eHealth Cards: Digital Health Records in Germany

Doctors throughout Germany will soon have instant, digital access to their patients’ records. German lawmakers passed a measure in July 2015 mandating the use of electronic health (eHealth) cards beginning in 2018 allowing doctors a wider view of patients’ records.  One of the reasons for this move is the German government’s aim to decrease the cost of healthcare across the nation and improve data sharing across different IT systems.

Currenty, the eHealth cards contain a patient’s name, address, birthdate, health care number, and a photo of the patient.  Under the new system starting in 2018, doctors will be compensated by the German government for creating these eHealth cards and inputting details of the decisions they make for their patients.  Eventually, they will be fined for not doing so.

Beyond the intial 2018 rollout, information about patients’ medication will be added and stored on their eHealth cards as well.  The Bundestag, the legislative and constitutional body in Germany, said in a statement that this expansion would ensure different doctors treating the same patient would avoid prescribing a dangerous mix of drugs.  Additional data like emergency contacts, allergies, and drug intolerances would also be stored.  In Germany, eHealth cards are the only proof of medical and dental benefits.


Privacy and Protection

Germany currently has the world’s toughest privacy laws.  This new law says data protection will be a “top priority.”  Addressing the concerns of privacy and medical identity theft among consumers, the Bundestag mandated data on the cards not only be encrypted but any access of the data must be controlled and logged. The German Bundestag specified that patients must first request that their data be collected and stored in this new way.  Patients will choose what data is allowed on their eHealth card, who has access to it, and can also opt to delete it anytime.  What remains to be seen is what will happen to this data when it is no longer needed.  Data on abandoned medical records must also be protected.

Technical implementation was coordinated with the German Federal Commissioner for Data Protection and Freedom of Information and the Federal Office for Information Security (BSI).  Advocacy groups such as The Federation of German Consumer Organizations (Vebraucherzentrale Bundesverband [VZBV]) have grave privacy concerns.  The VZBV has cautioned that data protection standards could be lowered through the Transatlantic Trade and Investment Partnership (TTIP).  Standardization of data protection is one of the facets of TTIP, and the European Parliament Committee at the center of these discussions has said they will only agree to the final TTIP if it aligns with individual protection and privacy outlined in the EU charter.

German lawmakers say their data will not be transmitted over the Internet but over a “secure health network” setup for just this purpose.  It will be encoded before leaving the doctor’s office.  Patients will allow access to their eHealth card by inserting a card and entering their PIN.  Doctors must then enter their access card to see the patients’ records.

However, in an emergency setting, doctors will have access to the records without the patients’ personal identification number.  This circumstance may provide an opening for someone to gain access to the data more easily.  In 2008, healthcare workers at UCLA Medical Center, where pop singer Britney Spears was being treated for mental illness, unlawfully viewed her medical records.  This was the second time this happened to Spears.  Physical access to the hospitals and offices where the data exists must also be considered for complete data protection.

Employers with self-insured health plans in the United States are facing challenges similar to their German counterparts in finding the balance between digital records and security.  Under President Obama’s Affordable Care Act, companies are mandated to collect and report online Social Security numbers and dates of birth of their employers, spouses, and dependents.  Not only is patient privacy at stake, but this also opens up a financial risk to both the employers and vendors as data breaches in the United States cost billions of dollars annually.


A Rocky Start

Germany’s foray into digitizing health records began in 2004.  Patient records were stored on a chip in the first generation health cards.  IT security professionals and doctors had concerns over the lack of security of having all of the patient records stored physically on the card.  These concerns put a halt to that system in 2010.  That practice was abandoned, and a new system began of storing only demographic information on the cards.  This new rollout was tough, as less than half of medical practitioners had Internet access in 2010.  In addition, not even 5% of doctors reported regularly sharing medical information with colleagues. Now just five years later, Germany is planning to store all records digitally.

With over 80 million citizens, Germany is the biggest economy in Europe.  Healthcare costs, as in many nations, have skyrocketed.  Former International Telecommunications Union secretary general Hamadoun Touré says that the link between technology and medicine is only getting stronger, “Information and communications technology will play a key role in delivering health care in the future – that’s true in developing and in developed countries.  In the developed world the driver is the ageing population. In the developing world it is a rapidly growing young population.”



Beginning in 2018, German doctors will store patients’ health records on cards called eHealth cards.  They will contain not only demographic information, but also notes from all doctors who have treated the patient on their courses of action.  Privacy concerns over how secure the information will be transferred and who will have access to it remain.


CIPP Exam Preparation                                      

In preparation for the Certification Information Privacy Professional/Europe (CIPP/E) exam, a privacy professional should be comfortable with topics related to this post, including:

Human Rights, Data Protection (I.A.a.-I.A.b.)











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