Electronic patient record: Most people with statutory health insurance have one

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Meanwhile, 70,499,929 electronic patient records (elektronische Patientenakte, ePA) have been created for all legally insured persons (as of February 9, 2025). This means that almost all ePAs are ready one week before the deadline and the process is now complete for most health insurance companies – or more precisely their record system providers IBM and RISE.

"All customers who have not objected to the use of the 'ePA for all' have been equipped with their personal file by the technical service providers Ernst & Young (EY) and IBM," according to the Federal Association of AOKs. In total, almost 26.4 million ePAs were created for the eleven AOKs, "even before the specified deadline", says Dr. Carola Reimann, Chairwoman of the AOK Federal Association.

Problems at IBM

There are currently technical problems with IBM's ePA file system, as reported by the Deutsches Ärzteblatt. According to the paper, there are problems ‘at the interface between the practice management system and the ePA system’, the AOK-Bundesverband told the paper. Barmer and Techniker Krankenkasse, for example, are also affected by the issue.

This information is not unexpected, as shortly before the launch of the electronic patient file, the Federal Association of Health IT (Bundesverband Gesundheits-IT, Bvitg) had already informed the Federal Ministry of Health and Gematik that IBM's system would not be ready in time. In addition, the two file systems from IBM and RISE were not interoperable and behaved very differently. Various parties repeatedly predicted a bumpy start.

Model regions

At the end of January, Bitmarck announced: "For all insured persons in the three model regions of Hamburg, Franconia and North Rhine-Westphalia, the creation of files by BITMARCK and RISE has been fully completed since the beginning of last week". In addition, the AOK Federal Association also informs that the objection rate is currently 3.8 percent.

"The task now is to securely connect doctors' surgeries, hospitals and other service providers and train them in the practical use of the ePA so that the insured persons' files are quickly filled with content and used sensibly to improve care," says Reimann. The AOK estimates that the nationwide rollout will begin in April. It is unclear whether the security gaps will be closed by then. Currently, all doctors and pharmacists are on a whitelist and can therefore access the electronic patient files of all those with statutory health insurance. In the future, however, this will only be possible in the respective treatment context – i.e. by inserting the card.

Insured individuals who wish to access their electronic patient file must have the app, a PIN for their electronic ID card or electronic health card and a card reader. An NFC-enabled smartphone can also be used as a card reader. Insured people must then create a health ID if they do not already have one. To date, around 2.2 million insured people have created their individual health IDs, which are required to access the electronic patient file.

Switch to ident apps

Gematik explained to heise online that the ups and downs in the number of health IDs are due to data transmission by providers. According to the Gematik spokesperson, the reason for this is "changes at the providers, which are due to the launch of the ePA for all, as well as the completed change of provider by the AOK in January 2025".

ePA app unlimited?

Not only doctors, but also insured individuals are testing the new ePA, for example the supposedly unlimited storage space in the cloud. Although each file can have a maximum of 25 MByte, in principle you should be able to upload as many documents as you like. "@TheDoctor512" wrote on Mastodon that he had used a script to store a total of 1 TByte of data in his electronic patient file. This earned him several letters from the health insurance company, which initially pointed out that he had exceeded his quota and that it would be increased. At 1 TByte, he was asked to refrain from further uploads.

(mack)