Digital Health

Germany's healthcare system has long been considered a digital laggard — fax machines in doctor's offices, paper prescriptions, and physical insurance cards were the norm well into the 2020s. But a massive wave of legislation and infrastructure investment is now transforming how patients, doctors, and insurers interact digitally. From mandatory electronic prescriptions to apps that your Krankenkasse pays for, here's everything you need to know about digital health in Germany.

Telematikinfrastruktur (TI) — Germany's Secure Health Network

The Telematikinfrastruktur (TI) is the backbone of digital health in Germany. Think of it as a secure, closed data highway that connects doctors' offices, hospitals, pharmacies, psychotherapists, and health insurance companies — all encrypted and separated from the public internet.

The TI is operated by gematik (Gesellschaft für Telematikanwendungen der Gesundheitskarte), a government-backed organization majority-owned by the Federal Ministry of Health (BMG). Gematik sets standards, certifies components, and coordinates the rollout of new digital applications.

TI 2.0 — The Next Generation

The current hardware-based TI is being replaced by TI 2.0, a software-based, cloud-native architecture. Instead of expensive physical Konnektoren in every practice, TI 2.0 will use software connectors and digital identities (GesundheitsID). The transition began in 2024 and is expected to take several years. For patients, TI 2.0 means faster, more reliable digital services and the ability to authenticate via smartphone instead of only through a card reader.

ePA (Elektronische Patientenakte) — Your Electronic Patient Record

The elektronische Patientenakte (ePA) is Germany's centralized electronic health record for every person with statutory or private health insurance. Since January 2025, the ePA operates on an opt-out model — every insured person automatically gets one unless they actively object (Widerspruch). This was a major shift from the previous opt-in approach, which had resulted in very low adoption.

What the ePA Contains

• Diagnoses: Current and past diagnoses from treating physicians
• Medications: A complete medication plan (Medikationsplan), including dosages and interactions
• Lab results: Blood work, pathology reports, and other diagnostic results
• Vaccination record: Your digital Impfpass, replacing the yellow paper booklet
• Discharge letters (Arztbriefe): Summaries from hospital stays
• Dental bonus booklet (Bonusheft): Digital record of dental checkups
• Maternity passport (Mutterpass): Pregnancy-related records
• Child health booklet (U-Heft): Pediatric checkup records

Patient Control Over Access

You retain control over who can see your ePA data. By default, treating doctors can access your record during an active treatment relationship (typically 90 days after your last visit). You can:

• Grant or revoke access to specific doctors, hospitals, or pharmacies
• Hide individual documents from certain providers
• View your complete record at any time via your Kasse's ePA app
• Download or delete documents

E-Rezept — The End of the Pink Paper Prescription

Since January 1, 2024, the E-Rezept (electronicprescription) is mandatory for all prescription medications covered by GKV. The iconic pink paper prescription (Muster 16) is officially a thing of the past for standard prescriptions.

How the E-Rezept Works

1. Doctor prescribes digitally: Your doctor creates the prescription in their practice software. It's signed with a qualified electronic signature and uploaded to the central E-Rezept server (operated by gematik).
2. You pick up at any pharmacy: You have three ways to redeem your prescription:
   • Versichertenkarte (eGK): Simply insert your health insurance card at the pharmacy — this is the most common method
   • E-Rezept App: The official gematik app shows your open prescriptions and lets you assign them to a pharmacy, including online pharmacies
   • Printout with QR code: For those who prefer paper, the doctor can print a QR code on a sheet (Patientenausdruck) that the pharmacy scans
3. Pharmacy dispenses: The pharmacist retrieves the prescription from the server, dispenses the medication, and marks it as fulfilled.

eAU — Electronic Sick Note

The eAU (elektronische Arbeitsunfähigkeitsbescheinigung) replaced the traditional paper sick note (the yellow "Gelber Schein") starting January 2023. If you're sick and visit a doctor, the process is now fully digital:

1. Doctor diagnoses: Your doctor determines you're unfit for work and enters the eAU into their system.
2. Automatic transmission to Kasse: The eAU is sent electronically to your Krankenkasse — you don't need to mail or submit anything.
3. Employer retrieves it: Your employer can pull your eAU data electronically from the Kasse's system. They see the dates of your absence but not the diagnosis.
4. You still notify your employer: You're still legally required to inform your employer that you're sick (by phone, email, etc.) — the eAU only replaces the paper document, not the notification duty.

DiGA (Digitale Gesundheitsanwendungen) — Apps on Prescription

Germany is the first country in the world to allow doctors to prescribe apps that are then paid for by statutory health insurance. These are called DiGA (Digitale Gesundheitsanwendungen, or Digital Health Applications), and they've been available since 2020 under the DVG (Digitale-Versorgung-Gesetz).

How to Get a DiGA

1. Doctor prescribes it: Your doctor (or psychotherapist) determines that a DiGA could support your treatment and writes a prescription (Verordnung).
2. Submit to Kasse: You send the prescription to your Krankenkasse (often via their app). Some Kassen also accept DiGA requests directly without a prescription for certain apps.
3. Receive activation code: Your Kasse sends you a Freischaltcode (activation code) — usually within a few days.
4. Download and use: Download the app from the App Store or Google Play, enter your code, and start using it. The Kasse pays the manufacturer directly.

The BfArM DiGA Directory

Not just any health app qualifies. DiGA must be listed in the official BfArM DiGA-Verzeichnis (Federal Institute for Drugs and Medical Devices directory). Apps go through a rigorous evaluation process and fall into two categories:

• Permanently listed (dauerhaft aufgenommen): The manufacturer has proven a positive care effect (positiver Versorgungseffekt) through a clinical study. These are fully established DiGA.
• Provisionally listed (vorläufig aufgenommen): Listed for up to 24 months while the manufacturer conducts the required study. If they can't prove effectiveness by then, the app gets delisted.

Popular DiGA Examples

• Deprexis: CBT-based therapy support for depression — one of the first and most established DiGA
• HelloBetter: Multiple apps for depression, stress, chronic pain, and insomnia, based on cognitive behavioral therapy
• Kaia Health: Physiotherapy exercises with motion tracking for back pain and COPD
• Zanadio: Multimodal program for obesity management (nutrition, exercise, behavioral therapy)
• Somnio: Digital sleep therapy for insomnia based on CBT-I (cognitive behavioral therapy for insomnia)
• Vivira: Personalized movement therapy for musculoskeletal pain (back, hip, knee)
• Selfapy: Online courses for depression, anxiety, eating disorders, and other mental health conditions

Videosprechstunde — Video Consultations

Video consultations (Videosprechstunde) are fully covered by GKV as a standard part of outpatient care. The COVID-19 pandemic massively accelerated adoption, and the option is now permanently established in the German healthcare system.

How It Works

• Book an appointment: Many practices now offer Videosprechstunde as a booking option on their website or through platforms like Doctolib or Jameda. Some have dedicated video consultation hours.
• Certified platforms only: Doctors must use platforms certified by the KBV (Kassenärztliche Bundesvereinigung). Popular certified providers include Doctolib Video, CGM ELVI, Patientus, Doxy.me, and Jameda Video.
• Join the call: You typically receive a link via email or SMS. No special software required — it runs in your browser. Some platforms have dedicated apps.
• Doctor bills normally: The doctor bills your Kasse just like an in-person visit. There's no extra cost to you.

What Video Consultations Are Good For

• Follow-up appointments: Discussing test results, adjusting medications, checking on recovery
• Mental health: Psychotherapy and psychiatric consultations work well via video
• Dermatology: Showing skin conditions to a dermatologist
• Chronic disease management: Regular check-ins for diabetes, hypertension, etc.
• Sick notes: Doctors can issue eAU via video for up to 5 days (for patients they already know)
• Prescription renewals: Getting E-Rezepte without an office visit

Online Appointment Booking

Finding and booking doctor appointments online has become much easier in Germany. While many practices still rely on phone bookings, several platforms let you search for available appointments and book instantly:

• Doctolib: The market leader in Germany (and France). Massive database of doctors across all specialties. Book appointments 24/7, manage your bookings, get reminders, and access video consultations. Free for patients.
• Jameda: Germany's largest doctor review and booking platform. Search by specialty, location, and insurance type (GKV/PKV). Includes patient reviews and ratings. Also offers video consultations.
• Arzt-Auskunft: Run by the Stiftung Gesundheit. A comprehensive directory of doctors, clinics, and emergency services. More focused on finding the right specialist rather than instant booking.
• TK-TerminService: Techniker Krankenkasse's appointment service for TK members. Helps find specialist appointments quickly, which is especially useful given Germany's long wait times for certain specialties.

Health Apps from Kassen

Beyond the ePA app, every major Krankenkasse offers its own comprehensive health app with a range of digital services. These are free for members and increasingly replace paper-based interactions:

TK-App (Techniker Krankenkasse)

• Digital Versichertenkarte (digital insurance card) on your phone
• Submit claims and receipts by photo
• Track reimbursements and benefits used
• Access TK-Safe (ePA functionality)
• Bonusprogramm tracking — earn rewards for healthy behaviors
• Doctor search and appointment booking
• Sick note and coverage status overview

AOK Mein Leben

• ePA access for AOK members
• Document management — store health documents digitally
• Medication plan and vaccination records
• Share records with doctors directly from the app

BARMER-App

• Digital Versichertenkarte
• Claims submission and tracking
• Bonus program management
• Teledoktor service — 24/7 medical hotline with callback
• Family management — handle children's insurance matters

DAK App

• Digital Versichertenkarte
• Upload Arbeitsunfähigkeitsbescheinigungen and other documents
• Bonus program and cashback tracking
• Find doctors and specialists nearby
• Direct messaging with DAK customer service

Telemedizin — Beyond Video Consultations

Telemedicine in Germany goes well beyond simple video calls. Several specialized forms of remote care are emerging and growing rapidly:

Remote Patient Monitoring (Telemonitoring)

Patients with chronic conditions like heart failure can be monitored remotely. Connected devices (blood pressure monitors, scales, ECG patches) transmit data to a Telemedizinisches Zentrum (telemedicine center), where medical staff watch for warning signs. Since 2022, GKV covers telemonitoring for heart failure patients, with more conditions expected to follow. Studies show this can significantly reduce hospital readmissions.

Teledermatology

Photo-based skin checks are gaining traction. Services like OnlineDoctor and dermanostic let you photograph a skin condition and send it to a board-certified dermatologist for assessment. You typically receive a diagnosis and treatment recommendation within 24-48 hours. Some are covered by GKV through selective contracts (Selektivverträge) with individual Kassen, while others operate on a self-pay basis (€25-40 per consultation).

Telepsychiatry and Online Therapy

Given Germany's severe shortage of psychotherapy spots (average wait time: 3-6 months), digital mental health services are in high demand. Beyond DiGA like Selfapy and HelloBetter, some providers offer full telepsychiatry — psychiatric consultations and medication management via video. Group therapy via video is also becoming more common and is covered by GKV.

Future Trends

• AI-assisted diagnostics: AI tools for radiology, pathology, and dermatology are being integrated into clinical workflows
• Digital twins: Personalized health models based on your data that predict disease risk and treatment outcomes
• Cross-border prescriptions: The EU is working on interoperable E-Rezept systems across member states
• Wearable integration: Smartwatch and fitness tracker data feeding into the ePA for continuous health monitoring
• Ambient clinical intelligence: AI that listens to doctor-patient conversations and auto-generates documentation

Data Privacy — DSGVO/GDPR in Health

Health data is classified as besondere Kategorien personenbezogener Daten(special categories of personal data) under the DSGVO (Germany's implementation of the EU's GDPR). This means it receives the highest level of legal protection.

Your Rights as a Patient

• Right to access (Auskunftsrecht): You can request a complete copy of all health data held by any doctor, hospital, or Kasse
• Right to rectification: You can demand correction of inaccurate health records
• Right to data portability: You can request your data in a machine-readable format to transfer to another provider
• Right to erasure: With limitations — medical records must be retained for 10 years by law, but you can request deletion from the ePA
• Right to restrict processing: You can limit how your data is used beyond direct treatment

What Doctors and Kassen Can See

Access to your health data is strictly regulated:

• Your treating doctor: Can access your ePA data during an active treatment relationship (typically 90 days). They see what you've made visible.
• Your Krankenkasse: Can see claims data (what treatments were billed), but cannot access your ePA contents. Your Kasse knows you visited a cardiologist, but not what the cardiologist found.
• Your employer: Has zero access to any health data. The eAU only confirms dates of absence — never the diagnosis.
• Pharmacies: Can access your E-Rezept data only when you present your card or app. They don't have standing access to your records.
• Researchers: Can access anonymized/pseudonymized data from the Forschungsdatenzentrum (health data research center) — but never identifiable patient data without explicit consent.