Beyond Implementation: Exploring Older Adults Perspectives on the Electronic Patient File (ePA) in Germany

Abstract

The German Electronic Patient Record (elektronische Patientenakte – ePA) represents a key digital infrastructure in Germany’s evolving health system. While its technical development and institutional implementation have received considerable attention, the everyday practices and perspectives of patients remain largely invisible in current research and public discourses. This contribution presents an ongoing qualitative study that foregrounds patient expectations, concerns, and first experiences regarding the use of the ePA. Drawing on initial interviews, we explore how patients make sense of the ePA, navigate access, and articulate concerns around data control, utility, and trust. Our findings point to a gap between institutional logics and lived practices, raising critical questions about infrastructural (non-)use or user agency. While data collection is ongoing, first insights already highlight the importance of embedding patient perspectives into the design and evaluation of digital health infrastructures. We argue that infrastructuring efforts must extend beyond technical rollout to include patients as co-creators of meaningful, accessible, and trustworthy health systems.