Rise in Objections to Electronic Patient Records

The implementation of electronic patient records (ePA) is facing challenges as the number of objections continues to grow. Currently, nearly all individuals with statutory health insurance have an ePA created, provided they have not opted out. However, recent data shows a decline in the total number of active ePAs.

As of February 8, the TI-Dashboard report from Gematik indicated that approximately 70,499,929 ePAs were in place. By the next day, this number had decreased to 70,489,531, and further to 70,486,940 by February 10. The sudden drop of around 12,000 accounts has raised questions, prompting inquiries to Gematik, the organization responsible for the digitalization of healthcare.

According to a spokesperson for Gematik, minor data adjustments may still occur due to ongoing discrepancies. The Techniker Krankenkasse reported an objection rate of 7%, while the combined AOK health insurance funds noted a 3.8% rate, and Barmer indicated a rate of 5.3%. The Federal Ministry of Health had anticipated a much higher objection rate of around 20%.

Despite the challenges, Gematik officials state that the establishment of patient records is progressing significantly, suggesting that the overall number of ePAs is unlikely to increase substantially going forward. Health Minister Karl Lauterbach remarked on the rapid advancement of digitalization in the healthcare sector, although various media outlets have indicated that the rollout of the ePA may be delayed.

Concerns regarding the security and functionality of the ePA were highlighted during the 38th Chaos Communication Congress, where vulnerabilities in the system were revealed. Experts had previously criticized the readiness of the necessary software, and the German Health IT Association had raised issues before the anticipated launch of the ePA. Reports indicate that the next version expected in July may not be the planned ePA version 3.1, but rather an interim version 3.0.5.

The ePA is expected to facilitate various health initiatives, including a nationwide vaccination tracking system, as emphasized by the Federal Government's Expert Council in its recent position paper. In contrast, other countries, such as Austria, are moving towards a centralized digital vaccination record, which does not allow for objections.

In Germany, the ePA is set to begin with an electronic medication list, with plans to introduce a more comprehensive electronic medication plan curated by healthcare professionals. Although the vaccination record is theoretically included in the ePA, healthcare providers currently lack the ability to input data into the system.

As the ePA continues to develop, interest in patient data is growing among various stakeholders. Recently, CDU politician Friedrich Merz suggested that reduced health insurance premiums could be offered to individuals who consent to share their health data. Additionally, law enforcement agencies have expressed interest in accessing health data, while advocates for data protection continue to call for stronger safeguards against the seizure of ePA data.

According to legal expert and data protection advocate Jan Kuhlmann, the security of data within the ePA remains a significant concern. He noted that the health data of all 72 million insured individuals will not be stored on physical cards but will instead reside in plain text on centralized cloud servers operated by companies like IBM and Bitmarck/Rise. He argued that a decentralized data storage approach, as previously recommended by former Federal Data Protection Officer Prof. Kelber, would provide greater security.