Country profile: Germany

Map showing initial epSOS countries (blue) and pointing out Germany (red)

Given the federalist tradition of Germany as well as the Bismarckian heritage of the German social security system, the contemporary healthcare system in Germany is extremely decentralized, with competences split between the federal level, the regional (Länder) level and the corporatist level. (i.e. a complex system of physician’s associations). Statutory health insurance provides coverage for 90% of the German population, with private for-profit health insurance covering the rest.

ICT use and eHealth strategy

The use of ICT in German GP practices is generally above the EU27 average. While almost  all GP practices are equipped with computers, less than two thirds are equipped with Internet access, which is slightly below the EU average. Electronic Medical Data Storage is common in Germany, as is the use of computers during consultations. The utilization of decision support systems is also above-average in Germany. The exchange of medical data remains a rare ocurrence in Germany, similar to the exchange of administrative data with reimbursers. The electronic transfer of laboratory results is conducted slightly more often than in most other EU countries.

The German Federal Ministry of Health has identified two main uses of ICT in healthcare:

  • The improvement of quality medical care
  • The improvement of efficiency in medical care

The central goal of current German eHealth policy efforts is the introduction of the electronic health card (Gesundheitskarte), which has been pursued since 2001.

In accordance with institutions on the regional level, GEMATIK, the German health telematic platform, was founded and assigned with the implementation of the services surrounding the electronic health card.

The Gesundheitskarte will serve not only as an eID card to access health services, but offers a massive catalogue of features, such as:

  • Storage of life-saving data
  • Medication History
  • Patient record including radiology results
  • Insurance details
  • Entitlement to treatment in other EU countries
  • ePrescription
  • Memo storage for other health professionals
  • Data provided by patients themselves (diabetes diaries, instructions regarding organ donation etc.)

This impressive set of features, framed by an eID-based coherent security and privacy framework, contributes to making the Gesundheitskarte one of the most massive undertakings in eHealth worldwide.

82 million insured citizens will be linked to over 100.000 physicians, 60.000 dentists, 22.000 pharmacies and 300 insurance companies in one cohesive, secure system.

Currently, the first batch of Gesundheitskarten has been emitted in North Rhine-Westphalia. If the project is deemed successful, the Gesundheitskarte will be introduced successively to all other Länder.

Legal framework

The legal framework surrounding eHealth in Germany is very fragmented. The main body of legal regulation is Art. 291a SGB V, which administers telemedical applications related to the Gesundheitskarte. Regulation for health insurance companies as well as the social security system as a whole frame the administrative procedures relevant for eHealth applications. The legal framework surrounding privacy issues is divided between the Länder-level and the federal level (Bundesdatenschutzgesetz, BDSG).

This means the provisions for privacy generally exceed the relevant European Directive 95/46/EC (which was implemented at the federal level), due to the fact that regional leglislation supersedes federal data protection laws.