Electronic Health Record

Anyone who is ill leaves traces in many stacks of paper. The family doctor has one folder, the hospital a second, the dentist a third. None of these stacks knows what’s in the others. The electronic health record is the attempt to gather all of that digitally in one place: diagnoses, X-ray images, lab values, prescribed medications, vaccinations. The data belongs to the patient, not to the practice. In Germany, since 2025 the health insurers have been automatically setting up such a record for all insured persons; anyone who doesn’t want one must actively object.

What changes for treatment and research

The practical benefit shows itself in an emergency. If someone arrives unconscious at the clinic, the treatment team can look up which medications the person takes and what they are allergic to. This can prevent errors that would otherwise become dangerous. Duplicate examinations are also avoided: an X-ray from last week doesn’t need to be taken again.

A second point concerns medications. If several doctors prescribe remedies independently of one another, these can interfere with each other. Experts call this an interaction. If the complete medication list is contained in one record, such issues are noticed more quickly. Studies estimate that in Germany tens of thousands of hospital stays each year are due to avoidable medication errors.

For the tech industry, the record is interesting for a third reason. It generates huge amounts of structured health data. In pseudonymized form, meaning without directly readable names, researchers are allowed to use this data for studies. This also makes it possible to train AI systems intended to detect diseases early. But this is exactly where the debate about data protection begins.

The path of the data from the practice into the record

Technically, the record is not a folder on your own phone. The data resides encrypted on servers operated by providers commissioned by the health insurers. Encrypted means: the contents are turned into unreadable gibberish that only someone with the matching digital key can decrypt. So the provider itself cannot read the findings.

All parties involved are connected via the telematics infrastructure, a sealed-off network exclusively for the healthcare system. It is not part of the open internet. Practices need a special reader device and an electronic ID to gain access at all. Insured persons access it via an app from their health insurer and identify themselves with their health card or national ID card.

The insured persons control the access rights themselves. By default, a practice may look into the record for 90 days after reading the card. Individual documents can be hidden, entire practices excluded. A common misconception is that the record is automatically complete. It only contains what someone actually puts into it, and old paper findings from the past do not migrate into it on their own.

Between the insurer’s app and headlines about security gaps

The most direct encounter with the record happens via one’s own health insurer’s app. There you see the medication plan, can upload findings, and track who last accessed it. It also comes up during a doctor’s visit, when after reading the card you are asked whether documents should be stored.

In the news, the topic usually appears in two variants. Either it’s about delays in the rollout, or about security researchers demonstrating vulnerabilities. At the Chaos Communication Congress at the end of 2024, a team showed how access could be gained using forged practice ID cards. Such reports are no reason for panic, but they explain why the launch was postponed several times.

The record should be distinguished from the electronic prescription. The e-prescription is merely a digital prescription for the trip to the pharmacy. The health record is the permanent store of the entire medical history. Similar systems exist in many countries; Denmark and Estonia have been running them for more than a decade.