Electronic patient record (ePA) started
People with statutory health insurance can now download an app with electronic patient files. However, medical practices are not yet connected across the board. Gradually, more and more will be equipped with the necessary technology and will then also be able to use and fill the ePA.
The essentials in brief:
- The electronic patient file is a digital application in which people with statutory health insurance can store health information themselves and have documents posted by their doctors.
- Since January 1, 2021, the statutory health insurance companies have been providing their insured persons with an electronic patient file via an app for smartphones and tablets. The electronic patient file for privately insured people is expected to follow in 2022.
- The use of the electronic patient file is voluntary. Access to the electronic patient file is only possible for doctors and other healthcare professionals who you have given access authorization to. You can limit such access authorization in terms of time.
What is the Electronic Patient Record (EHR)?
The electronic patient file is a digital application, an electronic file, in which people with statutory health insurance can initially store health information themselves and also have new documents posted by their doctors. In the ePA, all important information about your own health can be securely bundled without paper.
The use of the electronic patient file is voluntary. Insured persons have access to their file at any time and can decide for themselves which data they want to store in it (or have it stored) and which doctor's office, which pharmacy, which hospital is allowed to access it. Health insurance companies do not have access to the electronic patient file.
Private health insurers are expected to offer their policyholders an electronic patient record from January 1, 2022 .
What information can be stored in the patient record?
You can enter the following in the electronic patient file:
- own medical records that you already have,
- Health or pain diaries (such as blood pressure or blood sugar levels) or
- other data (e.g. from a fitness tracker).
Doctors and hospitals to which you have given authorization can view treatment documents such as
- findings,
- The diagnosis,
- doctor's letters,
- laboratory reports,
- therapy plans
set etc. Also can
- the electronic medication plan ,
- the emergency data set or
- advance directives
be stored in the ePA. Important information for medical emergencies is stored in the emergency data record, such as allergies, intolerances or medication taken regularly.
Not all document formats can currently be entered in the ePA. In the future, however, a large number of formats will be supported so that, for example, X-ray images, CT and MRI documents can also be uploaded.
You can upload all common formats to the ePA: PDF, JPG, TIFF, TXT, RTF, DOCX, XLSX, ODT, ODS, XML, HL7 CDA/R2 XML.
In the future, electronic prescriptions can also be stored in the ePA or electronic transfers for further processing.
From 2022 it should be possible to place the vaccination card, the maternity card, the examination booklet for children and the dental bonus booklet in the ePA.
What are the advantages of the patient file for the patient?
The ePA is a digital health management system for patients that is intended to contribute to better health care through an improved exchange of health-related information.
The exchange of documents between medical practices, pharmacies, clinics and patients is facilitated by the ePA. The ePA enables you as a patient and the doctors and hospitals treating you to get a better overview of your medical history, findings, diagnoses, laboratory values and X-rays or operation and therapy reports.
The coordination of treatment can be simplified and improved because documents are available and do not have to be requested first. Unnecessary double examinations are eliminated. In an emergency, all important information is collected and available quickly.
As a patient, it is easier for you to get a second medical opinion , since the medical documents are stored in the electronic medical records. You have your medical records together and no longer have to ask doctors' offices or hospitals to see your medical records once the information has been uploaded to your EHR.
Changing doctors can also be made easier because you have saved your medical documents in the EHR.
Many documents that are still available in paper form today can be saved in the ePA in the future and will therefore no longer be lost.
What is the status of the introduction and functionality of the patient file?
The electronic patient file will be introduced in several stages:
Stage 1: field test phase
Since January 1, 2021, the statutory health insurance companies have had to provide their insured with an electronic patient file. Insured persons can download the electronic patient file to their smartphone or tablet via their health insurance company's app.
In the initial phase, the benefit of the ePA for the users was still rather low, since the ePA can only be used to a limited extent. As a patient, you can upload the medical documents that you already have to the ePA. Not all formats can be set yet.
In this first phase, the ePA was introduced in around 200 selected medical practices and hospitals in Berlin and Westphalia-Lippe. The ePA could initially be used by those with statutory health insurance in the test regions.
With the findings from the test phase, a nationwide usability in all medical practices and hospitals should be prepared.
Stufe 2: Roll-out-Phase
In phase 2, all doctors, dentists, pharmacies and hospitals are to be connected to the electronic medical records in the second quarter of 2021.
Stage 3: Comprehensive networking in the 3rd and 4th quarters of 2021
According to the National Association of Statutory Health Insurance Physicians, when the electronic patient file officially starts on July 1, 2021, the technology will not yet be available across the board.
For the 3rd and 4th quarters, the area-wide networking of resident doctors, pharmacies and hospitals, ie the connection to the necessary technical infrastructure, is planned. Gradually, more and more doctors will be equipped with the necessary technology and will then also be able to use and fill the ePA.
In hospitals, the EPA must be up and running by January 1, 2022 at the latest.
From 2022, so-called "medical information objects" such as the vaccination card, the maternity card, the U booklet for children and the tooth bonus booklet should also be able to be saved.
Important: From January 1, 2022, a so-called "fine-grained authorization concept at document level" will be specified for the electronic patient file. Insured persons can then specify exactly who can access each document stored in the ePA.
From January 1, 2022, if you change health insurance , you can have the data from your ePR exported and take it with you to the new provider of the file. Unfortunately, this function will not be available in 2021. It is then also possible for your own ePA to be managed by another person of your choice. This is an advantage, for example, for people in need of care who cannot operate the EHR themselves.
Planned for 2023
From January 1, 2023, it should also be possible to document care in the ePA as well as other data provided by healthcare providers.
It is planned that electronic sick notes can then also be stored and shared via the ePA. In addition, other people involved in the treatment, such as midwives, physiotherapists or care facilities , will be connected to the EPA in the future.
Insured persons can then voluntarily make their data stored in the ePA available for medical research in pseudonymised and encrypted form .
How do I get an electronic patient file from my health insurance company?
Insured persons can download their health insurance company's app for the electronic patient record from the Apple and Google app stores.
You can use the ePA with a mobile device such as a smartphone or tablet. At Gematik you will find an overview of the ePA apps of the health insurance companies .
Technical requirements
The operating system of the smartphone or tablet must be compatible with the app. Usually you need an Android smartphone (at least Android 8) with Near Field Communication function (NFC) or an iPhone (at least 7 and iOS version 13).
You also need a securely delivered, valid and NFC-enabled electronic health card (NFC-eGK) and the associated PIN. In order to receive the PIN, you must identify yourself to your health insurance company. There are different options for this depending on the health insurance company.
You will also need a valid email address and your health insurance number.
Log-in
There are two different ways to log in:
- with a PIN and the personal NFC-enabled health card or
- with two-factor authentication
In the second solution, the ePA is paired with your smartphone. The second factor you need is a password, which you assign during the registration process. The device binding thus represents a further security factor in addition to your personal access data.
If you lose your smartphone on which you manage your ePA, you can have access to the ePA blocked by a blocking service.
Who can access the patient record?
Critically minded citizens fear that the ePA will make patients transparent and allow health insurance companies, insurers and other providers to access them.
Only you and your authorized medical service provider can access the electronic patient file. You alone decide who can access your file. Only you can view the ePA at any time and add or delete content.
Your doctors or other service providers connected to the telematics structure, such as hospitals or pharmacists, can only access your EHR if you have given them access authorization. In order to access your patient file, the service providers must first authenticate themselves with their health professional card. Your data from the ePA cannot be read out in the doctor’s office unless you have granted access authorization.
Health insurance companies do not have access to your data in the electronic patient file.
If you have given permission, the doctor can, for example, load your patient documents for your current treatment case into the ePA or update the medication plan or view documents for your treatment that are already there.
It has not yet been clarified whether you are also entitled to have the doctor:in place older treatment documents from your patient file in the ePA.
You can revoke the authorization for the doctor at any time or limit it in time. For example, you can give a doctor access authorization only for the day of the treatment appointment, but also for a longer period of time.
Can I delete my electronic medical record?
You can delete both individual data and the entire ePA at any time.
What if I don't use a smartphone or tablet?
The electronic patient file is tailored for use with a smartphone or tablet. Desktop or laptop use is not yet planned.
Nevertheless, insured persons without a smartphone or tablet can also use an electronic patient file, but not with all functions. You can apply for the ePA from your health insurance company. You need your electronic health card (eGK) and a personal PIN from the health insurance company. The electronic patient file will then be activated by your approval from July 1, 2021 at the latest at the next doctor's visit.
The health card is read in the card terminal and you enter your PIN. The doctor treating you can then upload documents to your ePA once they have been authenticated. For example, if you go to a specialist for further treatment, you can give them access to your patient data in their practice in the manner described and also have new treatment documents uploaded. In this case, however, you do not have access to your data.
The Federal Association of Consumers (vzbv) criticizes that digitization is only focused on apps and smartphones. There should be a multi-pronged technical approach that is also available to consumers without secure mobile devices or PCs. This could be, for example, health terminals that are available to consumers in hospitals.
Important : If a patient cannot or does not want to manage their ePA themselves, it is possible from January 1, 2022 to appoint a representative who will take care of the ePA for them.
Does the electronic patient record violate data protection regulations?
According to the Federal Data Protection Commissioner, the ePA in the 2021 version should not be compatible with the General Data Protection Regulation (GDPR) in certain areas . A dispute has arisen between the Federal Data Protection Commissioner Ulrich Kelber and the Federal Ministry of Health over data protection compliance. There are different legal opinions.
What is the Federal Data Protection Commissioner opposed to?
In his statements on the ePA, the Federal Data Protection Commissioner pointed out that patients must have full sovereignty over their data when the ePA is introduced. His criticism is primarily directed at the "all or nothing" principle when releasing documents in the first expansion stage of the ePA.
What does that mean in concrete terms for users of the ePA?
In 2021, patients will only be able to authorize all documents. For technical reasons, it is not yet possible to select individual documents. For example, you could not only grant your internist the right to inspect a laboratory result. Your internist would then see all the information contained in the doctor's folder of the EHR.
But : From 2022, a so-called "fine-grained selection management" will be introduced, so that the data sovereignty will then lie entirely with the patients.
This means: It will then be possible to select only individual documents and to allow those treating you to view selected documents.
For the transitional period in 2021, it is important that patients think about which doctor will give them permission to upload treatment documents before they are granted access.
For example, if you do not want other doctors to have access to psychiatric treatment documents, you should only have these treatment documents entered in the ePA when the fine-grained selection option is available from 2022.
How and where is the data stored?
Your ePA data is stored and encrypted centrally on servers in Germany. The servers are highly secured and are subject to European data protection regulations. Each data processing step in a file is carried out within the protected data centers in a further secured area, the so-called Trusted Execution Environment (VAU).
How secure is the electronic patient file?
The protection of your personal health data has the highest priority. The data security requirements of the ePA are therefore very high. The content is encrypted so that no one but you and those authorized by you can read the content.
Before a provider can offer an ePA, an extensive certification process must be completed in accordance with the specifications of Gematik GmbH. The file may only be offered after the assessment has been successfully completed. The certification process is repeated in the case of security-related changes.
The ePA is accessed via the telematics infrastructure, a secure, self-contained network.
All activities in your ePA are logged and can be viewed by you for three years from the activity. By logging the activities in the ePA, unauthorized access could also be traced.
In order to ensure the best possible data security, it is also important that you carry out the security updates on your mobile phone regularly. In addition, it is necessary for medical practices to maintain a high data security standard for their own EDP.
important terms
- Gematik : The company for telematic applications of the health card mbH, founded in 2005, for the introduction and further development of the electronic health card and its infrastructure. Shareholders are the Ministry of Health, the Central Association of Statutory Health Insurance Funds, Medical Associations, the German Pharmacy Association, the German Hospital Society and National Associations of Statutory Health Insurance (Dental) Physicians.
- Telematics Infrastructure : "Telematics" is a combination of the words "telecommunications" and "computer science". Telematics refers to the networking of different IT systems. The telematics infrastructure networks all players in the healthcare system. The secure exchange of information is to be guaranteed by a closed network to which only registered users have access.
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