Electronic health cards - European perspectives

1. 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

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. 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 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

24. 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. 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)

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) • 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

29. The perspective

30. 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. eEurope Systems (in Europe) must be interoperable eHealth services in Europe:Dynamic development driven by citizen demand Mobile self-awarecitizens 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

33. 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. Networking in Europe: European Health Telematics Association http://www.EHTEL.org

35. Many thanks for your attention! Do you have questions? Reinhold.A.Mainz@BMGS.Bund.DE Tel. +49 228 941 3199