“In Germany, the introduction of the electronic health card (eGK) is supported by the Federal Ministry of Health in the context of the development of electronic health services. Since 1995, individuals insured in the SHI possess an electronic health insurance card on which the individual’s administrative data are stored for billing purposes. Through the SHI Modernization Act of 2004, the future development of the insurance card into an electronic health card was resolved.

“The introduction of the eGK and its further development, as well as the creation of the required infrastructure, is the obligation of the corporatist associations and of gematik, which was founded in 2005. More than five years after the originally planned date in 2006, eGK was finally partially introduced during the last quarter of 2011. The introduction was carried out in stages: in a first step, all hospitals, physician practices and pharmacies were furnished with the new reader devices for the eGK (basic roll-out). In a second step, approximately 10% of the insured individuals were provided with the new chip eGKs by their sickness fund by the end of 2011 (gematik, 2012). Since January 2014, the eGK has been considered as proof of entitlement to use services where patients have already received a new card; however, this has not been achieved nationwide.

“The eGK contains the same administrative data as the old health insurance card. These include name, address, date of birth, sex, insurance number, insurance status and cost-sharing status. From the technical point of view, the eGK is designed in a manner that will allow medical data to be stored in future expansion stages, such as emergency data (e.g. allergies, drug intolerances) as well as references to patient health care directives and organ donation declarations. In future, it may, for instance, also be possible to store drug documentation, vaccination documentation or an electronic patient file. While the storage of administrative data is mandatory, patients can voluntarily decide on the management of their personal medical data. Most sickness funds will furnish the back of the eGK with a European insurance certificate. It allows the unbureaucratic provision of medical services in all 28 EU Member States as well as in Iceland, Liechtenstein, Norway and Switzerland (Bundesministerium für Gesundheit, 2011b).

“The criticism that is probably being discussed most in the context of the eGK is the safeguarding of data protection and the prevention of data abuse (Dittrich & Blum, 2008). In order to prevent the abusive use of services, every insured individual is provided with a card including a photograph (with the exception of children below 15 years of age and individuals requiring a high level of long-term care). A processor in the card makes it possible to store sensitive health information on the eGK in an encrypted manner and protect it against unauthorized access. Medical information can only be decrypted and read by physicians and other medical professionals if the patient and the physician have given their consent. The patient’s key is the eGK the physician’s key is the electronic health professional card. Both must introduce their cards into the practice’s or hospital’s card terminal (two key principle). Furthermore, they must consent to the accessing of the medical data by entering a PIN. An exception in this context will be for emergency data (Bundesministerium für Gesundheit, 2011b).”

Source: Busse R, Blümel M. Germany: health system review. Health Systems in Transition, 2014, 16(2):1–296.

“While in 2007 a large proportion of self-employed and employed workers owned a computer (93% and 90%, respectively), the proportion for unemployed people was merely 49% (Statistisches Bundesamt, 2008a).

“Private use of the Internet by those aged 10 years and over was at 58% in 2004 and increased to 71% by 2008. In 2008, the usage rate varied slightly among the sexes (76% of men and 66% of women stated that they were using the Internet) but varied significantly with age: 95% of the population aged 10–24 years used the Internet, 87% aged 25–54 years and merely 36% of those over 55 years (Statistisches Bundesamt, 2013a).

“In 2006, 95% of all family physicians in Germany used computers in their practices, which was above the EU15 average of 77%. In addition, 26% of practices had their own web sites and 48% used electronic patient files for their internal work (Dubois, McKee & Nolte, 2006). Pursuant to a survey on computer and Internet use carried out in 2007 among family physicians across the EU (Dobrev et al., 2008), 99% in Germany had a computer in their practice (EU average 87%, Estonia, Finland, Sweden and Hungary 100%) and 85% even had computers in their consulting rooms (EU 78%, Finland 100%). In Germany, 59% had Internet access (EU 69%, Estonia and Finland 100%), but only 40% had a broadband connection (EU 48%, Finland 93%). The main type of use, with 93% of German family physicians, was handling administrative patient data (EU 80%, Finland and Hungary 100%); 72% used their computer for physician–patient consultation and/or to assist in finding diagnoses or therapies, for example with specialist systems (EU 66%, Finland 100%). However, Internet connections to other service providers were used relatively rarely: only 6% were connected with other family physicians (EU 21%, Finland 68%), 8% with specialist physicians (EU 11%, Denmark 70%), and only 4% with hospitals (EU 20%, Denmark 76%); this is on a level within the EU with Bulgaria and ahead only of Romania and Latvia. In Germany, hardly anything but laboratory data is being exchanged electronically (63%; EU 40%, Denmark 96%), while, for example, electronic prescriptions were not being used at all up to 2008 (EU 6%, Denmark 97%) (Dobrev et al., 2008).”

Source: Busse R, Blümel M. Germany: health system review. Health Systems in Transition, 2014, 16(2):1–296.

“Information and communication technologies in the health care sector are ascribed increasing importance with regard to efficient utilization of resources, improvement of service quality and an increased patient orientation (Busse, Zentner & Schlette, 2006). Within the framework of the action plan “eEurope” for the promotion of the development of the information society in the EU, the initiative “eHealth” was started in 2004 for the health sector. In this context, the EU Member States are required to develop international standards for the exchange of health data (European Commission, 2012).”

Source: Busse R, Blümel M. Germany: health system review. Health Systems in Transition, 2014, 16(2):1–296.

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.

Page last updated Nov. 18, 2020 by Doug McVay, Editor.