Electronic health records (ePA) and e-prescriptions in Germany

Young man sitting on couch with smartphone

The digitalization of the German healthcare system has picked up speed in recent years: People with public (“statutory”) health insurance have the option of using electronic health records (elektronische Patientenakte, or ePA). That way, documents like medical findings and doctor’s reports can be kept together in one place. Prescription medications are mostly prescribed electronically now, too.

The use of electronic health records started in 2021 on a voluntary basis. As of January 2025, these records are gradually being generated automatically for everyone who has public health insurance in Germany. A number of private health insurers offer this option too.

The goal of the ePA is to improve medical care by making it easier to access important health-related information at any time. The current version doesn't yet include all of the features planned for it – these are still being added step by step. Doctors' practices, psychotherapy practices, hospitals and other healthcare providers are also still preparing to routinely save medical findings, doctor’s letters, treatment plans and other medical documents there.

The use of the ePA remains voluntary and free of charge for all insured people. If you don’t want to have an ePA, you can opt out by letting your health insurer know. You can also determine which information is to be saved there and who is allowed to access it.

Since January 2024, prescription-only medications have mostly been prescribed electronically in the form of e-prescriptions. Known as an E-Rezept in German, these have largely replaced the pink-colored paper slips. E-prescriptions can be handed in using your electronic health insurance card (EHIC), a smartphone app, or in the form of a paper printout. Some private health insurers also issue e-prescriptions.

What are electronic health records for?

Up until now, documents with information about diagnostic tests, diagnoses and treatments have been stored in many different digital systems or even in paper files. Some were kept by family doctors or pediatricians, others by psychotherapists or medical specialists, and sometimes patients took documents home with them. So it’s not always easy to access all of the necessary information when needed.

Electronic health records allow all of the important information to be kept together in one place. This should help to improve health care when the records are filled with more and more information:

  • Doctors can get a detailed picture of your current health without having to request documents from other practices first – and without you having to look for paper documents at home and then remember to bring them along to your appointment.
  • You can avoid having diagnostic examinations done too often, and doctors in different practices can coordinate your treatments better.
  • If you go to a new doctor, it’s easier for them to get an overview of your medical history.
  • Doctors and pharmacists can advise you better because they can see what other medications you are taking and point out possible drug-drug interactions. They can also see if you have any allergies.
  • It is easier to get a second medical opinion because much of the information needed for that is already available.

Important documents can’t get lost either – unlike paper documents.

Doctors and psychotherapists still have to make a written record of their diagnoses and treatments, regardless of whether these are stored in the ePA.

What information is kept in electronic health records?

Doctors, psychotherapists and other healthcare professionals can store the following kinds of information in your electronic health records:

  • Test results, medical findings and diagnoses
  • Your treatments
  • Doctor’s letters
  • Surgical reports and hospital discharge letters
  • Your prescribed medication (medication list)
  • Photos (for example, of wounds)

Specific information that could be useful in medical emergencies can be kept there, too – like information about allergies, any chronic illnesses, and who to contact in an emergency.

Electronic sick leave certificates (Arbeitsunfähigkeitsbescheinigung, or eAU) can be stored there, too. Your health insurer will keep a billing summary there as well, with information on all the healthcare services you have made use of.

You can also add documents to your electronic health records yourself, such as

  • existing medical documents – for example, you can scan past medical findings and save them there
  • health diaries, like notes you've made about pain, your blood sugar or blood pressure over time
  • data taken from apps that track your fitness or other aspects of your health

But the ePA is still a work in progress. So far it has not been possible to save image files like x-ray scans because they are too big. Future plans include keeping digital versions of certificates (Impfpass), maternity records (Mutterpass), dental check-up records (Bonusheft) and children’s check-up records (U-Heft) in the ePA.

Important:

You can decide which data is to be kept in your ePA – and which contents should be deleted.

How do you manage your electronic health records?

You can manage your ePA with your health insurer's app on your smartphone or tablet. Each public health insurer provides their own ePA app with instructions on how to set it up and use it. There is an overview of these apps here (in German).

Parents or other legal guardians manage the ePAs of children and teenagers up to the age of 15. A conservator can do this for adults who are unable to manage their own affairs.

If adults can’t manage their ePA themselves (for example, due to illness) or they don’t have a smartphone, they can give one or more trusted people access to their ePA. That way, friends and family who live far away can still help out. They do not need to have the same health insurer as the person whose ePA they are managing. They only need their own health insurer's ePA app. That allows them to manage the other person's ePA, but they can't delete it or appoint other representatives. You can also manage another person's ePA without having an ePA yourself.

If you can't or don't want to use an ePA yourself, you can also allow only your doctors to save data in it and use it.

In the future, all public health insurer ePA apps will also be accessible from desktop computers and laptops, and not just from smartphones or tablets.

If you have any questions about using the ePA, you can contact your health insurer's ombudsperson's office (Ombudsstelle).

Who has access to your electronic health records?

If you haven't raised any objections, the following places and healthcare professionals automatically have access to your ePA for 90 days as soon as they have scanned your health insurance card:

  • Doctors’ and psychotherapists’ practices
  • Hospitals
  • Nursing homes and nursing care staff
  • Midwives
  • Facilities for certain types of treatment known as "Heilmittel" in Germany, such as practices for physical therapy or occupational therapy

Pharmacists and paramedics are given access for three days. Company doctors and public health institutions (such as public health offices) also have access for three days – but, unlike other users, they first need to ask for your consent.

Different users are authorized to do different things in the ePA. Some can generally see all of your information, and can save or delete any kind of documents. Doctors' and psychotherapists' practices, hospitals, rehabilitation centers and public health institutions can do this. The rest are not able to see all the information, and they can only save or delete certain documents. For instance, nursing homes can only create and delete documents concerning nursing care. They are not able to see some data, such as copies of treatment documentation, electronic sick leave certificates or records of your willingness to donate organs.

You yourself can view and delete any of the data in your ePA, and you can also add some documents. Health insurers and long-term nursing care insurers do not have access to the information in your ePA, even though it is the health insurers who provide the ePA apps.

Important:

You can decide who can access your ePA. It is possible to deny access for individual practices or institutions, or to hide certain documents from them (see below: What are your objection options?).

You can also use the ePA app to specify the period of time during which different people can access your electronic health records. For example, you could give your family doctor’s practice full access with no time limit – but allow a certain specialist to only see specific documents on one particular day.

How is your data protected?

All of the information in your ePA is stored there in an encrypted form, in accordance with the latest technical standards. It is only possible to access the ePA through a special secure digital network known as the “telematics infrastructure” (TI). Doctors' practices, hospitals, pharmacies and other healthcare providers in Germany are connected to this network. ePA apps run via the TI network as well. Any software like this that is used in the TI must meet high data security standards.

All activities in the ePA are recorded in a log. The log is saved for three years. That way, you can see who has accessed your data. The other data in your ePA doesn't have to be deleted after a specific amount of time, so it can be stored for a lifetime.

It is likely that starting in mid-2025, data from electronic health records will be shared with the Health Data Lab at the German Federal Institute for Drugs and Medical Devices (BfArM). This will be done in "pseudonymized" form so the data they receive can’t be linked to you. A code might be used instead of your name, for example. Your data can then be included in scientific research – for instance, to find out more about current healthcare practices in Germany. If you don't want your data to be used in this way, you can object to it.

What are the risks associated with using the ePA?

Whether the ePA actually improves health care – and by how much – depends on how complete and correct the information in it is. If the stored data is incomplete or out of date, or if you have deleted information or blocked it for certain people, it will not always be possible to get a full picture of your illnesses and treatments based on the ePA.

Some people worry that ePAs could lead to discrimination or stigmatization – for example, if those treating a person can see that they have mental health problems, an addiction or AIDS.

Despite the high data security standards, there's no absolute guarantee that the stored data won't fall into the wrong hands – because of a data leak or cyber attack, for instance. If you use the ePA app, it's important to carry out the updates regularly on your smartphone or tablet in order to keep your data safe.

ePA data is sent to the Health Data Lab in a form that can't easily be linked to individuals. But there's still a small chance that people may be identified, especially if they have a rare disease. The research projects are carried out in a way that aims to prevent individuals from being identified through the analysis of their data, and the researchers are obliged to keep the information confidential. They can be punished if they don't.

What are your objection options?

People with public health insurance in Germany have the right to object to various aspects of the ePA:

  • Setting up or using the ePA: If you do not want to have an ePA set up for you, you can tell your health insurer that you object to it. If you already have an ePA, you can have it deleted. To do that, you object to further use either by contacting your health insurer or using the ePA app. All stored data is then also deleted.
  • Access rights: You can deny individual users access to your ePA – for example, if you don't want a certain doctor's practice to view it. You can do that by changing the settings in the ePA app or by contacting your insurer's ombudsperson's office. The ePA app also allows you to limit certain users' access to a specific window of time or specific documents.
  • Saving documents: If you don't want certain treatment-related documents to be saved in the ePA, you can say so directly at the doctor's practice or hospital.
  • e-prescription data: If you don't want information about your e-prescriptions to be automatically fed into your ePA, you can object in the ePA app or by contacting your insurer's ombudsperson's office.
  • Storing data from your health insurer: You can contact your health insurer to object to them saving information in your ePA about the treatments and other medical services they have paid for you.
  • Sharing of data with the Health Data Lab: As of July 2025, it should be possible to object to this using the ePA app or by contacting your insurer's ombudsperson's office.

You can withdraw objections at any time.

What is an e-prescription?

Since January 2024, prescription-only medications have mainly been prescribed electronically in the form of e-prescriptions (eRx). But paper prescriptions can still be issued – for instance, if there are technical problems or during a house call.

The idea behind e-prescriptions is to save time and effort: For example, you can get repeat prescriptions without going to your doctor’s practice – as long as your health insurance card has already been scanned in the practice during that billing quarter. Doctors can issue e-prescriptions during online consultations, too.

The e-prescription data is automatically saved in a medication list in your ePA, unless you object to it. In the future, the e-prescription data should make it easier to use other features in the ePA like the medication schedule. This includes additional information such as instructions on how to use the medication and in what doses.

Some practices can already issue e-prescriptions for non-prescription medications or for "private" prescriptions (which are not paid for by public insurers). In future, you should be able to get e-prescriptions for narcotic drugs, certified digital health applications (DiGAs), as well as special therapies and medical aids known as “Heilmittel” and “Hilfsmittel” in Germany. Digital referrals to specialists’ practices should be possible as well.

How can you hand in an e-prescription?

If you have an e-prescription that is issued in Germany, you can use it at pharmacies all over Germany. There are several ways to do this:

  • Health insurance card: The pharmacy can access your e-prescription by scanning your health insurance card.
  • E-prescription (“E-Rezept”) app: You can install this app on your smartphone and then log on to the app using your health insurance card and the PIN that goes with it. Using the prescription code in the app, you can go to a pharmacy and get what has been prescribed for you there. Alternatively, you can order it online from a pharmacy by using the app at home.
  • CardLink: This approach also allows you to use an e-prescription from home with your smartphone. To do this, you need an electronic health insurance card that can use NFC (these cards have a radio wave symbol on them), an NFC-enabled smartphone, and a special app (e.g. the pharmacy's app). To order the prescribed medication from the pharmacy, you hold your health insurance card close to the phone. Then you receive a text message with a confirmation code.
  • Paper printout: Your doctor’s practice can print out an e-prescription code for you. This is then scanned at the pharmacy.

You can also hand in e-prescriptions for other people – either with their electronic health insurance card, the family function in the e-prescription app, or the printed-out prescription code.

Are e-prescriptions safe?

E-prescriptions are stored securely and encrypted several times in the telematics infrastructure (TI). Unlike prescriptions on paper, you can’t lose, damage or fake them.

The e-prescription is signed digitally by the doctor’s practice that issues it. The only people who can access it are you, a person who you have authorized to do so, and pharmacists. It is automatically deleted 100 days after you have handed it in.

Bundesministerium für Gesundheit (BMG). Die elektronische Patientenakte für alle. 2024.

Bundesministerium für Gesundheit (BMG). Fragen und Antworten zum Elektronischen Rezept (E-Rezept). 2024.

Der Bundesbeauftragte für den Datenschutz und die Informationsfreiheit (BfDI). FAQ zum E-Rezept. 2024.

Gematik. Das E-Rezept für Deutschland. 2024.

GKV Spitzenverband. ePA für Alle – Informationsmaterial nach §343 Abs. 1a SGB V. 2024.

Kassenärztliche Bundesvereinigung (KBV). Telematikinfrastruktur. 2024.

Verbraucherzentrale. Elektronische Patientenakte (ePA): Digitale Gesundheitsakte für alle kommt. 2024.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Created on December 18, 2024

Next planned update: 2027

Publisher:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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