germany electronic health cards - european perspectives reinhold a. mainz federal ministry of health...
TRANSCRIPT
GermanyGermany
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
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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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eeEuropeEuropeeeEuropeEurope
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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eeEuropeEuropeeeEuropeEurope
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?
Tel. +49 228 941 3199
Many thanks for your attention!