- The EHIC (European Health Insurance Card) currently provides paper-based identification of insured individuals traveling in Europe, but is moving to an electronic format (eEHIC) - Technical specifications have been developed through a CEN workshop to standardize the eEHIC format and allow for interoperability across systems - The eEHIC aims to provide easier identification of insured individuals when receiving healthcare abroad as well as enable automated data exchange, but limitations remain as it only supports reimbursement and not direct access to medical records between countries

1. Patient Identification in
Europe –
From EHIC to eEHIC
Andreas Grode
Head of Technology & Innovation, gematik, Germany

2. Overview
• EHIC: Current content and usage
• From EHIC to eEHIC: Who was/is involved...
• Some technical details...
• Current status and next steps
• Limitations of (e)EHIC as patient identifier

3. EHIC: Principle layout

4. EHIC: Current content and usage
The European Health Insurance Card
• replaced the paper forms E111, E110,
E128 and partly E 119
• is a eye-readable only plastic card
• provides a unique insurant number
• is in use: ~200 Mio cards active
According to regulation 1408/71, all persons insured under the
legislation of a member state are entitled to healthcare during a
temporary stay in another member state.
• The EHIC certifies this entitlement.

5. From EHIC to eEHIC...
• Responsible European Body is „CA.SS.TM“
• „Administrative Commission on Social Security for Migrant
Workers”
• Since 2007 two groups have prepared the introduction
of the eEHIC
• AdHoc-Group eEHIC (Rapporteur Andreas Grode)
• examined the legal, functional and technical basics
• examined the added value
• Issued the Final Report 2009/06
• CEN Workshop eEHIC
• created an eEHIC standardized profile: CEN CWA 15974:2009
• describes the technical feasibility of an eEHIC which takes into
account the diversity in Europe
• includes the technical specifications for eEHIC

6. Objectives of electronification
• From an administrative point of view:
• Providing citizens with an easier and better accepted way to
proof their entitlement to receive care when travelling abroad
• From a technology point of view:
• Providing an automated, more reliable data entry and
transmission system for insured person’s identification data
• From an innovation point of view
• Providing opportunities for new services, i.e. remote access to
other data (administrative or even health-related)

7. Technical Basis: CEN CWA 15974
• In a nutshell the CWA:
• provides the definition of the EHIC dataset
• specifies the eEHIC interoperability interface between the smart
card and the Client Application of the HCP residing on the
Workstation or Card Accepting Device (CAD) itself
• specifies a logical format for exchange of eEHIC information
between Healthcare Providers and Competent Institutions
• provides the definition of the metadata schemas that ensure
interoperability
• provides a method to identify and to access to the (specific)
EHIC data set on the citizen’s smart card.

8. Technical specifications
allow flexible implementations
• CWA objective: freedom in implementation decision
• 4 possible types of cards can be issued
1.New card with EHIC data set on-card
2.A card with a “pointer” where the EHIC data is stored
(outside the card)
3.An existing card being able to add the EHIC data set as
defined for type 1
4.An existing card carrying all the information of the EHIC
dataset but differently than as per type 1
• The card reading infrastructure can accept all types
of cards
• MS can include additional services for eEHIC without
impacting the infrastructure of the other MS

9. CEN CWA eEHIC: 4 generic types
= eEHIC data
= “Pointer” to eEHIC Data
HCP
HCP HCP ?
HCP

10. Current Status and next steps
• CA.SS.TM is discussing how to introduce the
eEHIC (next meeting 2010-03-17)
• Usage of CEN CWA 15974 as the technical basis
• Which types of card have to be supported ?
• Is the introduction of the eEHIC affected by other
(ongoing) projects (and vice versa) ?
• How to integrate with EESSI

11. The Future... (about reimbursement)
Social Security
Home Member Institution
State
National (Social Security) Network
EESSI
Health Care Network
Professional
eEHIC
National (Social Security) Network
Host Member State Social Security
Institution

12. Limitations of (e)EHIC as patient
identifier
• Patient and Insurant may differ
• eEHIC is currently only used to support
reimbursement between Member States
• eEHIC needs to be accepted as identifier to
access medical data
• not always permitted (national legislation)
• no common process to access data from abroad

13. Thank you! Questions?