Electronic health cards European perspectives

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Electronic health cards - European perspectives
1st national eHealth conference 2006-02-01 Sofia,
Bulgaria
Reinhold A. Mainz Federal Ministry of Health
(BMG), Germany Group Telematics
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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

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• Electronic European Health Insurance Card

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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)

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(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
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• Overview Some activities of Member States of the
  EU in the field of electronic cards

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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

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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

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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

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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

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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

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Italy

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

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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,

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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?)

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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

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• The German example Target, strategy, concept,
  costs

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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

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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

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Strategy (2)

• Stepwise implementation of applications (and
  functions) of a private electronic patient record
  by using the established infrastructure

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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

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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)

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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)

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The healthcare system in Germany A system with
a pressing demand for communication
65 000 dentists
80 Mio. persons insured
2 200 hospitals
123 000 licensed practical doctors
Patient centered communication The Electronic
Health Card is the main tool for linkage of
data
21 000 pharmacies
Ca. 290 statutory health insurance funds
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Key elements of the security concept
The citizens tool
The professionals tool
The combination of these smart cards is the base
for a secure and trustworthy Telematics
Infrastructure
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Infrastructure

• 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 citizens
  consent (the health card in principle must be
  used)

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

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Cost categories (2004 2006/2007)

• 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 about1.000 1.500
  Mill. EUR (?) 20 per citizen
• Development costs about100 150 Mill. EUR (?)
  2 per citizen

Prognosis Return of investment within max. 3
years
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• The perspective

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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

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• Collaboration in Europe

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eHealth services in EuropeDynamic 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

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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

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Networking in Europe European Health Telematics
Association http//www.EHTEL.org
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Many thanks for your attention!
Do you have questions?
Reinhold.A.Mainz_at_BMGS.Bund.DE Tel. [phone]
3199