JMIR Publications

ABSTRACT

Background:

In January 2025, Germany began the nationwide opt-out rollout of the electronic patient record (elektronische Patientenakte; ePA) to approximately 74 million people insured under statutory health insurance, a central element of the country’s digital health reform agenda. Because lay audiences rarely evaluate complex sociotechnical systems such as electronic health records directly, journalistic media act as key intermediaries that structure the public visibility of risks, benefits, and responsible actors and thereby shape mediated trust. Within an infodemiology framework, news reporting is part of the wider health information environment, yet how national electronic health record rollouts are framed in the media remains underexamined.

Objective:

This study analyzed the overall tone, thematic emphases, and temporal dynamics of German-language media coverage of the ePA across the 2025 rollout year.

Methods:

We conducted a structuring qualitative content analysis of German-language online news articles published between 1 January and 31 December 2025. Articles were identified through a systematic hybrid retrieval strategy combining structured web searches with outlet-specific archive searches across national daily and weekly newspapers, major news portals, and specialist health, technology, and data-protection media. Each article was coded at the article level for overall tone (positive, neutral/ambivalent, negative) and at the segment level for predefined thematic categories using MAXQDA. Codes were aggregated quantitatively and examined for tone–theme associations and for monthly temporal patterns.

Results:

The final sample comprised 102 articles from 38 outlets. Coverage was predominantly negative (57/102, 55.9%), with neutral or ambivalent reporting forming a substantial secondary share (42/102, 41.2%) and positive articles remaining marginal (3/102, 2.9%); positive coverage never became dominant in any month. Risk-related and data-protection themes dominated the first half of the year, implementation and technical issues recurred throughout, patient-related themes grew from midyear, and political and regulatory themes intensified in the final quarter. Negative tone was systematically coupled with the category Risks and Problems, present in all 57 negative articles (100%), whereas Benefits and Opportunities appeared almost exclusively in neutral/ambivalent and positive articles and in no negative article. Five temporal phases of reporting were identified.

Conclusions:

German-language media framed the ePA in 2025 as necessary but problem-ridden, with critical resonance centered on data security, usability, and governance. Sustained positive coverage did not emerge, suggesting that public normalization of the reform had not occurred by year-end. Future tone is likely to depend on whether policymakers and health system actors credibly resolve the most prominent concerns. At the same time, investigative reporting served a corrective function by surfacing vulnerabilities quickly.