ePA 2026: Digital Patient Records Become Standard via Opt-out Procedure

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Germany's electronic health record system is undergoing a major change starting in 2026. The acquisition of the ePA, previously voluntary, becomes mandatory for all legally insured individuals (Opt-out). Individuals who wish to object can do so free of charge and without needing to state a reason by contacting their health insurance fund. This ePA aggregates various data types digitally, including doctor's letters, lab values, X-ray images, vaccination records, and maternity passes. Technically, the system is based on the Telematics Infrastructure (TI), a network separated from the public internet. All data are end-to-end encrypted and stored in the machine-readable standard HL7 FHIR. This enables seamless data exchange between practices, pharmacies, and hospitals, allowing for algorithms to automatically detect drug interactions. The Patient Data Protection Act prohibits the commercial use of this data or access by employers and life insurance companies. It is expected to particularly benefit chronically ill patients, as specialists can directly access prior findings. Future developments include connecting wearable devices and enabling AI analysis using anonymized data.