ePAs: The Digital Future of Healthcare Coming Soon Nationwide
Wide-scale Implementation of Digital Patient Records Imminent - Expanded Electronic Health Records for Wider Implementation
Electronic Patient Records, or ePAs, have already made their way into daily medical practice for some, but now, they're set to expand throughout Germany beginning Q2, starting in April. Although the exact dates are yet to be announced, this digital evolution in healthcare is officially on the horizon. Here's what patients can expect, and an inside look at a family doctor's experiences in Nuremberg.
How's the rollout shaping up?
As of January 15th, about 70 million insured individuals in Germany have received their ePA from their health insurance company. Initial tests in three regions are revealing some hiccups, but a nationwide roll-out is soon to follow, according to Managing Health Minister Karl Lauterbach (SPD). He anticipates a ramp-up phase beyond the model regions in the coming weeks. After a thorough testing of the previous phase, a broader testing phase on a voluntary basis for doctors will follow.
The countrywide implementation follows the principle: "Safety first." Electronic patient records were introduced in 2021 as an optional service but were sparsely used. In response, the traffic-light coalition reversed this approach with a law - now everyone will receive an ePA unless they specifically opt out.
What information will be stored?
The ePA is intended to accompany insured individuals throughout their lives. Collecting essential healthcare information like doctor's letters, findings, laboratory values, and prescribed medications, the digital storage can be accessed by practices, clinics, and pharmacies when insured persons insert their health insurance card into a reading device. Access is limited to 90 days, and insured individuals can use their smartphone app to revoke access rights or specify which doctors should have access for how long. They can also upload self-recorded documents such as blood pressure diaries or past diagnoses.
Practice experiences
300 medical practices, pharmacies, and clinics in the three model regions - Hamburg and the surrounding area, Franconia, and parts of North Rhine-Westphalia - are already testing the ePA in daily practice. Dr. Nicolas Kahl's Nuremberg family practice is among them. According to him, it's still not all smooth sailing, but it's stable. Currently, Kahl and his team can upload PDF files, such as EKG or lung function test results, to the ePA, with all e-prescriptions being automatically stored.
Since the pilot phase began, the number of ePA accesses has significantly increased - over 276,000 in the past week alone, with medication lists being called up almost 69,000 times. Approximately 3.5 million e-prescriptions are routinely fed into ePA every day, according to the ministry.
What's the criticism?
Regional Associations of Statutory Health Insurance Physicians (KV) in the model regions point out that it's still premature for a nationwide launch. Technical issues and challenges in integrating the ePA into practice workflows are persisting, they report. In certain cases, access to electronic records cannot be granted, or there are lengthy loading times. The KV in Bavaria also sees no progress in rectifying these problems. The acceptance of doctors and insured persons could suffer if the ePA is launched too soon, they caution.
What advantages will the ePA offer?
Experts believe that ePAs can enhance treatment by allowing doctors to see the findings of other doctors and avoid chasing test results, saving time and preventing duplicate treatments. According to family doctor Nicolas Kahl, this is especially helpful when treating patients they are unfamiliar with, or when patients are unable to provide their medication information. "It will be worth it in the long run," Kahl assures, although it will take months, if not years, to see its full benefits. Only findings and medications set or prescribed post-ePA implementation will be included in the electronic records. Patients will need to upload older diagnoses or prescriptions themselves if they want to store them in their ePA, with a maximum of ten documents per year allowed.
User acceptance
Approximately 4% of AOK's 27.49 million insured individuals have objected to the ePA, while 7% of Techniker Krankenkasse's 11.9 million insured individuals have done so. In Dr. Kahl's practice, only a small number of patients have expressed reservations. "It's in the single-digit percentage range," Kahl explains. Those apprehensive about the ePA often have fears about data security or discomfort with their healthcare provider accessing their records, he notes. However, most patients appear unconcerned, as they haven't even noticed they have an ePA yet, according to Kahl.
How secure is the data?
Computer specialists and various healthcare organizations raised concerns about potential security gaps allowing unauthorized access to ePA records before the testing phase began. Lauterbach asserts that security problems for mass access have been resolved. Nevertheless, Bianca Kastl and Martin Tschirsich from the Chaos Computer Club continue to question the effectiveness of the security measures, citing persistent vulnerabilities despite updates. "The promised updates are merely an attempt to mitigate the damage from one of the many attacks we've demonstrated," as stated by Kastl. "Electronic patient records can still be attacked with little effort."
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- The ePA rollout in Germany, starting from April, aims to expand the use of electronic patient records nationwide, following a ramp-up phase beyond the model regions.
- As insured individuals access their ePAs, they can store essential health information such as doctor's letters, medications, lab values, and EKG or lung function test results, which can be retrieved by healthcare providers and pharmacies using the health insurance card.
- Although some technical issues have been reported in the testing phase, critics warn against a premature nationwide launch of ePAs, citing concerns about data security and the need for smoother integration into clinical workflows.
