germany electronic health cards - european perspectives reinhold a. mainz federal ministry of health...

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Electronic health cards - European perspectivesElectronic health cards - European perspectives

Reinhold A. MainzFederal Ministry of Health (BMG), Germany

Group Telematics

1st national eHealth conference

2006-02-01

Sofia, Bulgaria

2R. A. Mainz, 2006-02-01, Sofia, Bulgaria, 1st national eHealth conference

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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 cardInsurance 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 cardElectronic health cards for all insured persons elder

than 15 yearsIncludes 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

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:Patient centered communication:The Electronic Health Card The Electronic Health Card

is the main tool for linkage of datais the main tool for linkage of data


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The combination of these smart cards is the

base for a secure and trustworthy Telematics Infrastructure

Key elements of the security conceptey elements of the security concept

The citizen`s tool The professional`s tool


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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 citizen`s 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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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

1.000 – 1.500 Mill. EUR (?) [~20 € per citizen]

Development costs about

100 – 150 Mill. EUR (?) [~2 € per citizen]

Cost categories (2004 – 2006/2007)

Prognosis:

Return of

investment within

max. 3 years

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The perspective


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Services used at homeshall be availablewhile 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

Perspectives

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Collaboration in Europe


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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

eHealth services in Europe:Dynamic development driven by citizen demand

Systems (in Europe) must be interoperable


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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

Co-operation in Europe on eHealth


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Networking in Europe:

European Health Telematics Association

http://www.EHTEL.org


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Do you have questions?

[email protected]

Tel. +49 228 941 3199

Many thanks for your attention!

germany electronic health cards - european perspectives reinhold a. mainz federal ministry of health...

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