Electronic Patient Record (ePA): What Is in It, Who Sees It & How to Opt Out

If you have statutory health insurance in Germany, you very probably have an electronic patient record — even if you never applied for one. Since 2025 the ePA (elektronische Patientenakte, Germany's electronic patient record) has been created automatically, and instead of having to consent, you can object to it. This guide explains soberly what ends up in the record, who may look into it and when, how you hide individual documents — and why the ePA still does not replace your own medication list. As of 2026.

1. What the electronic patient record actually is

The ePA (Germany's electronic patient record) is a digital storage place for your health data, held by your Krankenkasse — your statutory health insurer. The decisive difference from anything you knew before: it does not belong to a practice but to you as the insured person. You decide what is in it and who may see it.^¹

It is explicitly not a replacement for the documentation kept at the practice: every practice continues to keep its own treatment records. The ePA is an additional layer on which information can travel between practices, hospitals and pharmacies — without CDs, photocopies and faxes.

The underlying infrastructure is run by gematik, Germany's digital agency for the health service. The insurers only supply the app — which is why the record looks different from one Krankenkasse to the next, while the rights are the same everywhere.

2. Opt-out: why you have an ePA without having applied for one

Until 2024 the opposite applied: anyone who wanted an ePA had to apply for it actively at their insurer. Very few insured people did. With the switch to the "ePA für alle" ("ePA for everyone") the principle was reversed — since 2025 the statutory health insurers create the record automatically for everyone insured with them, unless an objection has been lodged.^²

This procedure is called opt-out: it is not you who has to go looking for the record, it is you who has to speak up if you do not want it.

How the objection works

• Possible at any time: no deadline — before the record is created, shortly afterwards or years later.
• No reasons required: your insurer may not ask you to justify it.
• Informally, with your health insurer: via the app, the customer portal, the service hotline or in writing. Ask for written confirmation.
• No disadvantages: treatment, reimbursement and contributions do not depend on the ePA.
• Reversible: you can have the record activated again later.

Important: the objection can be graded — you do not have to choose between "everything" and "nothing". Among the options are an objection to the record as a whole, an objection to it being filled by particular providers and — as a separate item — an objection to pseudonymised data being passed on for research.^⁴

The automatic procedure does not cover people with private health insurance. For them the ePA is a voluntary offer that the insurance companies have implemented to differing degrees — here a quick enquiry with your insurer is worth it.

3. What is in the ePA — and what is not

The record fills up from several sources: practices and hospitals, data held by your health insurer, and you yourself.

At least as important is the other side: what is not in the ePA. Missing from it are over-the-counter products you buy yourself, food supplements, herbal preparations, dose changes agreed over the phone and everything you have stopped taking. This produces the most common misconception of all: the ePA medication list is a prescription history, not a picture of what you actually take. Someone who never collected the pack, or stopped it again, still appears in it — and someone who takes magnesium and ibuprofen every day does not. How to turn this into a reliable overview is set out in the guide Keeping a medication list.

4. Who has access, and when

Access to the ePA is tied to a treatment context. Nobody may simply look inside — it takes a concrete reason and your involvement, in practice usually by inserting your health card or by granting access in the app.^³

That release creates a time-limited right of access, preset according to the type of institution and changeable by you. As a rough guide: medical practices a few weeks to months, pharmacies only a few days, hospitals the period of treatment. You can see the exact values in your insurer's app — right down to individual institutions that you shut out permanently.

• Practices and hospitals: access only within a treatment context, limited in time, which you can shorten or block completely.
• Pharmacies: brief access, primarily to the medication data, for example to check an interaction.
• Your health insurer: may provide the record technically, but may not look at the medical content.
• Employers, private insurers, public authorities: no access — and they may not make it a condition either.

Every access is logged, and you can view the log in the app: who opened which document, and when? That is the real lever — it turns a promise into something you can verify. A look every few months is enough.

5. Your rights: object, hide, delete, check the log

The rights around the ePA are laid down in law and apply in the same way at every health insurer.^⁴

• Object to the record: in whole or in part, at any time, without giving reasons.
• Hide documents: invisible to everyone or to particular institutions, but kept for you.
• Delete documents: remove them from the record for good.
• Control the access period: change the time limits or block institutions permanently.
• View the log: who accessed what, and when.
• Upload your own documents: earlier findings, readings, privately paid results.
• Take it with you when you change insurer: the contents can be transferred.
• Object to research data sharing: a switch of its own, independent of the rest.

A common misunderstanding: hiding or deleting something in the ePA removes nothing from the practice's own documentation. The practice that produced the finding keeps its own file — the ePA is only the layer that passes things on.

6. Getting in: your insurer's app — and what works without a smartphone

To see and steer your record you need the app of your own health insurer. Getting started works like this:

1. Install your own insurer's app. Apps from other insurers do not work.
2. Prove your identity. The usual routes are the health card with PIN plus an NFC smartphone, a GesundheitsID (the national health login), video or Postident identification, or a visit to a branch office.
3. Request a PIN if you need one. It comes by post and often has to be applied for separately — which takes a few days.
4. Open the record and look through it. Just an overview to begin with: what is already in there?
5. Go through the settings. Access periods, blocked institutions, hidden documents, the research data switch.
6. Set up a representative if you want someone you trust to have access in an emergency.

Without a smartphone: the honest part

This is the system's biggest weakness, and there is no point glossing over it: without a smartphone the ePA is in practice barely something you can steer yourself. The record is still created and filled, but viewing it, fine-tuning it and checking the log are only possible to a limited extent without the app.

As alternatives there is the Ombudsstelle (ombudsman's office), which every insurer has to provide: it accepts objections and implements certain settings on request — in writing, by telephone or in person. Some insurers additionally offer terminals in their branches or desktop access. And you can name a representative who manages the record from their own device.

7. Representatives, children and relatives

You can allow other people to manage your record on your behalf — sensible with a chronic illness, in later life, or if you have no suitable device yourself. The representation is set up in the app, can be revoked at any time and runs through the representative's own identified access: card and PIN stay with you. That is the clean route — handing on card and PIN is legally problematic and unsafe. A representative does not, however, replace a Vorsorgevollmacht (health and welfare power of attorney) or a rechtliche Betreuung (court-appointed guardianship).

For children, those with parental responsibility manage the record. From around the age of 15 young people can as a rule run it themselves and parental access ends — a good moment to hand over responsibility for prescriptions, appointments and taking medicines together. Where there is a court-appointed guardianship or a power of attorney covering health decisions, the authorised person can take over the record; proving this to the health insurer is the most laborious part. If you are coordinating a lot of preparations, you will find everyday strategies in Chronic illness in daily life and Medications in old age.

8. What the ePA really delivers

Objectively considered, a well-filled record makes a noticeable difference in these situations.

• In an emergency — allergies, long-term diagnoses and regular medication can be found, even when you cannot give any information yourself.
• When you move between people treating you — a specialist appointment, a second opinion, a hospital admission or a house move: findings do not have to be produced all over again.
• Fewer duplicate investigations — an MRI scan that already exists or a current lab value saves time, money and, in the case of X-rays, radiation exposure as well.
• Interaction checks at the pharmacy — if the medication list is complete, risky combinations can be recognised before they go over the counter.

A fifth point is underestimated: preparing for appointments. If you read up beforehand on what was discussed last time, you get considerably more answers in the same amount of time. How to do that systematically is set out in the guide Preparing for a doctor's appointment. A clean overview also pays off before planned procedures — see Medications before surgery.

9. Where the ePA reaches its limits

The value of a record depends entirely on whether it gets filled. That is exactly where the limitation lies that you should know about before you rely on it.

• Not retrospective. Findings from before your ePA existed do not land in it automatically — whatever you need, you have to upload or request yourself.
• Filled inconsistently. Practices and hospitals are required to put in certain documents, but the implementation varies. A record can therefore look surprisingly empty.
• PDFs instead of structure. Much of the content sits there as a document rather than as an analysable data set — which makes finding individual values harder.
• Prescriptions instead of actual use. Over-the-counter products, food supplements, as-needed medication and dosages you have changed yourself are systematically missing.
• No offline access. Without a network, abroad or during an outage the record is not available — for travelling, a printed list remains sensible, see Medications when travelling.

That is not a criticism of the principle but a way of placing it: the ePA is a distribution channel between institutions. Your own day-to-day overview including self-medication is a different job. How to keep the two apart is described in Managing medications digitally.

10. Research data and data protection — soberly considered

Data from the ePA can be passed on in pseudonymised form to the Forschungsdatenzentrum Gesundheit (Germany's national health research data centre). Pseudonymised means: name, insurance number and other direct identifiers are replaced. That is not the same as anonymised — with very rare combinations of characteristics a theoretical risk of re-identification remains. This distinction is worth knowing, without dramatising it.^²

Anyone wanting to use the data has to go through an application procedure and show a permissible purpose. Use for assessing the risk of individual people — by insurers or employers, for instance — is expressly not provided for.

The objection to research data sharing is a switch of its own. You can set it without objecting to the record as a whole — and the other way round. In the app you will usually find it under "Datenfreigaben" (data releases) or "Widersprüche" (objections). It is worth a look, because many people never check the default setting.^⁴

And what about security?

The ePA sits in a sealed-off infrastructure and the data is stored encrypted. As with every large system, IT specialists have pointed out weaknesses in the past, particularly in the procedure for granting access rights; such reports are examined and lead to improvements. A system of this size is never "finished and secure" but permanently under revision.

The objective weighing-up therefore reads like this: on the one side a residual risk that can never be brought down to zero. On the other, concrete harm caused by missing information — from the duplicate X-ray to the overlooked interaction. Both answers are legitimate.

11. Step by step: your ePA check

Just under half an hour is enough for a thorough run-through. This order has proved itself:

1. Get access. Install your insurer's app, identify yourself, request a PIN if necessary.
2. Review what is there. Which documents are in the record? Does the medication list match reality?
3. Check the log. Who has accessed it so far? Is there anything you cannot place?
4. Adjust the access periods and shorten them wherever they go further than you are comfortable with.
5. Hide the sensitive items instead of deleting them too hastily.
6. Set the research switch deliberately — decide actively instead of accepting the default.
7. Set up a representative. Name someone you trust, for an emergency.
8. Compare it with your own list and raise any differences at your next appointment — and have your medication plan updated while you are there.

One more note on the documents themselves: doctors' letters and findings are written for a professional readership. Understanding blood test results and Understanding the package leaflet help you make sense of them — but they do not replace an explanation from the practice.

12. How brite helps you alongside the ePA

The ePA distributes information between institutions. brite covers the other half: what happens between appointments.

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