Consumer perspectives on the national electronic health record and barriers to its adoption in Germany: does health policy require a change in communication?

Background: The national health record (ePA) was introduced January 1, 2021 in Germany and is available to every person insured under statutory health insurance. This study investigated the acceptance and expectations of the national health record in Germany, focusing on consumer perspectives, expectations, barriers, information needs, and communication aspects.

Methods: An exploratory, observational, cross-sectional online survey was conducted one year after ePA introduction, followed by descriptive statistical analysis.

Results: The top three ePA use cases were medical document collection, simplified data exchange between medical institutions, and emergency medical information. Adoption barriers included lack of information and access, privacy concerns, and perceived lack of necessity. Participants that felt informed about the ePA, reported they received information primarily from health insurances, the media, and educational or professional sources, mainly through printed brochures, social media, or via emails. Most participants (86.5%) preferred being informed through conversations, particularly with health insurance providers (81.5%) and doctors (61.0%). Written information was highly desired (94.5%), preferably via email or information letters/flyers. However, more than half of the participants (55.6%) reported being uninformed about the ePA introduction.

Conclusion: The study revealed a communication gap between providers and consumers, leading to a low acceptance rate of digital health technologies. Comparisons with other countries showed low adoption rates for opt-in systems. The authors suggest changing communication strategies, given users prefer direct information from doctors or health insurance companies. Adopting an opt-out system with professional social media and marketing campaigns could increase nationwide ePA adoption.