>> The Münch Foundation already asked the question about the status of the ePA in Germany and Europe in 2016. At that time, Germany ended up in eleventh place in the corresponding rankings. Denmark, Sweden and Estonia took the top spots. According to the authors, the study showed “that in countries with a well-established ePA, a clear requirement from the legislature was the basis for the successful introduction”.
In the current update of the “European Scorecard” there are few major changes to be observed compared to 2016. The Scandinavian countries – Denmark, Finland and Sweden – still lead the ranking (see Fig. 1). These are followed by Estonia and Spain. The United Kingdom (by seven places) and France (by six places) show significant improvement. An increase of three places can be seen in Spain and Switzerland.
But how can the Scandinavian pioneering position with regard to the ePA be explained? “The top positions of Denmark and the other, very advanced countries Finland, Sweden and Estonia are based - in addition to the excellent infrastructural conditions, such as the almost complete coverage with broadband internet and a high Internet affinity of the population - in particular on the progressiveness in terms of use of the content offered and available functions of the respective ePA,” explain the study authors. These ePAs are not just limited to health data. There was secondary use of ePA data and there were also binding standards for interoperability. Furthermore, the ePA is used in all hospitals, including always in emergency rooms. At the same time, there is very good integration of general practitioners and specialists, e-prescriptions can be issued, and all patients would enjoy full access to their own ePA.
The United Kingdom shows the biggest jump up in the ranking compared to 2016: by seven places, France the second largest by six places. The reasons are given in the
Analysis cited infrastructural factors, particularly for the United Kingdom, such as high eHealth literacy and a lower proportion of older doctors on the one hand, and improved specific regulations for the content of the ePA, such as the listing of procedures carried out or access to one's own ePA, on the other hand . “The only negative development in 2016 was in the medication plan, which according to current data has been omitted,” the study authors state and summarize: “The three countries Spain, Switzerland and the United Kingdom, which were still in the yellow category in 2016, were moderately advanced group belonged to the green, advanced group.”
The fact that Spain was able to move up three places is due to the fact that the ePA is well-established in the healthcare system in this country. According to the study authors, almost all general practitioners currently use an ePA, and of these, over half use it to issue prescriptions. In addition, around 70 percent of Spanish specialists used an EHR.

Standards for interoperability are a success factor
In the case of Switzerland (improvement by three places, now in 6th place), the authors explain the jump with the complete broadband Internet expansion, which is accompanied by a high frequency of Internet use by the population. In addition, the secondary data use of ePA data that has now been implemented also plays a role.
Overall, according to the authors, the study shows that more countries than in 2016 have made good progress in the use and functionality of the ePA. The second best and moderately advanced group (marked yellow in Fig. 1) leads Portugal in ninth place. France follows in tenth place. The country has moved up six places, leaving the red group of less advanced countries. However, this obviously doesn't just have something to do with the real improvement in ePA distribution. France's significant leap forward can be justified in particular by the fact that there is now better data available for this country, "that is, a lot of information on the contents and functions of the ePA that was not coded with any information in 2016 can now be coded with a positive information , i.e. a higher score,” says the study.
In addition, EHRs are widely used in hospital emergency rooms in France. The infrastructural characteristics, university degrees in MINT subjects or the use of the Internet to obtain health-related information are also positive.
In eleventh place are the Netherlands (no change compared to 2016) and Austria (deterioration by three places). Belgium, Lithuania and Poland follow in 13th place. The authors are convinced that Poland's relative improvement is due in particular to the improved broadband internet offering and the specific regulations that now exist for the content of the ePA.
Germany is also in 13th place, falling two places in the ranking compared to the 2016 study “and thus barely slipping into the red, less advanced group”. The devastating verdict of the study experts is: “Apart from an improvement in broadband internet, the Federal Republic was unable to show any improvements in any other indicator.” Germany is even further away from catching up with the very advanced countries. Although Germany has very good infrastructural conditions, as shown, for example, by its scoring in sub-category A (see Fig. 3), the indicators considered in sub-categories D and E in particular indicate that ePA in Germany is not - as politicians and self-government had hoped - are widespread and implemented and therefore used.
“Although there is a top-down approach both legally and in the form of expressions of interest from self-administration partners and, as current surveys show, there is great acceptance of the ePA on the part of insurers, it can currently be observed that only some cost bearers have ePA in on their own initiative "In the form of so-called 'isolated solutions' and thus follow more of a bottom-up approach," write the study authors in their outlook. They point out that both the Techniker Krankenkasse, in collaboration with the American IT and consulting company IBM, and the AOK Federal Association have currently developed their own ePA, which should be compatible with the telematics infrastructure. Nevertheless, the authors see good signs that the “big hit” in ePA matters could be successful in Germany in the near future.
However, they assume that the ePA will not be pushed forward within the Gematik framework, but rather in alternative solution approaches, such as linking it to the citizen portal planned by the federal government. <<

Author: Olga Gilbers