Electronic patient file for all - growing criticism of opt-out regulation

Since January 15, 2025, people with statutory health insurance in Germany will automatically receive an electronic patient record (ePA) - unless they actively object. This will turn a once voluntary digital project into a mandatory infrastructure for the entire healthcare system. Critics speak of a dangerous paradigm shift: what once began as a voluntary offer is now becoming a tacit data platform - with potentially far-reaching consequences for data protection, transparency and individual self-determination.

Opt-out instead of opt-in: a silent turning point

Until now, the ePA had to be actively requested. From 2025, the logic will be reversed: if you do nothing, you are automatically included. Only those who actively object - i.e. opt out - will be left out. This change is happening quietly, without broad media debate and without mandatory individual information for insured persons. The responsibility for preventing the creation of files therefore lies entirely with the citizens themselves.

Entrepreneur and author Markus Schall, publisher and operator of an independent information portal, has deliberately objected to this process - not because he rejects digital solutions in principle, but because the way in which they are being rolled out reminds him of what many companies are currently experiencing: Forced migrations to cloud services, for example with email providers such as HostEurope. "Such transitions are increasingly no longer explained, but simply implemented - and anyone who wants to object has to log in, click, agree, reject, confirm, save. Convenience is working against freedom," says Schall.

Data protection and access rights remain opaque

Although the "ePA for all" is supposed to meet the highest data protection standards according to the Federal Ministry of Health, many questions remain unanswered in practice. Who exactly has access to which data? Are older findings automatically transferred? What will access by health insurance companies or third-party providers look like in the future?

While it is officially emphasized that data sovereignty always lies with the insured person, experience shows that misunderstandings, access errors or unintentional approvals often occur in complex digital systems. What's more, once health data has been stored digitally, it is in fact difficult to retrieve it completely, despite the option to delete it.

For whom the ePA makes sense - and for whom not

In fact, there are also groups for whom the eHR offers real benefits: for example, people with chronic illnesses, multimorbid patients, cancer patients undergoing treatment or people who frequently switch between specialists. Here, centralized documentation can actually lead to better coordination, fewer duplicate examinations and a better overview.

However, for healthy people with little digital affinity or data sensitivity, the ePA offers hardly any practical benefits - but instead carries considerable risks. Those who rarely go to the doctor, do not have complex treatment histories or prefer to keep their own records may lose more control than they gain.

Objection still possible - but not forever

It is still possible to object to the automatic creation of the electronic health record until January 15, 2025 - with some health insurance companies even after this date. In most cases, a login to the customer portal or a written declaration is required. Anyone who fails to react in time will automatically receive an EPA. Although this can be deactivated or deleted at a later date, the insured person will then have to bear the cost again.

The objection page at many health insurance companies is sometimes difficult to find or cumbersome. This has led to growing criticism of the information policy and the transition process.
Digital healthcare: Opportunity or permanent monitoring?

In principle, the digitalization of the healthcare system has enormous potential: better availability of information, more efficient care, modern research. However, as with all technical developments, the framework determines the impact. If systems are introduced without genuine freedom of choice, this undermines trust in digitalization as a whole.

Markus Schall comments: _"Digitalization should remain a tool - not a coercive system. If you really want to help, you offer options, but not a tacit takeover. People must not become data sets."_

Further background information, analyses and recommendations

A detailed background article on the EPR, including a timeline, case studies, legal evaluation and individual assessment, is now available as a specialist article on Markus Schall's info portal. It also includes practical tips on how to object and critical voices from Germany and abroad.

Frequently asked questions about the ePA for all

* What is the electronic patient record (EPR) anyway?
The EPR is a digital storage location for medical information such as doctor's letters, X-rays, vaccinations and diagnoses. It is intended to be available to all people with statutory health insurance and to give treating doctors a better overview of the patient's medical history - provided the patient allows this.
* Do I have to actively agree to receive an ePA?
No. From January 15, 2025, the electronic health record will be created automatically for all people with statutory health insurance - unless you actively object in advance (opt-out rule).
* How can I object to the ePA?
The objection is usually made via the online portal of your own health insurance fund. You can log in there and initiate the objection. Some insurance companies also accept written declarations. Once an objection has been made, no file is created.
* Until when can I object?
The official deadline is January 15, 2025. ePA can be deleted or deactivated after this date, but the burden is then on the insured person - and it is unclear whether data that has already been created will be completely deleted.
* What are the advantages of the ePA?
People with complex medical histories or several treating physicians in particular can benefit from the ePA, as all relevant information is available in one place. Access to the ePA can also be life-saving in emergencies - provided the correct authorizations have been set beforehand.
* What are the risks of using the ePA?
The central storage of sensitive health data always entails risks: for example, due to data breaches, unauthorized access or unclear data transfer. Even if the insured person is officially supposed to retain control, the practical handling is often complicated.
* What happens if I do nothing?
Then an electronic patient file is automatically created for you - regardless of whether you want to use it or not. Your health insurance company will not ask you to do this individually - the responsibility lies with you.
* Where can I find further information or an assessment?
A detailed background article with a timeline, graphics and critical analysis is available free of charge at markus-schall.de. There you will also find an overview of how you can protect yourself or make a conscious decision.

M. Schall Verlag
Hackenweg 97
26127 Oldenburg
Germany

https://markus-schall.com
Herr Markus Schall
info@schall-verlag.de

Schall-Verlag was founded in 2025 by Markus Schall - out of a desire to publish books that create clarity, stimulate reflection and consciously avoid the hectic flow of the zeitgeist. The publishing house does not see itself as a mass marketplace, but as a curated platform for content with attitude, depth and substance.

The focus is on topics such as personal development, crisis management, social dynamics, technological transformation and critical thinking. All books are the result of genuine conviction, not market analysis - and are aimed at readers who are looking for guidance, insight and new perspectives.

The publishing house is deliberately designed to be compact, independent and with high standards in terms of language, content and design. Schall-Verlag is based in Oldenburg (Lower Saxony) and plans multilingual publications in German and English.

This release was published on openPR.