professional card and can be selected by the patient via the directory service.
What are the advantages of electronic health records?
Patients can easily share documents with doctors via the electronic patient files. This makes sense, for example, if you want to involve other doctors in a (preliminary) diagnosis in order to hear their advice. One goal is that patients save themselves, for example, multiple X-rays or blood tests for the purpose of a new diagnosis. A central anamnesis questionnaire could save a lot of effort. It is also planned for mid-2023 that patients will be able to release their data for research purposes. If the patient builds up a comprehensive file, this is the basis for sound medical treatment by all doctors.
What are the disadvantages of the electronic medical record?
First of all, the electronic patient record (ePA) means additional work for everyone involved. The insured must register with their health insurance company for the ePA in a multi-stage process. In addition to the technical equipment, doctors, midwives and other service providers also need the necessary knowledge to fill the ePA. New processes must be created here in medical practices and hospitals. For example, the questions arise as to who is allowed to enter documents in the EHR and how the documents get into the doctor’s IT system. In the case of technically less experienced patients, the practices incur further additional work if they have to be made aware of the new possibilities.
What should the electronic patient file be able to do in the future?
In the future, patients will be connected to digital health applications via version 2.5 of the electronic patient file in order to bundle the data in the EHR. The possibility of releasing the data for research is also planned. A TI messenger called TIM will enable direct communication with doctors in the future. In addition, the connection to an electronic medication plan and an electronic patient summary is planned.
Expansion stages of the electronic patient file
Is the electronic patient record mandatory?
No, the electronic patient record is not mandatory, but the opt-out version of the EHR is planned for the future. In other words, if you don’t want it, you have to object. How exactly a contradiction will be possible is not yet clear.
Are there patient files beyond the ePA?
There are already various electronic patient records, such as the electronic case record (eFA) for interdisciplinary collaboration between doctors. If the patient agrees, the treating physicians share the patient-related data and documents across institutions in order to guarantee the best possible medical care. Hospital associations use the Electronic Institutional Patient Record (EEPA) to be able to work across the same disciplines.
A health record (GA) is usually offered by commercial providers (activity tracker, blood pressure and glucose readings), but some health insurance companies also provide it. However, the health files are usually not connected to the doctors’ IT systems, which means that patients cannot share the data with their doctors.
(mack)
