Doctors on e-patient record: Systems must be reliable & secure before rollout

A letter from the Federal Ministry of Health to the shareholders of Gematik was recently published, confirming what had been apparent for some time: the active use of electronic patient record (elektronische Patientenakte, ePA) in doctors' practices throughout Germany will take at least until April. Doctors welcome the fact that things have not really got going yet. The reasons for this lie in technical deficiencies in the pilot regions in Hamburg, Franconia and North Rhine-Westphalia and in the security gaps presented at the 38th Chaos Communication Congress.

"If software doesn't work properly, it can't be rolled out in our practices. This postponement therefore makes sense. Practices currently have their hands full treating the many patients with respiratory infections – We can't have faulty software," commented Holger Rostek, Chairman of the Brandenburg Association of Statutory Health Insurance Physicians. Dr. Sibylle Steiner, Director of the National Association of Statutory Health Insurance Physicians, is also relieved about the new plans.

The use of data from the ePA for research purposes will also not be available in mid-2025, as planned, and the full-text search requested by many doctors is not on the agenda until spring 2026. The nationwide rollout of the ePA in surgeries, hospitals and pharmacies is not due to start until April 2025 at the earliest. In addition, communication via TIM should be possible from July 2025 – a messenger for doctors and patients connected to the telematics infrastructure and others. The reason for the newly targeted launch date is the unsatisfactory test situation to date; for example, the ePA can only be tested with a few patients and there are still interoperability problems.

According to Rostek, it is also annoying that the further expansion of the ePA is also being delayed. The digitally supported medication process with the ePA 3.1 was actually planned for the summer, which many doctors would have found a relief. However, the electronic medication plan is not planned for the planned interim version, ePA 3.0.5, which is to replace ePA 3.1, but various improvements are planned, for example for the substitute regulation. There are currently still problems with the electronic medication list (eML), which was already published with ePA 3.0.

Security in progress

It has already been stated in the past that the ePA will only be rolled out throughout Germany once it has provided positive experiences in the model regions and the security gaps have been closed. However, there are still some uncertainties, for example regarding the "whitelist" – mentioned by Health Minister Karl Lauterbach, on which all practices participating in the tests are listed and to what extent this measure ensures greater security with the ePA.

The doctors also point out that it is the health insurance companies and not the practices that are available to answer questions about the ePA. "Our practices are there to provide medical care, not IT support. We look after the health of our patients – and that has priority," explains Rostek. The KBV provides information for practices to print out.

Further contradictions

The health insurance companies' IT service providers have now created an ePA for all those with statutory health insurance, provided that no objections have been raised by the insured person. As more and more objections are currently being received, the number of ePAs already created is now also falling and currently stands at 70,394,759 records (as of February 17, 2025). If you want to actively use your ePA, you need to install the app on your smartphone and know the PIN of your electronic health card or ID card. It is possible that the desktop app of some health insurance companies will also work now or in the future, but this will also require either a card reader or a smartphone as a card reader.

(mack)