There are many ambiguities with the new version of the electronic patient file (ePA 3.0) – and not only with regard to the announced start date, as participants at the tenth general meeting of the Free Medical Association in Berlin found out. The EPA is not yet functional, but should be delivered to 70 million patients. Therefore the term “dark green banana software”, considered mature in practice, is quite appropriate.
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Digital threats: EU Council approves cyber shield and early warning systemSpeakers at the event included former Federal Commissioner for Data Protection and Freedom of Information, Prof. Ulrich Kelber, and former head of the Institute for Quality and Efficiency in Health Care (IQWIG), Prof. Jurgenwickeller was involved. All participants criticized EPA’s transition to an objection-based resolution (opt-out).
Uncertainties regarding liability and data protection
However, very few insured people may have paid attention to what could happen to them with the electronic patient file – because contradictory information from the Federal Ministry of Health is in circulation. Only a few health insurance companies provide comprehensive information about version 3.0 of the EPA. EPA provides comprehensive access options to data for those involved in the remediation process. Silke Luder from the board of the Free Medical Association explained that pharmacies where prescription drugs are redeemed can basically see everything except the dental bonus booklet. At this year’s EPA summit it became clear that mail-order pharmacies are increasingly demanding access to patient files.
However, further questions arise regarding liability for doctors. Although the National Association of Statutory Health Insurance Practitioners emphasized that doctors are not required to read all the documents at the EPA, it is unclear how this will ultimately play out in court. They also criticized the fact that restrictions on seizure and the right to refuse to provide evidence for health data are not included in the Health Data Access Act. Data protection authorities had already criticized it in late 2023.
freedom of doctors
According to Wieland Dietrich, president of the Free Medical Association, confidentiality is “the basis of the indispensable relationship of trust between doctor and patient”. This requires “professional and, if possible, organizational independence of doctors”. This freedom is under constant threat. According to Lueder, the new regulations with EPA 3.0 threaten medical privacy, “which has been the basis of the doctor-patient relationship for 2,500 years.”
Wieland Dietrich, president of the Free Medical Association, described it as a “deadly misguided view” that doctors use patients’ health data to generate profits if necessary for financial reasons at the expense of privacy. For example, such incentive systems already exist in Book V of the Social Security Code Profitability Bonus, Which doctors get for “economic reasons and provision of laboratory services”.
Dietrich pointed out that the medical profession is becoming increasingly commercialized and guided by false incentives that may compromise independent action in the best interest of patients. The changes to Social Security Code V, which the head of the National Association of Statutory Health Insurance Practitioners recently described as a rapidly growing tumor, “are overdue not only in this area,” Dietrich said. “Telematics infrastructure continues to capture and disrupt processes in many practices. It serves a variety of business interests,” and its costs will rise to “much greater heights.”
leap of faith
According to recent statements by Health Minister Carl Lauterbach, Google, Meta and Co. will soon be allowed to train with health data. The fact that data from electronic patient records will be available to Big Tech for AI training in the future is causing an uproar. For diaperers, the EPA’s promised benefits are exaggerated and the health benefits are not yet known. The risks and side effects of EPA are also not discussed. Statements are circulating that cannot be verified or indicate that there is not a single concrete research project related to the EPA. He also quoted Matthias MeiweseHealth spokesperson for SPD: “EPA works with confidence in progress. Added value only comes with data.”
debate becomes taboo
“We want digitalization, but not like this,” declared Christian Messer, head of MEDI Berlin-Brandenburg. People have been waiting for “intelligent digitalization in the health care system” for a long time. There would be no benefits from EPA initially, “but there would be considerable risks,” Messer said. Legal status means a paradigm shift in medicine and medical treatment. Messer said, “Silence becomes consent. This is new. What’s worse, debate about it is becoming taboo. The lure of data and money is too great.” At the Federal Health Ministry, people are talking about the treasure trove of data that drug addiction exposes.
“Who cares about HIV, drug use, depression if you can make more money off this data?” And wouldn’t it be interesting if a woman with dual citizenship in Poland was arrested for having an abortion? “We have to be interested in all this, we have to care about it,” warned Messer.
Unnecessary double examinations as an argument?
Silke Lüder also expressed criticism of the promised benefits of the electronic patient file and pointed to open questions such as liability. She explained that she has been working with digital patient files for decades and that only a few duplicate exams can really be avoided by using existing documents. In his opinion, it is often useful to take a more objective look at the patient. According to Tovikler, the reasons for dual examinations include the following:
- the first exam is too old
- The first test is of inadequate quality (objective or subjective)
- Financial reasons, false incentives
- count for further training
- The patient wants it (and other reasons)
- Initial check is not available
Wikler says only that last point may be influenced by the EPA data.
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