Digital Patient Records in Hospitals: Just 40% Pilot Them—Fines Loom from April
5 min read
75 million electronic patient records (ePA) have been created. Yet fewer than 4% of insured individuals actively use them. In hospitals, only one in four institutions has launched its pilot phase. Meanwhile, from 2026, digitalisation discounts of up to 2% per billed case will apply. The ePA is Germany’s largest healthcare digitalisation project—and it’s stalled.
Key takeaways
- 75 million ePA created, under 4% used: The opt-out rate is just 5%, but almost no one accesses their patient record (borncity, AOK, KZV BW, 2026).
- 40% of hospitals in pilot phase: This sounds like progress—back in September 2025, only 7% had started. Yet 43% don’t expect full hospital rollout before Q3 2026 (DKI express survey, March 2026).
- Up to 2% discount per case: Five mandatory digital services must be contracted; otherwise, digitalisation deductions will apply to every inpatient case (§5(3h) KHEntgG).
- Germany ranks 16th out of 17: In the Bertelsmann Foundation’s Digital Health Index, Germany barely edges out Poland. Estonia and Denmark show how it’s done.
- €7 billion in potential savings: According to McKinsey, the ePA alone could cut duplicate diagnostic tests and communication gaps. What’s been achieved so far? Almost nothing.
75 million medical records, 4% of users: The ePA in numbers
Since its nationwide rollout in April 2025, every individual with statutory health insurance in Germany has automatically been provided with an electronic patient record (ePA) – unless they explicitly opted out. The opt-out model is working: only around 5% of insured individuals have objected, with rates at 4.3% for AOK, 7% for Techniker Krankenkasse, and even 10% for KKH.
The challenge isn’t creating the records – it’s getting people to use them. Recent data shows that just 4.2 to 4.6 million insured individuals have registered a health ID (Gesundheits-ID), roughly 6% of those covered by public health insurance (GKV). Active usage is even lower: only about 3.6% regularly access their ePA.
For hospitals and primary care physicians, this means the infrastructure exists on paper – but barely touches day-to-day care. Today, most patients admitted to a hospital still experience the familiar mix of paper forms, faxed reports, and phone calls.
The federal government has allocated €4.3 billion through the Hospital Future Act (KHZG) to change this. McKinsey estimates the ePA’s savings potential at €7 billion annually – fewer duplicate tests, faster data sharing, and more efficient communication between GPs, hospitals, and specialists. Of the healthcare sector’s total digitalisation potential, valued at €42 billion per year, only a fraction has been realised so far: €1.4 billion (McKinsey eHealth Monitor, 2025).
Why hospital rollouts are stalling: HIS updates, staff, and processes
The DKI’s March 2026 flash survey, which drew responses from 489 hospitals, paints a nuanced picture. A full 90 % of participating facilities have already kicked off technical implementation. And 40 % are now piloting the electronic patient record (ePA) within their clinical workflows—a striking leap from the 7 % reported in September 2025.
Yet here’s the catch: 18 % of hospitals are still waiting—more than five months past the mandatory deadline—for the essential update to their hospital information system (HIS). Meanwhile, 43 % don’t expect full ePA deployment before the third quarter of 2026. The bottleneck isn’t just technical—it’s the underlying processes that are holding things up.
«Rolling out the ePA in hospitals is a genuine transformation project that demands countless procedural and organisational adjustments. Hospitals can’t just flip a switch and make it work.»
– Prof. Dr. Henriette Neumeyer, Vice-President of the German Hospital Federation (DKG) Executive Board (DKG press release, March 2026)
Organisational hurdles weigh heavier than technical ones. The ePA must be woven into existing admission processes, access rights defined, data protection concepts adapted, and medical staff trained. All of this takes time and manpower—two resources already in short supply across German hospitals.
Then there are the technical setbacks that chip away at confidence. In February 2026, a smoke detector alarm in a Frankfurt data centre knocked out the entire telematics infrastructure for eight hours—leaving the ePA, electronic prescription (E-Rezept), secure healthcare professional email (KIM), and discharge summary (VSDM) inaccessible. That same month, a software glitch caused 6,400 ePAs at AOK Bavaria to be suspended and erroneously emptied. No data was lost in either incident, but the episodes only fuelled sceptics’ doubts.
And one underestimated problem lingers: replacing TI connectors. Around 7,900 TI connectors with outdated RSA encryption must be swapped out by the end of 2026, as certificate renewal isn’t technically feasible. At the same time, the transition to new eHBA cards wraps up on 30 June 2026. For hospitals that haven’t even received their HIS update yet, the to-do list is piling up fast.
Digitalisation discount: What will it actually cost hospitals from 2026?
Definition
Digitalisation discount refers to a percentage deduction applied to each fully or partially hospital-billed case, which takes effect when a hospital fails to commission or implement certain mandatory digital services on time. The legal basis is §5(3h) of the KHEntgG.
From 1 January 2026, discounts will apply to five mandatory digital services. Any hospital unable to demonstrate—by 31 December 2025—that it has at least commissioned these services will face a deduction on every billed case:
| Mandatory service | Discount |
|---|---|
| Patient portals | 0.5 % |
| Digital documentation of care and treatment | 0.6 % |
| Clinical decision support systems | 0.2 % |
| Digital medication management | 0.4 % |
| Digital service requests | 0.3 % |
| Maximum total discount | 2.0 % |
For a mid-sized hospital handling 15,000 inpatient cases annually with an average case revenue of 5,000 euros, the maximum 2% discount translates to an annual loss of 1.5 million euros. These aren’t hypothetical figures—it’s the real cost for hospitals that fail to commission all five mandatory services on time.
The pressure doesn’t let up: by the end of 2027, at least 60% of hospital cases must be digitally documented; by the end of 2028, this rises to 70%. Hospitals that have commissioned the services but fall short of these minimum usage rates will face penalties once again.
Estonia, Denmark, Germany: A Discouraging Comparison
In the Bertelsmann Foundation’s Digital Health Index, which compares 17 OECD countries, Germany ranks 16th. Only Poland fares worse. Leading the pack are Estonia and Denmark, which for over a decade have demonstrated how digital healthcare should function.
In Estonia, 99% of the population has an electronic health record, and 100% of doctors, hospitals, and pharmacies are connected to the national ENHIS system. The backbone is the X-Road infrastructure, which since 2002 has interoperably linked all public and private IT systems across the country.
Denmark nearly hits 100% for e-prescriptions and sees over a third of its population using the sundhed.dk health portal—with 1.7 million monthly logins. General practitioners and pharmacies are 100% connected, while specialists reach 98%.
What unites both countries is centralized political leadership with binding targets, clear interoperability standards from the outset, and tangible benefits for citizens. The Bertelsmann Foundation identifies five key success factors: strong governance, centralized direction over a federal patchwork, clear interoperability rules, a positive error culture, and visible added value for citizens.
Germany, by contrast, has 130 health insurance funds with disparate apps, a Gematik bogged down between ministerial oversight and industry coordination, and 16 federal states each pursuing their own digitalization strategies. The result? Even the ambitious KHZG funding program has failed to overcome this structural fragmentation. PwC estimates hospitals must shoulder around 16% of digitalization costs—and up to 50–100% of recurring operational expenses (PwC, November 2023).
What IT Leaders Must Do Now
The situation is frustrating—but not hopeless. Those who set the right priorities now can avoid penalties while laying the groundwork for true digital transformation in hospital operations.
1. Clarify and escalate the status of your HIS update. 18% of hospitals are still waiting for theirs. If your HIS provider is lagging, document it in writing—this serves as proof for cost managers that delays aren’t your hospital’s fault.
2. Define and launch a pilot unit. The jump from 7% to 40% in pilot phases proves it: progress starts with action. One unit is enough to begin. What matters isn’t just having the technology available—it’s ensuring doctors and nurses integrate the electronic patient record (ePA) into their workflows.
3. Secure procurement accreditations for the five mandatory services. Penalties apply for failing to contract—not for failing to implement. A signed contract or project order can prevent deductions, even if implementation is still underway.
4. Implement a training plan. The DKI survey makes it clear: the bottleneck isn’t technology—it’s organization. Training for doctors, nurses, and administrative staff must run parallel to technical rollouts, not after.
5. Look ahead. The ePA isn’t an isolated IT project. It’s the foundation for the European Health Data Space (EHDS), which from 2029 will enable cross-border patient data exchange. Those who build this foundation now will position their hospital for the next phase of connectivity. Those who wait will face even greater time pressure to catch up in just three years.
Frequently Asked Questions
What is the opt-out rate for the ePA?
On average, around 5% of policyholders have opted out of the ePA. The rate varies by health insurance provider: 4.3% at AOK, 7% at Techniker Krankenkasse, and 10% at KKH. Since its launch in April 2025, opt-out numbers have plateaued.
What happens if a hospital fails to avoid the digitalisation discount?
The discount applies to every fully or partially inpatient billing case and can reach up to 2% of the case revenue. For a hospital with 15,000 cases per year and an average case revenue of 5,000 euros, this could mean up to 1.5 million euros in annual losses. From late 2027, minimum utilisation rates of 60% will also be verified.
How does Germany compare internationally on electronic health records?
In the Bertelsmann Foundation’s Digital Health Index, Germany ranks 16th out of 17 OECD countries analysed. Estonia (ranked 1st) has had 99% coverage and 100% physician connectivity for over a decade. Denmark nearly hits 100% for e-prescriptions, with 1.7 million monthly users of its national health portal.
What is the savings potential of the ePA?
According to the McKinsey eHealth Monitor 2025, the ePA alone could save around 7 billion euros—thanks to fewer duplicate diagnostic tests, more efficient communication between service providers, and faster access to patient data. McKinsey estimates the total digitalisation potential for the healthcare system at 42 billion euros annually.
Is the ePA secure?
In late 2024, the Chaos Computer Club identified theoretical vulnerabilities that could allow unauthorised access to third-party health records; Gematik closed this gap before the national rollout. By February 2026, two incidents occurred: an eight-hour outage of the telematics infrastructure (TI) due to a data centre failure, and a data incident at AOK Bavaria, where 6,400 health records were mistakenly locked. No data was lost, but these incidents highlight that the infrastructure is still maturing.
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