Version 3.0 of the electronic patient record (ePA) is causing a stir in Germany. While the Federal Health Ministry does not tire of emphasizing its advantages, there are still many unanswered questions. Everyone with statutory health insurance, including children, should receive an electronic patient file by mid-February – provided there are no objections. From the age of 15, young people can object themselves, and for younger children their parents can object.
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Donald T. loves TikTokBut doctors and psychiatrists see problems that have not yet been adequately addressed. In the past, medical representatives had already criticized the fact that children should automatically receive EPA and that there were legal ambiguities in this regard.
Pediatricians and teens are calling for opt-in
According to the Professional Association of Pediatricians and Adolescents (BVKJ), one of the unanswered questions concerns filling out the EPA when legal guardians express different wishes regarding the storage of their children’s data. It is also not clear whether parents’ objections are enough to warrant not creating an EPA. The association considers it problematic that the data of young people under the age of 15 is not protected. Legal guardians may gain insight even if young people express a legitimate interest in not informing their parents, for example when seeking contraceptive advice.
BVKJ also criticizes (PDF) That doctors are required to fill children’s EHRs with sensitive data that could lead to stigma or discrimination. Even if the doctor is convinced that it is not in the child’s best interest. BVKJ President Michael Hubmann emphasizes that he would advise parents and patients to carefully consider the decision regarding their participation in EPA until the problems outlined are resolved. Their demand that the request not be stored, even if it is expressed only by a parent or a child over 14 years of age, must be taken into account.
The demands of the BVKJ are also supported by others, including the Bavarian Association of Statutory Health Insurance Physicians. The Lower Saxony Association of Statutory Health Insurance Practitioners had also pointed out in the past the possibility of conflicts in practices. At a representative meeting of the National Association of Statutory Health Insurance Practitioners (PDF), a proposal was recently passed that would require the EPA to switch from an opt-out to an opt-in model for minors. They also require that billing and diagnostic data be viewable only by the insured person and made available to other persons providing treatment if necessary.
Uncertainty regarding access options
As long as there are still uncertainties, for example especially regarding the options for children to access and view electronic patient files, those responsible should leave the opt-out changes in place for the time being,” the Federal Association of demands Chairman Mathias Heinicke. Contract psychiatrists and experts on digitalization and data protection issues have not yet commented on the demands.
According to Heinicke, the potential for conflict among practices is very high. For example, it is possible to have family coverage for a child through a non-custodial primary insured (e.g., the mother’s new partner) who does not have custody but who still provides coverage for the child. Is responsible for the EPA. Although these and similar cases are exceptions, the potential for conflict remains. As early as 2024, the association had already called for an opt-in for children in the electronic patient file.
inadequate education
According to the results of an analysis of health insurance companies’ information sheets, medical associations are demanding that health insurance companies inform their insured persons about the EPA more extensively than before. Consumer advocates have also recently advisedThe medical associations MEDI Jeno Deutschland and MEDI Baden-Württemberg also warn about the dangers arising from insufficient information to patients about the risks of EPA. They criticize the fact that some health insurance companies primarily look after their own interests when informing their insured persons. Many health insurance companies provide information mainly about the benefits of EPA in their letters, while topics such as data protection are not addressed. According to MEDI boss Dr. Norbert Smatek with feedback from his patients.
“We psychiatrists in particular have to deal with particularly sensitive health data,” explains Dr. “Uninformed patients will not adequately protect their health data. This means we have to provide even more information, which Hardly possible in a caring situation.” Christian Messer, Vice President of Medi Zeno Germany. According to Messer, the duty of confidentiality is also breached by the EPA: “If the results are accessible to temporary assistance at the pharmacy in the future, it would not be clear who is liable in the event of a breach of the duty of confidentiality.”
The threat of commercialization of health data
MEDI also warns of the potential commercialization of health data. Federal Health Minister Karl Lauterbach reinforced concerns at the Bitcom digital health conference when he reported on the interest of IT giants such as Meta, OpenAI and Google in German health data. Medi boss Dr. Norbert Smetak emphasizes that this data is collected exclusively for treatment purposes. Legal clarification of the “right to dispose of pseudonymised health data” is therefore required.
(Mac)
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