Electronic patient record: From shelf warmer to longterm bestseller?

Since January 1st, 2021, the electronic patient record (ePA) has been available free of charge to all people with statutory health insurance through their own health insurer. Over the course of a year, the new digital health platform has undergone constant development, but has hardly been able to attract any new users. Very few of the 73 million people with statutory health insurance seem to be aware of the existence of the ePA, which is also reflected in the current user figures: According to gematik, only half a million insured people use the digital tool to manage their health data. For this reason, the electronic patient record has long been described by the media and healthcare experts alike as a “shelf warmer” in digital healthcare. This diagnosis raises several questions at once:

  • What is the reason for the low user activity of the ePA?
  • What advantages can the digital record offer us currently?
  • What does the ePA need to become a longterm bestseller in healthcare?

Stagnant utilization: what's the ePA missing?

Limited functionalities

Probably the most important and obvious reason for the low usage of the ePA is its still limited functionalities. Despite initial add-ons integrated on January 1st 2022, the digital record is still under construction. At present, patients can only store data from existing applications and documentation in their ePA, such as emergency data, medication plans, doctor’s letters, medical reports or X-rays (expansion stage: ePA 1.1). It will also be possible to store vaccination cards, maternity records, children’s examination booklets and dental bonus booklets from the beginning of 2022 (expansion stage: PA 2.0, 2022). However, the integration of new data sources (e.g., DiGA data from 2023) and the possibility of releasing data to the German Research Data Center (FDZ) are likely to make things more interesting for many insured persons and physicians (expansion stage: ePA 2.5, 2023).

Lack of Awareness Campaigns

Another reason for the low utilization of the electronic patient record is the near complete lack of public attention it has received to date. A representative survey conducted at the end of 2020 by the market research institute Consumerfieldwork shows: Even shortly before the official launch of the ePA, around 4 in 10 insured people had never heard of the electronic patient record. Only 9.4 percent of respondents – and thus only one in ten of those with statutory health insurance – had knowledge of how the record worked at that time and associated it with actual added value for their healthcare. In view of the current user figures, this communication gap between associations, health insurers, physicians and their insureds, as well as patients, does not appear to have been closed to date. The lack of educational campaigns will inevitably have an impact on the widespread integration of the electronic patient record.

The key to patient relevance: What does the ePA need?

Given its current stage of development, the ePA is not yet the central element of healthcare that it should be one day. But that is precisely why it makes sense to explore the question of what the ePA can be in the future and what use cases might develop around this hub of patient care.

Innovative value-added functions

In the search for ePA functions that create added value for their potential users, it is worth taking a look at the additional functions that some health insurance companies are already making available to their policyholders. Barmer, for example, offers its customers the “Mediplaner” function in its “eCare” electronic patient file, which is designed to manage the intake of medication and plan it using a reminder function. In addition, eCare offers the option of keeping a variety of health documents digitally, including the vaccination, emergency, allergy, eyeglass and X-ray passports.

TK has also added interesting features to its version of the electronic patient file, TK-Safe, which should significantly increase the relevance of the application for its users. For example, TK insurees can see in their ePA which vaccinations or preventive examinations are due. They can also view a constantly updated chronological overview of their periods of incapacity to work, medical treatments, vaccinations, hospital stays, medications and preventive services, as well as having access to a doctor’s directory containing an overview of all their treating doctors with all the necessary contact data.

ePA data as a basis for research and care

Looking at the electronic patient record as a future source of data also opens up interesting perspectives and is exciting from the point of view of users as well as researchers, industry and service providers. On the one hand, the data collected in the ePA can play a decisive role in the course of primary use, i.e. in the form of improved patient care. On the other hand, it could increasingly benefit medical research in the future (=secondary use), because pseudonymized data can be made available to the research data center via the ePA in the future. Patients are in possession of a valuable asset through their own ePA data and can gain autonomy over it. The possibility of (extended) data sharing by patients can thus become a significant incentive for increased use of the electronic patient record.

In the future, a wide range of possibilities and application scenarios – with or without a health connection – would be possible: be it to improve one’s own treatment, to earn money (see Use Case #1) or perhaps even to make it easier to find a partner (see Use Case #2).

Targeted education and communication

In order to bring the ePA to the insured and patients, targeted educational work is needed. This requires not only health insurers, but also physicians, hospitals, outpatient care providers, and health care associations and organizations. Statutory health insurers are already showing what information campaigns on electronic patient files can achieve. TK, for example, offers a big amount of information material both online and offline. Furthermore interviews with individual ePA users can be found, regarding the registration, use and further development of its own ePA, TK-Safe. Similar material can be found at many other public health insurers. However, in order to make the electronic patient file a permanent feature, the commitment of other players in our healthcare system will also be required.

No sooner said than done! As a supporting member, we therefore set up our own workshop on the topic of ePA in time for the Hashtag Gesundheit members’ meeting on April 22, 2022. As part of the event, we discussed use cases for the electronic patient record of the future together with the participating association members in order to make a joint contribution to the education of patients*, insured persons and young talents in the healthcare sector. At the same time, we use the controversial use cases to also evaluate privacy concerns and ethical issues regarding ePA use of the future.