Since the rollout of Germany’s electronic patient record (ePA) system, expectations for a digital revolution in healthcare have run up against a stubborn reality: most people just aren’t logging in. Despite the fact that, as of early 2026, roughly 70 million of Germany’s 75 million statutory insured citizens have an ePA automatically created for them, a mere 3.6 percent are actually using it to manage or view their health data, according to a recent survey by the Redaktionsnetzwerk Deutschland (RND), cited by Deutschlandfunk and several major German news outlets.
This low adoption rate has disappointed policymakers, health insurers, and medical professionals alike, especially considering the significant reforms and investments poured into the project. The ePA—intended as a one-stop digital repository for medical records, test results, and doctor’s notes—was supposed to empower patients, streamline care, and help Germany catch up with other countries in digital health. But so far, the numbers tell a different story.
According to RND’s survey, which canvassed several of the country’s largest statutory health insurance providers (covering more than half the market), only a small fraction of insured individuals are actively engaging with their electronic records. Since July 2025, when the ePA system was first broadly implemented, active use has ticked up by just one percentage point, reaching the current 3.6 percent. That’s a modest gain, but hardly the surge officials had hoped for.
The ePA’s journey began in earnest at the start of 2025, following a reform by the so-called "Ampelkoalition" (the governing coalition). Statutory health insurance companies automatically set up electronic patient records for all insured individuals who didn’t actively object. That sweeping move brought the system to about 70 million Germans almost overnight, as reported by RND and Deutschlandfunk. The idea was to minimize bureaucracy and jumpstart digital participation, but it may have led to a sense of passivity among users—after all, if something is handed to you by default, are you more likely to take ownership?
Hoping to bolster engagement, lawmakers introduced another key measure: since October 1, 2025, medical practices and hospitals have been required to upload all relevant treatment data to the ePA. This includes everything from lab and imaging results to doctor’s letters, discharge summaries, and even operation reports. The hope was that a richer, more complete digital record would entice patients to log in, check their files, and maybe even take a more active role in their health.
But according to the RND’s findings, this mandate hasn’t moved the needle much. "The hopes that the obligation for practices and clinics to fill the ePA with relevant documents would lead to a significant increase in active users have not been fulfilled," RND reported. The numbers bear this out across Germany’s largest insurers.
At Techniker Krankenkasse (TK), the country’s biggest health insurance fund, about 11.5 million ePAs have been created. Of these, only around 850,000 people are active users—a rise of just 100,000 since July 2025, as noted by RND. Barmer, another major provider, reports about 8 million ePAs and 440,000 active users, an increase of roughly 190,000. Meanwhile, the eleven Allgemeine Ortskrankenkassen (AOK), which together account for about 26 million ePAs, have seen 365,000 insured individuals set up a personal health ID to access the system. That’s 165,000 more than in the summer of 2025, but still a small share overall.
So what do these "active users" actually do? The ePA platform allows patients to view their health records, upload older documents, and—crucially—set permissions for which doctors can see which parts of their data. Access is available via each insurer’s app, but there’s no obligation to use it. For many, the process of logging in and managing digital health information still seems unnecessary, or perhaps intimidating.
“Just 3.6 percent of statutory insured persons actively use the electronic patient record as of early January 2026,” RND summarized. That means millions of Germans have a digital health record sitting dormant, potentially brimming with valuable information, but untouched.
Part of the challenge may be cultural. Germany has long prided itself on privacy and data security, and the idea of storing sensitive health information online—even in a system designed with strict controls—can still feel uncomfortable to many. Patients must actively log in to set who can access their data, but the default is that the record exists, whether they use it or not. For some, this might feel like a loss of control, rather than an invitation to take charge.
There’s also the question of digital literacy. While smartphone and app use are widespread in Germany, navigating a new health platform—especially one that requires creating a personal health ID and managing access rights—can be daunting. The system’s complexity may deter older or less tech-savvy users, even as it promises convenience and empowerment.
Interestingly, the ePA’s lackluster adoption isn’t for lack of content. Since October 2025, doctors and hospitals have been diligently uploading lab results, imaging, and correspondence, as required by law. The infrastructure is there, and the data is flowing in. But without a stronger push—or perhaps a more compelling reason—for patients to log in, the system risks becoming a digital filing cabinet that sits unopened.
Some experts suggest that more targeted education, outreach, and user-friendly design could help. Others point to the need for incentives: perhaps linking ePA use to easier appointment scheduling, medication refills, or even integration with popular health and fitness apps. For now, though, the ePA remains a digital tool in search of its users.
It’s worth noting that Germany is not alone in facing these challenges. Across Europe and beyond, digital health records have struggled to gain traction, even when rolled out at scale. The balance between privacy, usability, and utility is a delicate one, and solutions that work in one country may not translate directly to another.
As of January 2026, the ePA’s future in Germany remains uncertain. Policymakers and health insurers continue to hope that, as more people become accustomed to digital services in other areas of life, they’ll eventually embrace the ePA as well. For now, though, the numbers are clear: Germany’s grand experiment in digital health is still waiting for its breakthrough moment.
