‘Joint decision trap’ reloaded? The governance of electronic health records (EHRs) implementation in Germany

Fragmentation in health systems causes discontinuities in the provision of health services, reduces the effectiveness of interventions and increases costs. The fragmentation between ambulatory care sector and hospital sector is a major health policy concern in Germany; the country ranks at the bottom in international comparisons when it comes to the integration of health services. Integrated health systems must include the data structures that can link patients’ health information over time. The establishment of electronic health records (EHRs) is the basis of a digitalised health system as EHRs record individuals’ most important health-relevant information in a digital documentation system and make this information available to healthcare providers across disciplines, facilities and sectors. Despite the political efforts undertaken, one might wonder why intersectoral care and healthcare data integration in Germany remain controversial and are still in an embryonic phase. EHR users in Germany amount to less than 1% of the insured persons, and ongoing political debates indicate that a wider implementation will be anything but straightforward. By exploring the main stakeholders in the existing (fragmented) health system governance in Germany and their interests, this paper examines the topic through the lens of integrated care, offering insights based on decision-making theory. In so doing, it demonstrates that the EHR deployment and use of health data are and will be a matter of governance, rooted in the principles of and the tension between the self-governance of corporatist actors and public administration in Germany.