When the ePA quietly launched in 2021, it promised to revolutionize healthcare by giving patients digital control over their medical data. The idea was solid: store lab results, prescriptions, doctor’s letters and more in one secure, centralized app, accessible across hospitals, clinics and pharmacies. But the execution fell flat. The system relied on people opting in— and almost nobody did. By late 2023, fewer than 1 % of insured citizens had signed up. Most didn’t even know it existed.
Realizing this approach was going nowhere, the government changed tactics. Throughout 2024, a national campaign geared up for a new “opt-out” system: instead of asking people to sign up, every insured person would automatically receive an ePA unless they said no. By late 2024, awareness had risen substantially: about 60 % of Germans reported they knew about the upcoming “ePA für alle” scheme. Many even said they planned to use it: in a 2024 poll, 61 % of respondents familiar with the ePA said they intended to use it actively.
The results were immediate once the opt-out model launched in January 2025 — and surged with the October 2025 mandate for providers to use it.
70 million accounts were created in weeks.
Yet active use — meaning people logging in, uploading documents, or sharing access — remains far less widespread. A 2025 survey found that while many support digital healthcare in principle, nearly half of respondents still feel overwhelmed by the digital shift: 48 % said they find digital health tools too complex. Privacy and data-security concerns remain a major barrier: over 60 % of Germans consider data protection the top criterion when evaluating the ePA rollout.
In short: Germany’s ePA finally reached critical mass, not through persuasion but by flipping the default. The infrastructure is now nearly universal — the next step is earning trust, building usability, and turning a passive record into an actively used one.
At JLI, we understand that putting individuals in control of their health data is a process. It is not about simply developing an underlying technology but rather demonstrating the value (the ‘what’s in it for me’) for the individual. This leads to uptake and use and thereby putting individuals truly in control of their data. We are committed to the long term societal benefits of individuals being in control of their own health data. JLI is closely involved with the Digitale Voordeur Amsterdam, giving every citizen the ability to securely manage their health information and decide how and with whom to share it. Read more about it here:
https://www.joeplangeinstitute.org/data_and_health/digitale-voordeur-amsterdam/.
