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  • 05/27/09
  • eHealth_Bulgaria

    1. 1. Electronic health cards - European perspectives Reinhold A. Mainz Federal Ministry of Health (BMG), Germany Group Telematics 1st national eHealth conference 2006-02-01 Sofia, Bulgaria
    2. 2. Content <ul><li>Electronic European Health Insurance Card </li></ul><ul><li>Overview: Some activities of Member States of the EU in the field of electronic cards </li></ul><ul><li>The German example </li></ul><ul><li>The perspective </li></ul><ul><li>Collaboration in Europe </li></ul>
    3. 3. Electronic European Health Insurance Card
    4. 4. The eHealth Action Plan - Overview of actions with responsibility by the Member States : 2008 <ul><li>Promote the use of cards in the health sector </li></ul><ul><li>Adopt implementation of a European electronic health insurance card (EC) </li></ul>
    5. 5. (Electronic) „European“ (Health) (Insurance) Card - eEHIC <ul><li>Responsible: Administrative Commission to the basic Regulation on Social Security Schemes and the Free Movement of Persons (EEC No 1408/71) </li></ul><ul><li>Secretariat: EC DG EMPL </li></ul><ul><li>EC eHealth Action Plan (COM(2004)356): Introduction of an eEHIC shall start in 2008 </li></ul><ul><ul><li>on-line verification of insurance data? </li></ul></ul><ul><li>„ Inclusion“ of medical data? </li></ul><ul><ul><li>emergency data set </li></ul></ul><ul><ul><li>key to the electronic health record </li></ul></ul>Off-line use of chip cards or need to set-up secure and interoperable infrastructure services
    6. 6. Overview: Some activities of Member States of the EU in the field of electronic cards
    7. 7. Austria <ul><li>1) until end 2005: e-card </li></ul><ul><ul><ul><li>Electronic social security card; usable as a tool for all eGovernment processes </li></ul></ul></ul><ul><ul><ul><li>Only used for health insurance entitlement online checks (  connector concept) </li></ul></ul></ul><ul><ul><ul><li>Access together with health professional cards </li></ul></ul></ul><ul><ul><ul><li>Enables the citizen also to sign administrative documents electronically </li></ul></ul></ul><ul><li>2) beginning in 2006: implementation of a first application using medical data: ePrescribtion </li></ul>
    8. 8. Belgium <ul><li>1) 1998: SIS card as social security card </li></ul><ul><ul><ul><li>Insurance data can be read by everybody, some medical data can be read and stored by health professionals using a health professional card </li></ul></ul></ul><ul><li>2) until 2009: electronic id card for all eGovernment applications </li></ul><ul><ul><ul><li>Shall include the SIS card data </li></ul></ul></ul>
    9. 9. Estonia <ul><li>1) since 2002: electronic national id cards for every citizen </li></ul><ul><ul><ul><li>eGovernment portal  can and shall provide health related applications to the citizens </li></ul></ul></ul><ul><ul><ul><li>Central document index for patient related documents of the health system </li></ul></ul></ul>
    10. 10. Finland <ul><li>1) electronic national id cards for every citizen </li></ul><ul><li>2) beginning in 2007: Access to electronic health records shall be given after authentication by the national id cards </li></ul>
    11. 11. France <ul><li>1) until 2006: Sesam Vital II card </li></ul><ul><ul><ul><li>Electronic health cards for all insured persons elder than 15 years </li></ul></ul></ul><ul><ul><ul><li>Includes biometric data for security measures instead of a PIN </li></ul></ul></ul><ul><li>2) beginning in 2007: as a tool for access to an electronic patient record </li></ul><ul><ul><ul><li>Access together with health professional cards or special passwords </li></ul></ul></ul>
    12. 12. Italy <ul><li>1) electronic health cards in the regions Veneto and Lombardia </li></ul><ul><li>2) End 2005: Some other Italian regions begin to issue electronic health cards </li></ul>
    13. 13. Slovenia <ul><li>1) 2000 - 2004: electronic health card </li></ul><ul><ul><ul><li>Health insurance entitlement online checks </li></ul></ul></ul><ul><ul><ul><li>Access together with health professional cards </li></ul></ul></ul><ul><ul><ul><li>Public kiosks for the citizens, where they shall change some personal data </li></ul></ul></ul><ul><li>2) modell regions: implementation of first applications using medical data like allergies, immunization, … </li></ul>
    14. 14. Spain <ul><li>1) Since 2004: Andalusia tests an electronic health card, </li></ul><ul><ul><ul><li>used as a tool for access to electronic patient records </li></ul></ul></ul><ul><li>2) Beginning in 2006: electronic national id cards for every citizen </li></ul><ul><ul><ul><li>For eGovernment applications (including eHealth?) </li></ul></ul></ul>
    15. 15. Switzerland <ul><li>1) Since 2004: Modell region Tessin for the carta sanitaria </li></ul><ul><ul><ul><li>no foto, biometric data (fingerprint) instead of a PIN </li></ul></ul></ul><ul><ul><ul><li>Card can be used for ePayment functions (coffee in a hospital, …) </li></ul></ul></ul><ul><ul><ul><li>Software on the card for a reservation system </li></ul></ul></ul><ul><ul><ul><li>Mandatory (?): Insurance data, emergency data, eprescription </li></ul></ul></ul><ul><ul><ul><li>Not mandatory: electronic patient record on servers, some copies on the card itself </li></ul></ul></ul>
    16. 16. The German example: Target, strategy, concept, costs
    17. 17. Target <ul><li>Modernize the healthcare system by use of ICT: </li></ul><ul><ul><li>establish more citizen oriented services </li></ul></ul><ul><ul><li>support patient-centred care </li></ul></ul><ul><ul><li>improve quality and services </li></ul></ul><ul><ul><li>reduce costs </li></ul></ul><ul><ul><li>provide data for health systems management </li></ul></ul>
    18. 18. Strategy (1) <ul><li>Establish an ICT infrastructure financed by one / some applications, so that other applications can build on the infrastructure – without having those basic costs </li></ul><ul><ul><li>Choosen applications with priority (positive cost-benefit analysis): </li></ul></ul><ul><ul><li>Mandatory </li></ul></ul><ul><ul><li>Online verification of insurance status </li></ul></ul><ul><ul><li>Transport of (drug) prescriptions </li></ul></ul><ul><ul><li>Voluntary for citizens </li></ul></ul><ul><ul><li>Drug interaction and contraindication checks </li></ul></ul>
    19. 19. Strategy (2) <ul><li>Stepwise implementation of applications (and functions) of a private electronic patient record by using the established infrastructure </li></ul>
    20. 20. Strategy (3) <ul><li>Data provided electronically in principle can be better used for different purposes </li></ul><ul><li>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 </li></ul>
    21. 21. Citizen managed personal electronic health record <ul><li>A citizen managed personal electronic health record </li></ul><ul><ul><li>is offered and operated by the healthcare system </li></ul></ul><ul><ul><li>is defined by law and contracts of the self-governmental healthcare system on the federal level </li></ul></ul><ul><ul><li>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 </li></ul></ul><ul><ul><li>data can be provided by the citizen </li></ul></ul><ul><ul><li>the citizen is the owner of the data (right to delete!) (  „virtual record“, „view“) </li></ul></ul>
    22. 22. Access to the personal electronic health record <ul><li>A special smart card („Gesundheitskarte“, Health Card) is the citizens tool to manage data in a trustworthy and secure way </li></ul><ul><ul><li>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) </li></ul></ul><ul><ul><li>logging of access </li></ul></ul><ul><ul><li>management-rights (hide/unhide/delete!) - except for administrative data </li></ul></ul><ul><ul><li>(in principle) electronic authorisation by the insured person required (exception: emergency data set) </li></ul></ul>
    23. 23. The healthcare system in Germany: A system with a pressing demand for communication 80 Mio. persons insured 123 000 licensed practical doctors Ca. 290 statutory health insurance funds 65 000 dentists 2 200 hospitals 21 000 pharmacies Patient centered communication: The Electronic Health Card is the main tool for linkage of data
    24. 24. The combination of these smart cards is the base for a secure and trustworthy Telematics Infrastructure K ey elements of the security concept The citizen`s tool The professional`s tool
    25. 25. Infrastructure <ul><li>A special infrastructure is constructed </li></ul><ul><ul><li>connecting „closed virtual private networks“ operated by responsible healthcare organizations (sectors: doctors, hospitals, pharmacies, dentists, …) </li></ul></ul><ul><ul><li>using special „connectors“ to connect local systems to the network, to infrastructure services and to smart card terminals </li></ul></ul><ul><ul><li>using cryptographic techniques between components for authentication and encryption / decryption </li></ul></ul><ul><ul><li>using (qualified) digital signatures </li></ul></ul><ul><ul><li>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) </li></ul></ul>
    26. 26. Overview about the planned infrastructure for the Electronic Health Card - Solution Architecture –
    27. 27. Storage concept <ul><li>data - resp. copies of the original data - (in principle) is / are stored by each healthcare provider in a distributed environment </li></ul><ul><li>some data is stored (also) on the „Gesundheitskarte“ itself </li></ul><ul><ul><li>(European) Emergency data / basic clinical data set </li></ul></ul><ul><ul><li>identification data </li></ul></ul><ul><ul><li>insurance data </li></ul></ul><ul><ul><li>private cryptographic keys (on the card only) </li></ul></ul><ul><li>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 </li></ul>
    28. 28. <ul><li>Central infrastructure set-up </li></ul><ul><ul><li>connected virtual private networks </li></ul></ul><ul><ul><li>infrastructure services </li></ul></ul><ul><li>Local infrastructure set-up </li></ul><ul><ul><li>modern hard-/software in doctors offices, hospitals, pharmacies </li></ul></ul><ul><ul><li>connector </li></ul></ul><ul><ul><li>smart card terminals </li></ul></ul><ul><li>Infrastructure set-up costs about 1.000 – 1.500 Mill. EUR (?) [~20 € per citizen] </li></ul><ul><li>Development costs about 100 – 150 Mill. EUR (?) [~2 € per citizen] </li></ul>Cost categories (2004 – 2006/2007) Prognosis: Return of investment within max. 3 years
    29. 29. The perspective
    30. 30. <ul><li>Services used at home </li></ul><ul><ul><li>shall be available </li></ul></ul><ul><ul><li>while staying in other Member States </li></ul></ul><ul><ul><li>(or world-wide) </li></ul></ul><ul><li>Smart cards are (at the moment) the security tool to identify persons, authenticate them, derive rights for access to data, applications, services, infrastructure </li></ul><ul><li>Most services will be network based, smart cards can store some synchronized data </li></ul>Perspectives
    31. 31. Collaboration in Europe
    32. 32. eHealth services in Europe: Dynamic development driven by citizen demand Mobile self-aware citizens want to use the eHealth services all other Europe <ul><li>Cross-border health care / European-wide services </li></ul><ul><li>Services used at home shall be available while staying in other Member States / countries </li></ul><ul><li>Demand of citizens is beyond </li></ul><ul><li>national borders (use of specialiced centres) </li></ul><ul><li>Generic concepts and (framework) architectures as well as the use of standards can lead to a European (international) market of eHealth products and services </li></ul>e Europe Systems (in Europe) must be interoperable
    33. 33. Co-operation in Europe on eHealth <ul><li>Transparency about national strategies, roadmaps and developments gives chances to learn from others </li></ul><ul><li>Finalized developments can be used by others to avoid reinventing the wheel </li></ul><ul><li>Co-operation backed by agreements on the policy level is needed </li></ul><ul><li>Bilateral – but co-ordinated – pilot projects on different issues </li></ul>e Europe
    34. 34. Networking in Europe: European Health Telematics Association
    35. 35. Many thanks for your attention! Do you have questions? [email_address] Tel. +49 228 941 3199