2024-10-28 15:10:00
Those who have public health insurance currently receive mail from their health insurance company: in January 2025 the electronic medical record will begin for all those who do not object. All health data in one virtual place: does it make sense or is it risky? A decision aid for those who are undecided.
Doctor’s letters and tests, blood values, medication plans, dental treatments or even the date of the last tetanus vaccination: an electronic health record (ePA) will soon be automatically created for all public health insured people who do not actively object.
Such data can gradually be stored in this. What is the purpose of all this, who decides what gets stored there, and what concerns are there?
Where is this file created and what is stored in it?
According to consumer advice centers, the file, documents and data it contains are stored and encrypted centrally on servers in Germany. The requirements for data security are very high. Technically this works via the so-called telematic infrastructure, an autonomous network to which healthcare workers are connected.
According to the Ministry of Health, only insured people and those to whom they have authorized access can read the contents of the electronic medical record. Insured persons decide for themselves what exactly is stored there, also in consultation with their doctor.
How does it work in practice?
Via a smartphone app from the respective health insurance company. This allows insured persons to store their documents in the file themselves, for example by scanning and uploading reports or old laboratory results. You can also create self-managed diaries with blood pressure measurements. During your visit to the doctor, the doctor fills out the chart with the results of current treatments using the computer in his office.
Health insurance companies also upload the services for which they were billed into the file. This way it is clear in black and white when a doctor was visited, what diagnosis was made there or what medications were prescribed and when. The electronic medical record for all those who do not object will begin in mid-January 2025.
What’s the point?
An example: pensioner X moves from the city to the countryside, needs a new family doctor and enrolls in the new practice. Your medical card is inserted into the reader, the practice can see your electronic medical record, and the new doctor can see what treatments X has already received or what medications you are taking.
This could also be useful in an emergency if X had to go to hospital. Doctors could identify pre-existing conditions in the electronic medical record or better exclude possible interactions during drug administration if they see which drugs X otherwise takes regularly.
As soon as my health card is inserted into a reader, am I an open book?
Depending on the settings in the app. There, insured persons should be able to decide for themselves which document is visible to whom. This can be done, for example, using sensitivity levels: a document in the e-file is marked as enabled for everyone who has access by inserting the chipcard, or it is only enabled for certain doctors or marked as blocked so that only the patient himself can see it. “At any time you can view, insert, delete or hide content, grant or limit access rights and raise objections,” the consumer advice centers say.
What other advantages does the electronic medical record have?
Transparency and greater information for patients because they have an overview of their health data. The data could also make it easier to get a second opinion or ask more specific questions of the doctor. It is also stated that duplicate examinations could be avoided. Reference is also made to opportunities related to artificial intelligence.
But what if I prefer not to have an electronic file?
If you don’t want the electronic record you have to actively oppose the health insurance company, then it won’t even be set up. However, it should be possible to delete an already created file again at a later time.
There is criticism that checking the file via a smartphone app may discourage older people or those who are not very tech-savvy. In this case, interested parties can nominate a trusted person who will take care of the technical support of the case for them. In any case, if the dossier is not contradicted, it exists without any intervention on your part and is then compiled mainly by the treating doctors.
Sensitive health data stored centrally: Isn’t it risky?
In the digital space, there is always a risk of data theft and hacker attacks, so the use of such technologies always remains a personal consideration. The umbrella association of public health insurance companies (GKV) emphasizes that the data processing in the electronic health record takes place “in a security-tested and reliable technical environment at the highest level”. The apps are also “safety tested to the highest standards.”
However, Federal Data Protection Officer Louisa Specht-Riemenschneider recently criticized the opposition solution at a discussion event at her company, i.e. that everyone automatically receives an electronic file unless they object: this is a decision policy from a data protection perspective one would have been happier with a consent-based solution. “Then we would have had a self-determined decision for patients and a legitimacy under data protection law that would have been accepted by the general population.”
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Interview between Time.news Editor and Health Data Expert
Time.news Editor (TNE): Welcome to our special segment where we delve into the latest developments in public health and technology. Today, I’m thrilled to be speaking with Dr. Lena Meyer, a renowned health data expert, about the upcoming launch of the electronic medical record system in Germany. Thank you for joining us, Dr. Meyer!
Dr. Lena Meyer (DLM): Thank you for having me! I’m excited to share insights on this important topic.
TNE: The electronic medical record, or ePA, will be automatically created for public health insurance members in January 2025 unless they opt-out. What excites you the most about this initiative?
DLM: The most exciting aspect is the potential for enhanced patient care. By having all health data in one accessible place, patients and healthcare providers can make informed decisions quickly. This can improve the coordination of care, especially for patients moving between different healthcare providers.
TNE: That sounds promising! However, with all health data stored in one virtual place, some might feel concerned about privacy. How secure is this data?
DLM: The data will be stored and encrypted on servers in Germany, adhering to strict data security requirements. The telematic infrastructure ensures that only authorized personnel can access this information. Patients themselves can control who sees what by adjusting their app settings.
TNE: Could you elaborate on how patients can manage their data visibility?
DLM: Certainly! Patients can designate specific documents as visible to all their healthcare providers, limit access to certain doctors, or even keep certain information completely private. This level of control empowers patients to manage their own health data actively and transparently.
TNE: It sounds like the system allows for a more personalized approach. Could you share an example of how this might help someone in a real-world scenario?
DLM: Absolutely! Take, for example, a pensioner moving from the city to a rural area. When they visit their new doctor, that doctor can simply insert their health card to access their electronic medical record. This allows for immediate insight into their medical history, which saves time and ensures continuity of care. If they were to have a sudden medical issue, the doctor could quickly identify pre-existing conditions and any medications that could potentially cause interactions.
TNE: That’s a significant advantage, especially in emergency situations. But what if someone prefers to keep their records off the digital grid? How can they opt-out?
DLM: If someone wishes to opt out of the ePA, they simply need to express their objection to their health insurance company. It’s important to note that opting out is an active choice—they should not be automatically enrolled.
TNE: Let’s touch on a concern raised by critics. Some argue that the benefits of ePA data might lead to over-reliance on technology or issues with data accuracy. How do you respond to that?
DLM: Those concerns are valid. It is essential for healthcare providers to maintain their clinical judgment and not rely solely on electronic data. Regular training and updates on data entry accuracy are crucial to minimize errors. We must also design the ePA to complement personal doctor-patient interactions, not replace them.
TNE: And what role do you see artificial intelligence playing in this new health data landscape?
DLM: AI could contribute significantly by analyzing health data trends, identifying potential health issues early, and even assisting in creating tailored treatment plans. However, as with any new technology, we must proceed with caution, ensuring that ethical standards are upheld and that human oversight remains paramount.
TNE: Dr. Meyer, thank you for your insights into the electronic medical record system. It’s clear that while challenges remain, the potential benefits for patients and healthcare providers alike are substantial. We look forward to seeing how this develops in the coming months!
DLM: Thank you, and I hope to see a successful roll-out that empowers patients and enhances healthcare delivery!