1. Electronic health cards - European perspectives
Electronic health cards - European perspectives
1st national eHealth conference
Sofia, Bulgaria
Reinhold A. Mainz
Federal Ministry of Health (BMG), Germany
Group Telematics

2. Content
Electronic European Health Insurance Card
Overview: Some activities of Member States of the EU in the field of electronic cards
The German example
The perspective
Collaboration in Europe

3. Electronic European Health Insurance Card

4. The eHealth Action Plan - Overview of actions with responsibility by the Member States: 2008
Promote the use of cards in the health sector
Adopt implementation of a European electronic health insurance card (EC)

5. (Electronic) „European“ (Health) (Insurance) Card - eEHIC
Responsible: Administrative Commission to the basic Regulation on Social Security Schemes and the Free Movement of Persons (EEC No 1408/71)
Secretariat: EC DG EMPL
EC eHealth Action Plan (COM(2004)356): Introduction of an eEHIC shall start in 2008
on-line verification of insurance data?
„Inclusion“ of medical data?
emergency data set
key to the electronic health record
Off-line use of chip cards or need to set-up secure and interoperable infrastructure services

6. Overview: Some activities of Member States of the EU in the field of electronic cards

7. Austria 1) until end 2005: e-card
Electronic social security card; usable as a tool for all eGovernment processes
Only used for health insurance entitlement online checks ( connector concept)
Access together with health professional cards
Enables the citizen also to sign administrative documents electronically
2) beginning in 2006: implementation of a first application using medical data: ePrescribtion

8. Belgium 1) 1998: SIS card as social security card
Insurance data can be read by everybody, some medical data can be read and stored by health professionals using a health professional card
2) until 2009: electronic id card for all eGovernment applications
Shall include the SIS card data

9. Estonia 1) since 2002: electronic national id cards for every citizen
eGovernment portal  can and shall provide health related applications to the citizens
Central document index for patient related documents of the health system

10. Finland 1) electronic national id cards for every citizen
2) beginning in 2007: Access to electronic health records shall be given after authentication by the national id cards

11. France 1) until 2006: Sesam Vital II card
Electronic health cards for all insured persons elder than 15 years
Includes biometric data for security measures instead of a PIN
2) beginning in 2007: as a tool for access to an electronic patient record
Access together with health professional cards or special passwords

12. Italy 1) electronic health cards in the regions Veneto and Lombardia
2) End 2005: Some other Italian regions begin to issue electronic health cards

13. Slovenia 1) 2000 - 2004: electronic health card
Health insurance entitlement online checks
Access together with health professional cards
Public kiosks for the citizens, where they shall change some personal data
2) modell regions: implementation of first applications using medical data like allergies, immunization, …

14. Spain 1) Since 2004: Andalusia tests an electronic health card,
used as a tool for access to electronic patient records
2) Beginning in 2006: electronic national id cards for every citizen
For eGovernment applications (including eHealth?)

15. Switzerland
1) Since 2004: Modell region Tessin for the carta sanitaria
no foto, biometric data (fingerprint) instead of a PIN
Card can be used for ePayment functions (coffee in a hospital, …)
Software on the card for a reservation system
Mandatory (?): Insurance data, emergency data, eprescription
Not mandatory: electronic patient record on servers, some copies on the card itself

16. The German example: Target, strategy, concept, costs

17. Modernize the healthcare system by use of ICT:
Target
Modernize the healthcare system by use of ICT:
establish more citizen oriented services
support patient-centred care
improve quality and services
reduce costs
provide data for health systems management

18. Strategy (1)
Establish an ICT infrastructure financed by one / some applications, so that other applications can build on the infrastructure – without having those basic costs
Choosen applications with priority (positive cost-benefit analysis):
Mandatory
Online verification of insurance status
Transport of (drug) prescriptions
Voluntary for citizens
Drug interaction and contraindication checks

19. Strategy (2)
Stepwise implementation of applications (and functions) of a private electronic patient record by using the established infrastructure

20. Strategy (3)
Data provided electronically in principle can be better used for different purposes
But: Statistical data can not be read from medical application related storages (encryption!); at the source of data separate purpose related data streams have to be implemented using aggregation, pseudonymisation and anonymisation techniques

21. Citizen managed personal electronic health record
A citizen managed personal electronic health record
is offered and operated by the healthcare system
is defined by law and contracts of the self-governmental healthcare system on the federal level
data is provided by healthcare professionals (in form of copies from the original documentation) – if the citizen gives his consent for an application and to specific healthcare providers
data can be provided by the citizen
the citizen is the owner of the data (right to delete!) ( „virtual record“, „view“)

22. Access to the personal electronic health record
A special smart card („Gesundheitskarte“, Health Card) is the citizens tool to manage data in a trustworthy and secure way
access to the Electronic Health Card – and the managed data - exclusively by authorized healthcare professionals authenticated by using a Health Professional Card (HPC) (in principle)
logging of access
management-rights (hide/unhide/delete!) - except for administrative data
(in principle) electronic authorisation by the insured person required (exception: emergency data set)

23.
The healthcare system in Germany: A system with a pressing demand for communication
dentists
80 Mio. persons insured
2 200 hospitals
licensed practical doctors
Patient centered communication:
The Electronic Health Card
is the main tool for linkage of data
pharmacies
Ca. 290 statutory health insurance funds

24. Key elements of the security concept
Key elements of the security concept
The citizen`s tool
The professional`s tool
The combination of these smart cards is the
base for a secure and trustworthy Telematics Infrastructure

25. A special infrastructure is constructed
connecting „closed virtual private networks“ operated by responsible healthcare organizations (sectors: doctors, hospitals, pharmacies, dentists, …)
using special „connectors“ to connect local systems to the network, to infrastructure services and to smart card terminals
using cryptographic techniques between components for authentication and encryption / decryption
using (qualified) digital signatures
storing and transporting data using cryptography, so that data can only be used with a citizen`s consent (the health card in principle must be used)

26. Overview about the planned infrastructure for the Electronic Health Card - Solution Architecture –

27. Storage concept
data - resp. copies of the original data - (in principle) is / are stored by each healthcare provider in a distributed environment
some data is stored (also) on the „Gesundheitskarte“ itself
(European) Emergency data / basic clinical data set
identification data
insurance data
private cryptographic keys (on the card only)
citizens can use their own data after authorization by a smart card with qualified digital signature (might be the health card itself) and if the data has been copied to a special storage space

28. Cost categories (2004 – 2006/2007) Prognosis:
Central infrastructure set-up
connected virtual private networks
infrastructure services
Local infrastructure set-up
modern hard-/software in doctors offices, hospitals, pharmacies
connector
smart card terminals
Infrastructure set-up costs about – Mill. EUR (?) [~20 € per citizen]
Development costs about 100 – 150 Mill. EUR (?) [~2 € per citizen]
Prognosis:
Return of investment within max. 3 years

29. The perspective

30. while staying in other Member States (or world-wide)
Perspectives
Services used at home
shall be available
while staying in other Member States
(or world-wide)
Smart cards are (at the moment) the security tool to identify persons, authenticate them, derive rights for access to data, applications, services, infrastructure
Most services will be network based, smart cards can store some synchronized data

31. Collaboration in Europe

32. Systems (in Europe) must be interoperable
eEurope
eHealth services in Europe: Dynamic development driven by citizen demand
Mobile self-aware citizens want to use the eHealth services all other Europe
Cross-border health care / European-wide services
Services used at home shall be available while staying in other Member States / countries
Demand of citizens is beyond
national borders (use of specialiced centres)
Generic concepts and (framework) architectures as well as the use of standards can lead to a European (international) market of eHealth products and services
Systems (in Europe) must be interoperable

33. Co-operation in Europe on eHealth
eEurope
Co-operation in Europe on eHealth
Transparency about national strategies, roadmaps and developments gives chances to learn from others
Finalized developments can be used by others to avoid reinventing the wheel
Co-operation backed by agreements on the policy level is needed
Bilateral – but co-ordinated – pilot projects on different issues

34. European Health Telematics Association
Networking in Europe:
European Health Telematics Association

35. Many thanks for your attention!
Many thanks for your attention!
Do you have questions?
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