Table of Contents
- the German electronic patient record a financial disaster for statutory health insurance providers?
- The State of Germany’s Electronic Patient Record (ePA) in early 2026
- The Promise vs. The Reality
- Infrastructure Failures and Physician Frustration
- Perverse Financial Incentives
- The Data: Millions of Records, minimal Engagement
- Strategic Analysis
the German electronic patient record a financial disaster for statutory health insurance providers?
The State of Germany’s Electronic Patient Record (ePA) in early 2026
As we assess the healthcare landscape in February 2026, we must ask a difficult question: Is the electronic patient record (ePA) succeeding? The data suggests a clear “no.” Despite the ambitious rollout of ePA 3.0, active usage hovers around a negligible 4%. Furthermore, technical errors persist, including a recent incident where AOK Bayern mistakenly deleted user records. Here is an advisory breakdown of the current situation.
The Promise vs. The Reality
The ePA was marketed as a necessary evolution for healthcare. Proponents argued that every person with statutory health insurance required one. The narrative suggested that refusing an ePA would hinder emergency treatment, a claim that was technically inaccurate as emergency responders rarely have immediate access to these cloud-based records during on-site operations.
Since January 2025, patients and doctors have tested this system under an “opt-out” model. This meant records were created automatically unless a patient objected. However, the pilot phase revealed significant infrastructure flaws.
Infrastructure Failures and Physician Frustration
The backbone of this system is the Telematics Infrastructure (TI). Throughout 2025, the TI proved unstable. Practices frequently reported total system failures on Monday mornings. Thousands of clinics attempting to register professional IDs simultaneously caused the network to crash. When the TI fails, doctors cannot process sick notes (eAU), prescriptions, or patient records.
While stability has improved by early 2026, hardware certificates continue to expire unexpectedly, disrupting daily practice workflows. Since October 2025, usage has been mandatory for practices. As of January 1, 2026, physicians face fee reductions if they fail to offer ePA services.
Perverse Financial Incentives
Beyond technical issues, the fee structure has created friction between medical specialists.
- Specialists receive €14 for the initial creation of an ePA entry.
- General Practitioners (GPs) receive only €4 for maintaining that record.
This disparity encourages specialists to create entries purely for the higher fee, regardless of clinical value, while discouraging GPs from performing the necessary long-term maintenance. This supports the skepticism many doctors feel regarding the system’s actual purpose.
The Data: Millions of Records, minimal Engagement
The most telling metric is active usage. The shift from an opt-in to an opt-out model created millions of “dormant” accounts, but it did not drive engagement.
As of January 2026, approximately 75 million records exist. However, data from major insurers paints a stark picture of inactivity:
- Techniker Krankenkasse (TK): 11.5 million records created; only 850,000 active users.
- Barmer: 8 million records created; only 440,000 active users.
- AOK: 26 million records created; only 365,000 active users.
Strategic Analysis
We have moved from a 1% usage rate in the old system to roughly 4% under the new mandate. While statistically a 400% increase, this represents a massive misallocation of capital in practical terms. Billions of euros have been invested into a system that 96% of the population ignores.
The system is technically operational but practically irrelevant to the everyday lives of patients. With looming security concerns and data deletion errors appearing at major insurers like AOK Bayern, building public trust remains the primary hurdle for the remainder of 2026.