One year of mandatory ePA: connected, but barely used

4 min read

Since 1 October 2025, healthcare providers have had to upload findings and lab results to electronic patient records (ePA). A year later, almost every connected provider has used them, but only 5.4 million insured people can actively access their own. The case shows decision-makers what a legal requirement achieves in an IT rollout.

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What is the Telematics Infrastructure? The Telematics Infrastructure is the secure network of Germany’s healthcare system. Medical practices, pharmacies and hospitals use it to access applications such as electronic patient records.

A metric that reveals little

According to Germany’s Federal Ministry of Health, more than 159,000 of around 160,000 providers connected to the healthcare system’s Telematics Infrastructure have used the ePA. That sounds like a rapid success. However, whether a provider uploaded data just once as a trial or does so daily is not recorded. The proportion demonstrates first contact. It says nothing about routine everyday use.

The document count offers a closer look. Gematik, the digital agency majority-owned by the federal government, reported around 22 million uploaded documents between the ePA launch in January 2025 and the end of September 2025. Sibylle Steiner, an executive board member of the National Association of Statutory Health Insurance Physicians (KBV), puts the total since launch at almost 160 million. The ministry puts throughput at around 3 million documents per week.

A 1-percent reduction in remuneration as a lever

From 1 October 2025, medical practices faced a 1-percent reduction in remuneration if they could not submit electronic evidence that they had uploaded data to the ePA. Shortly before the deadline, the starting position was uneven. In a KBV survey, around twelve percent of practices said their practice management system had no ePA module. Three-quarters of practices already using the records had experienced technical problems accessing them or uploading data in the previous month. More than 80 percent of survey participants considered patients poorly or very poorly informed.

According to Gematik’s figures, 82,000 of the 98,500 medical practices participated in the system. They were joined by 27,500 dental practices, 12,500 pharmacies and 1,300 hospitals. The ministry had no figures for the statutory sanctions against non-participating providers. It pointed to potentially lower usage, for example during holiday periods. Moreover, sanctions concern the evidence submitted.

Medical practices bear the burden

According to Steiner, 91 percent of documents come from medical practices. Those same practices continue to be held back by disruptions and, in some cases, insufficient technical stability. On 18 September 2026, the medical association MEDI GENO Deutschland e. V. reached a similar conclusion and called for urgent improvements to technology, data protection and medical confidentiality. Those doing most of the work feel every outage first. Each additional document increases the volume that the systems must handle.

Records without access

On the insured-person side, the figures differ widely. Health insurers have created an ePA for just over 73 million of the 74.5 million people with statutory health insurance. Opting out is possible. Among privately insured people, whose insurers offer the records voluntarily, the number is 386,000. Only people with a digital health identity can actively access their own records, view them or block sensitive content. Gematik counts 5.4 million insured people with this identity.

Steiner reports that even patients willing to use the app often fail at the registration process. An April 2026 Civey survey commissioned by Pharma Deutschland found that only 23.6 percent of insured people actively access their records. A survey and a count of identities measure different things. How far they overlap remains unclear. Both are far below the number of records created.

The ministry provides an indication of actual use in medication lists: more than 35 million digitally stored lists of prescribed medicines have been opened.

What the figures offer for companies’ own projects

The requirement has produced three things: almost universal connection, a stock of more than 73 million records and a steady flow of documents. A fourth effect is missing from the figures. Dr Norbert Smetak, chair of MEDI GENO and a cardiologist in private practice in Kirchheim unter Teck, argues that the ePA can succeed only if it provides a tangible benefit to patients and those treating them. After a year, he says, it has so far fallen far short of this goal.

Companies can derive questions to examine from this. Does their own metric measure first contact or actual use? Does the group doing most of the work also bear the disruptions? And who supports user registration when access to the application itself can already fail? Whether sanctions increase participation remains an open question in healthcare, because no figures are available.

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Image source: AI-generated (October 2026)

Translated from the German original using artificial intelligence. The German version is authoritative.