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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. Content. Electronic European Health Insurance Card

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electronic health cards european perspectives

Electronic health cards - European perspectives

1st national eHealth conference


Sofia, Bulgaria

Reinhold A. Mainz

Federal Ministry of Health (BMG), Germany

Group Telematics

  • 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
the ehealth action plan overview of actions with responsibility by the member states 2008
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)
electronic european health insurance card eehic
(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

  • 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
  • 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

  • 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

  • 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
  • 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

  • 1) electronic health cards in the regions Veneto and Lombardia
  • 2) End 2005: Some other Italian regions begin to issue electronic health cards
  • 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, …
  • 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?)

  • 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


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
strategy 1
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):


  • Online verification of insurance status
  • Transport of (drug) prescriptions

Voluntary for citizens

  • Drug interaction and contraindication checks
strategy 2
Strategy (2)

Stepwise implementation of applications (and functions) of a private electronic patient record by using the established infrastructure

strategy 3
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

citizen managed personal electronic health record
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“)
access to the personal electronic health record
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)
the healthcare system in germany a system with a pressing demand for communication
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


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

  • 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)
overview about the planned infrastructure for the electronic health card solution architecture
Overview about the planned infrastructure for the Electronic Health Card - Solution Architecture –
storage concept
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
cost categories 2004 2006 2007
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]


Return of investment within max. 3 years

  • 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
ehealth services in europe dynamic development driven by citizen demand


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
co operation in europe on ehealth


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

Networking in Europe:

European Health Telematics Association


many thanks for your attention
Many thanks for your attention!

Do you have questions?


Tel. +49 228 941 3199