E-prescription and patient file: Digital medical history at the touch of a button

The Bundestag has launched e-prescriptions and electronic patient files for everyone. How is that supposed to work? How will this reform the healthcare system? And what is problematic?

Doctor’s letters sent by fax, folders full of findings, X-rays on CD: the healthcare system in Germany is still in the 20th century. That should change. The Bundestag has passed two laws that are intended to give a boost to digitalization. The central components are the establishment of electronic patient files for everyone and the implementation of e-prescriptions. What is it about and what are the problems?

What does she want? Federal Government concrete?

Federal Health Minister Karl Lauterbach has announced a digital strategy: The “Law for the Improved Use of Health Data” is intended to give a boost to medical research in Germany – through simplified use of health data in research and the pharmaceutical industry. The “Digital Law” is intended to bring about a breakthrough for electronic patient files and e-prescriptions.

What does the new law mean for electronic prescriptions?

People in Germany filled almost 500 million prescriptions last year, most of them on paper. That should change: The e-prescription should become a binding standard in drug supply on January 1, 2024. Instead of the usual pink slip, patients receive a code on their cell phone or electronic health card that they can use to pick up medication at pharmacies. The prescription should also be able to be redeemed via the app.

What does the e-file bring to patients and doctors?

A patient’s entire medical history could be viewed in the file at the touch of a button – from treatments, operations, preventive examinations, X-rays to prescribed medications. The big advantage: Doctors treating new patients could immediately see what has been done so far, where the risks lie and additional precautions make sense. When prescribing medication, they could also identify whether there is a risk of undesirable interactions with other medications.

Where is the patient file located so far?

Since the beginning of 2021, insured people have been able to use the electronic patient file (ePA) on a voluntary basis through offers from their health insurance companies. According to Federal Health Minister Lauterbach, only less one percent of the approximately 73 million people with statutory health insurance have done this so far. The reason is complicated registration procedures and sometimes immature apps for use.

How does Lauterbach want to change that?

Instead of having to actively apply for an ePa, those with statutory health insurance should receive it automatically at the beginning of 2025. This should only be avoided if you expressly object (opt-out). Lauterbach assumes that not many insured persons will reject the e-file. A similar approach in Austria showed that only “about three percent objected,” said the SPD politician.

Who decides what is stored?

The data belongs to the patients. You can therefore also determine which data is stored in the ePA and which should be deleted again. For example, if you don’t want the dentist to see the psychological diagnosis, you can block this. Patients can also decide that the doctor only writes into the patient file, but does not see what is already contained there.

The law explicitly states that when registering HIV infections, abortions or mental illnesses, doctors must inform their patients about the possibility of objections to the documentation of this data.

Who transfers the previous patient data?

The law obliges doctors to enter medication data, doctor’s letters, discharge letters and diagnostic reports into the electronic file as standard. You can also add further information, including from previous treatments – if this is necessary and the insured person requests it.

Against this background, the federal chairwoman of the General Practitioners Association, Nicola Buhlinger-Göpfarth, criticized poorly functioning data transmission and retrieval technology. The federal government must now “guarantee without any ifs and buts that the technology runs smoothly,” demands Buhlinger-Göpfarth.

Can my data be used by pharmaceutical companies?

Yes. One goal of the reform is to give pharmaceutical research in Germany a boost by making patient data available on a large scale. However, the data is given pseudonyms and can no longer be directly assigned to the patient. Lauterbach assures that “no misuse of this data is possible.”

Why does Lauterbach want the data for research?

The Federal Minister of Health is of the opinion that Germany has fallen dramatically behind in cancer research due to data protection reasons. Health data is currently the most important source for new research, said Lauterbach.

The SPD politician emphasizes that there is already a huge amount of data in Germany, but it is in separate silos and cannot be linked to one another. However, patients should be able to expressly object to the use of their data from the electronic patient file for research purposes.

What about people who don’t use apps?

You could still benefit from the advantages of electronic patient records, even if you cannot access the data via the app from anywhere. Because it would be available from the doctor. The e-file can also be used via a desktop computer or viewed in selected pharmacies.

What concerns are there?

From the perspective of the Federal Data Protection Commissioner, too many questions remain unclear when it comes to electronic patient files. For example, how patients can block their data. Patient advocates want people to continue to have to actively consent to receive an electronic patient file.

When it comes to using health data for research, critics are concerned with the extent to which pseudonymized data can be assigned to specific patients. It is also controversial whether the consent of the insured person to use data only applies to certain research projects or to all research projects.

What improvements are planned for telemedicine?

Telemedicine should become an integral part of healthcare. Video consultations in particular should be used even more extensively and made easier to use. To this end, the current limitation on video consultation hours will be lifted in a first step. The video assessment to determine the need for care is introduced. “Assisted telemedicine in pharmacies” will also be possible in the future.

How are things going so far? digitalization of Healthcare?

The digitalization of the healthcare system has so far been quite slow. From the perspective of Federal Health Minister Lauterbach, Germany is a developing country in this area and needs to catch up. The minister is convinced that there will only be noticeable progress if the measures bring a noticeable benefit to patients, doctors and other health professionals.