Rethinking electronic health record implementation in Germany: A value-based health system approach

Adopting a nation-wide cross-sectoral Electronic Health Record system (elektronische Patientenakte, ePA) has been a challenge in Germany for years, leading to inefficiencies in patient care. Without a significant coverage across the population, critical patient information remains scattered across healthcare providers, resulting in delayed treatments, duplicated tests, and avoidable medical errors.
Starting in 2025, Germany plans to implement an opt-out approach for ePA. Under this system, all insured population will be automatically enrolled in ePA unless they explicitly choose to opt out. The opt-out model is seen as a crucial step in driving digital health innovation in Germany, helping to overcome years of slow progress in the adoption of electronic health records. The opt-out implementation approach is, however, not a panacea and should be supported by several measures.
The opt-out ePA could be a game-changer, enabling doctors to access vital patient information instantly, improving care coordination and outcomes. At the system level, by empowering data-driven decision-making, ePA could be not just another digital tool but a powerful engine that could drive a structural change—ensuring efficiency, reducing costs, and fostering personalized care. This project lays out a blueprint to break through the longstanding barriers and turn ePA into a true catalyst for innovative, person-centred health system in Germany.