Berlin Hardly anyone uses it – and it can do almost nothing: The electronic patient record (ePA) is the problem child of Health Minister Karl Lauterbach (SPD). Launched in 2021, it is the core of the SPD politician’s digital agenda.
It is intended to make X-ray images on CD, paper files and faxes superfluous and make medical data available for research. In countries like Israel this is a matter of course, in Germany it is still a dream of the future.
This should change a fundamental change of strategy, which the traffic light parties agreed in their coalition agreement and which Lauterbach is now launching. Insured persons currently have to actively opt for an ePA. This should change with the opt-out procedure: only those who object will not receive a digital file.
“We will present a corresponding draft law for this fundamental decision in a timely manner,” Lauterbach told the Handelsblatt. Participation remains voluntary. “But in principle every person with statutory health insurance in Germany should receive an electronic patient file, so its use will become the norm.”
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This is the only way treatment information can be stored and used for further diagnostics and therapy. For this purpose, the company Gematik, which is responsible for the digitization of the healthcare system, is to be commissioned by resolution of the shareholders’ meeting on Monday to examine the technical and organizational requirements.
In the draft resolution, which is available to the Handelsblatt, it says: “In order to implement the opt-out ePA as quickly as possible, it is necessary to parallelize legislation and the design of the technical and organizational measures.”
The aim is to implement the procedure in 2024. This is considered difficult. In particular, the Federal Data Protection Commissioner Ulrich Kelber (SPD) had been critical of the opt-out procedure in the past.
Electronic patient record: four decision-making levels
Kelber should be included in the examination of the procedure, as well as the health insurance companies as the ePA operator, the Federal Office for Information Security (BSI), the implementing industry and the shareholders of Gematik. This includes the Federal Ministry of Health as the majority owner.
The draft resolution also shows how the opt-out procedure is to be regulated, i.e. at which points insured persons can object. Specifically, there should be four decision-making stages. If the insured person does not object, an ePA is automatically created and made available for the patient in the first stage.
>> Read here: Germany can save 42 billion euros with digital medicine
In the second stage, the file can be filled by the doctor treating you and in the third stage it can be viewed by the doctor for treatment purposes. Finally, in the fourth stage, the health data can be donated anonymously for research purposes.
Health Minister Lauterbach hopes that this last stage in particular will bring great added value for medicine. In order for meaningful medical research and preventive care models to be possible at all using modern approaches such as artificial intelligence, the pool of data must be as large and complete as possible.
“We can only continue to guarantee modern healthcare for everyone if we take advantage of the opportunities offered by digitization,” said Lauterbach. Medicine is getting better and more efficient.
>> Read here: Lauterbach wants to radically rebuild electronic patient records
In addition, both the electronic patient summary file (ePKA) and the electronic medication plan (eMP) are to be integrated into the digital file and no longer implemented as independent applications.
Statutory health insurance companies have had to offer electronic files since 2021. According to Gematik’s TI dashboard, 556,000 of the 74 million people with statutory health insurance in Germany currently have a digital file.
The reason for the low number of users is not only the limited functions. They should be gradually expanded. In the future, it should be possible to store data such as X-rays and medication plans in the file.
According to the Technikradar 2022 of the Körber Foundation, a large part of the population is fundamentally skeptical about the ePA. One in five stated that they did not want to use the file. The reason is concerns about data protection (50 percent) and ambiguity about who can see which data (53 percent).
More: Germans are losing their fear of digitization – data protection is becoming less important