Digital public health in Germany

The German healthcare system is complex, with different levels of government and stakeholders involved. Therefore, implementing a consistent and cohesive digitalisation strategy nationwide is challenging. Unsurprisingly the system seems to operate according to the mantra: “From the cradle to the grave: forms, forms”. It is still one of the most paper-based healthcare systems in Europe. Until 2021, there were no electronic health records. Electronic prescriptions are delayed until 2024. The systems structures appear stuck and inflexible. The COVID-19 pandemic displayed the weaknesses of the German healthcare system: A lack of digital infrastructure, limited access to teleconsultations and telemedicine, healthcare professionals lacking training in digital health tools, etc. However, instead of giving up, there was a push from the industry and legislators toward applying more digital tools in the healthcare routine. Germany was among the first countries to develop one of the safest contract tracing apps worldwide (Corona-Warn-App). It further lifted its restrictions on telemedical consultations and was the first country to introduce medical and care apps on prescription (DiGA and DiPA). Additionally, the first national health portal was introduced in 2020 to provide the general population with information on health- and disease-related topics and an overview of currently implemented and planned digital health services. Now, it is discussed setting up a national Health Data Lab to empower public health research through secondary data based on health insurance claims data. Nevertheless, the question remains where the German legislative sees the role of health promotion and primary prevention. While public health associations push for recognising these crucial aspects of public health, all national projects currently focus on diagnostics and treatment. The question remains if and when Germany will realise the potential of digital public health in primary health promotion.