Ninety Percent Started, Twenty-Six Finished: Germany's ePA in Hospitals
A hospital-association survey finds nine in ten German hospitals have begun connecting to the national patient record, but only a quarter can use it everywhere. The interesting number is the distance between the two.
Dr. Sven Jungmann
CEO
Two numbers from the same survey, set side by side, do most of the work. Ninety percent of German hospitals have begun the technical connection to the national electronic patient record. Twenty-six percent can actually use it across the whole house. The first figure says the sector is moving almost everywhere; the second says almost nowhere has it arrived. Both come from a flash survey of 489 hospitals the Deutsches Krankenhausinstitut (German Hospital Institute) ran for the Deutsche Krankenhausgesellschaft (German Hospital Association), reported on 25 March 2026.
The record in question is the elektronische Patientenakte, or ePA — Germany's national, cross-provider health record, which is not the same thing as the hospital's own internal information system. Its use became a legal obligation for hospitals on 1 October 2025. From 1 April 2026, hospitals not connected to it lose their claim to the flat-rate reimbursement (the TI-Pauschale) that funds the underlying telematics infrastructure. The survey therefore lands at the point where the deadline stops being a date on a slide and starts subtracting from a budget.
Whose measurement this is
Before the figures, the instrument — because it fixes how much they can carry. This is a self-report survey, commissioned by the hospitals' own association, sent to 489 of Germany's roughly 1,700 hospitals, and filled in by the institutions about themselves. That is a sound way to read the temperature of a sector, and because the DKG runs it repeatedly, it lets us see direction rather than a single snapshot. What it is not: an independent audit. It does not check what 'hospital-wide use' means at each site, and an association reporting on its members' progress has an evident interest in the framing. The figures are not thereby wrong — they are a sector describing itself, which is a different evidentiary object than inspected fact.
What the figures will bear
Read as a sequence, the numbers describe motion without arrival. Ninety percent have started the technical activation. Forty percent are now piloting the record inside real care processes — against 7 percent in late summer 2025, a steep and genuine climb. Yet only 26 percent run it everywhere, and 18 percent are still waiting on their vendor to ship the software update their hospital information system needs, more than five months after the obligation took effect. Asked to look forward, 43 percent do not expect hospital-wide use to be possible before the third quarter of 2026.
What the sequence rules out is the comfortable story that hospitals are dragging their feet. Ninety percent have begun; the work is under way almost everywhere it can be. The brakes are the ones the survey itself names, and which the DKG's Henriette Neumeyer put plainly: hospitals are doing their part of the homework, but the solutions in the primary systems are not yet good enough to use. Add scarce clinical-IT specialists and funding instruments that cover less than the true cost of integration, and the gap between 90 and 26 resolves into something concrete — the distance between deciding to connect and the connection being technically usable.
“Ninety percent have started and twenty-six percent have finished. The gap between those two figures is the whole question.”
What it cannot tell you
The survey also refuses the opposite reassurance — that the rollout is on schedule. Three-quarters cannot yet use the record everywhere, and a plurality do not expect to before late 2026. And there is a deeper limit built into what it measures. It counts connection and self-reported readiness; it says nothing about the only thing that ultimately reaches a patient — whether the records, once they flow, are complete, correct, and actually consulted at the point of care. A connected hospital and a clinically useful record are separate achievements. This instrument can see the first and is blind to the second.
The pattern, not the headline
None of this is peculiar to the ePA. The same lag between a statutory deadline and operational capacity trailed the electronic prescription, and, at its own scale, the uptake of digital health applications. The lesson repeats because the cause does: in a landscape of heterogeneous, historically grown software and thin specialist-IT capacity, a mandate fixes the date but does not manufacture the means. Anyone scoping the next compulsory digital step should ignore the launch-day percentage and watch the slope between 'started' and 'finished' — and ask, before the date is set, whether the tools the deadline assumes are ready to be switched on.
Source: Deutsche Krankenhausgesellschaft. Kliniken treiben Umsetzung der ePA voran – trotz schwieriger Rahmenbedingungen, press release of 25 March 2026, reporting a flash survey of 489 hospitals by the Deutsches Krankenhausinstitut. This is a self-report survey commissioned by the hospitals' own association, not an independent audit; the figures describe how the sector reports its own progress.
