Electronic health records: control access or opt out

A fictional example

Fictional example: Liam, 38, grew up in Cork and now works in Graz. He logs into the Austrian ELGA portal with ID Austria for the first time and opens the access log. It shows which practices have looked at his records and when. One older report he would rather keep to himself, so he blocks it. Everything else stays visible to the people treating him.

Liam also wants to see his nine-year-old daughter's records. She is co-insured with him and they share a main residence, so he can log in as the parent with custody. He does not need to opt out of anything: the portal settings already cover what he wants.

Which record applies where you live?

Each country runs its own system. Some follow an opt-out model, Switzerland an opt-in model, and Italy asks for your consent before professionals may consult your record.

In Germany, private health insurers may offer an ePA on the same opt-out basis, and some have started. In Italy, each region or autonomous province runs its own FSE, so details vary. Whether a record is useful for you depends on your situation; for medical questions, ask your doctor.

How do you limit who sees what?

Germany

When you insert your health insurance card at a practice, it is granted access to your ePA. In the app you can limit that access by time and content. You can also object to one specific practice or facility in the app or through the ombudsperson office; it then cannot work with your record until you withdraw the objection. If one treatment should not be added at all, say so during the appointment.

Austria

The ELGA portal shows who viewed which data and when, and which providers currently have access; you can extend or shorten that access for each provider. You can also block, unblock, download or permanently delete documents.

France

Access to your DMP depends on your consent. You can block specific health professionals and mask documents so that professionals consulting the record no longer see them. You can change these settings at any time. In an emergency, professionals and the regulating doctor of the SAMU-Centre 15 can access your DMP unless you object.

Italy

You give or withdraw consent to consultation in your FSE or through your region's procedure, and you can change it at any time. Without consent, only you and the doctor who wrote a document can see it. You can also obscure single documents; sensitive data such as HIV status or a termination of pregnancy are obscured automatically. You can view the accesses and ask to be notified each time.

Spain

In the HCDSNS you can hide each document from the index page and undo it later. A warning explains that professionals may still need to open hidden documents in emergency mode. The access log lists who opened your documents, and you can file a complaint about a specific access online.

What happens when you opt out?

In Germany there is no obligation to have an ePA, and you can object at any time. Before the record exists, tell your insurer. Once it exists, object in the app or with the insurer: the account is deleted with all its content, including data already passed to the research data centre. You can also object only to research use, to billing data or to the digital medication process and keep the rest.

In Austria you can leave ELGA completely or only drop e-reports or e-medication. Do it in the portal, by form with a qualified electronic signature, or by post with a signed form and a copy of official photo ID to the ELGA-Widerspruchstelle, Postfach 180, 1021 Wien. A full opt-out deletes all data; you can rejoin at any time, but deleted data does not come back. Your electronic vaccination record is not affected.

In France you can object within six weeks of the Assurance maladie message, close your space later at any time, online or by phone, and ask for it to be created again. In Italy, the regional leaflet describes withdrawing consent to consultation and obscuring documents, not leaving the system. For Spain, the ministry's guidance describes hiding documents; for anything beyond that, ask your regional health service.

Sample wording for a written objection

Use the official form where one is offered. A short cover note to a German insurer could read: “I object to the creation and use of my electronic patient record. If a record already exists, please delete it. Name, date of birth, insurance number: … Please confirm in writing once this has been done.”

How can someone act on your behalf?

In Germany you can authorise a proxy who then manages your ePA. In Austria, parents with custody can represent children until their 14th birthday if the child is co-insured with them and they share a main residence; from 14, teenagers manage their own ELGA rights. Adults can be represented with a valid electronic power of attorney or a paper copy of a power of attorney or official document.

In the Swiss EPD, a trusted person can manage your record with the same rights as you, and parents can manage it for their children. In France, minors can ask the professional or facility adding to their DMP to keep certain information from their parents. In Italy, a carer can use a frail person's FSE on their behalf with a delegation; your local health authority or regional portal explains how.

Tip: A proxy or delegation is safer than sharing your login, because it can be withdrawn. More on this in Helping digitally without collecting other people's passwords.

Switzerland: why the rules are different

Switzerland is not an EU member, so EU health data rules do not apply automatically. Opening an EPD is voluntary. You choose a provider and need, among other things, an AHV number, a smartphone, an accepted ID document and an electronic identity certified for the EPD. The EPD is free in principle; some providers charge a fee depending on the canton, but every canton has at least one free option.

In a medical emergency, professionals can access your EPD directly, and you are notified by email or text message. Health insurers, authorities and employers have no access. You can close the EPD at any time without giving a reason; the record and all documents are then deleted, while your doctors keep their own files. A new law would give every resident an electronic health dossier unless they object within a set period, but it is not yet in force, so you cannot object to it today.

What changes with the European Health Data Space?

The EHDS Regulation was published in the Official Journal on 5 March 2025 and entered into force on 26 March 2025. From March 2029, patient summaries and e-prescriptions are to be exchanged in all Member States; from March 2031, medical images, lab results and hospital discharge reports follow. How e-prescriptions already work today is explained in Redeeming an e-prescription.

You get fast, free access to your electronic health data, can see who accessed it and can restrict access to parts of your record or to specific people. Member States may offer an opt-out from cross-border exchange. You can also opt out of secondary use, such as research, in a simple and reversible way, although data may still be used for certain public interest purposes under strict safeguards. National digital IDs often unlock these services; see what the EU Digital Identity Wallet can do.