N E T R D S. Smart Card and Network Solutions for the Electronification of the European Health Insurance Card

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1 N E T R D S Smart Card and Network Solutions for the Electronification of the European Health Insurance Card ehealth Munich, April 21 st 2005 Dr. R. Tavakolian and Dr. G. Brenner Central Research Institute of Ambulatory Health Care in Germany, Herbert-Lewin-Platz Berlin; rtavakolian@kbv.de; Tel.:

2 Setting the field March 2002 Basic decision of the European Council in Barcelona for European Health Insurance Card (EHIC) February 2003 Proposal for gradual phasing of visual EHIC (2004) towards an electronic EHIC (2008) October 2003 Decisions No. 189, 190, 191, on introduction of the visual EHIC June 2004 Start of roll-out of the visual EHIC

3 Objectives of Fostering mobility of European citizens Simplification of procedures for involved institutions: - Health insurance providers - Healthcare providers - Interstate clearance bodies Integration of electronic data sets for EHIC into national cards Online verification to prevent fraud and misuse Contribution to interoperability of ehealth in Europe

4 Regulatory base of Regulations EC No. 1408/71 and EC No. 574/72 Decisions No of the Administrative Commission from June 18th 2003 Consortium contracts with the European Commission covering September March 2006 General Agreement of Netc@rds-Parties Declaration of Accession of A2 and A3 partners

5 Work items of 1. Status survey and analysis on EHIC handling 2. Technical proposal based on the - Proposal for electronic data storage on chip cards - Suggestions on interoperable infrastructure components - Demonstrator setup of a verification network - Automated optical data capture of conventional EHIC - Post-processing interface of EHIC data (XML Output file) 3. Strategic proposal for eehic introduction

6 Patient arrives with EHIC Prototype example of EHIC handling Identity Check Passport or ID-Card Not available Fill-out form 80 or photocopy EHIC and ID Private payment Certify identity by physician Declare duration of intended stay by insured on form 81 Specify chosen insurance provider by insured on form 81 Treatment Archiving form copies for 2 years Sending forms immediately to chosen health insurance

7 Handling of visual EHIC Lengthy Identification procedure for EHIC but no verification of entitlements rights Broad variety of forms to be signed by insured Error prone manual data capture for hospital information systems Varying compliance with specified character set by EHIC issuers Unlawful reject rate expected to increase

8 Home Country Member-State Health Insurance data server Case 1: dataset captured from card Member-State of Temporary Stay dataset dataset dataset Case 4: dataset captured from eyereadable medium (EHIC, paper) dataet Case 3: dataset captured from server Case 2: dataset captured from card & server

9 Health Insurance Chip Cards available in the Pilots France Germany Austria Slovenia Italy (Lombardia)

10 Pilot regions Germany: France: Austria: Greece: Italy: Finland: Czech Republic: Slovakia: Slovenia: Hungary: Freiburg, Ortenaukreis Paris Vorarlberg, Oberösterreich, Tirol Athen, Thessaloniki Lombardei, Venezien Turku Prag, Znojmo, Hodonin Bratislava, Zámky Pomurje Budapest, Balaton, Györ

11 Zentralinstitut für die kassenärztliche Versorgung HIC-Introduction in Europe Phase A Phase A2/A3 Pilotes Visual EHIC Phase 1 : Preparation German Health Memory Card Austrian HIC Tests Netc@rds Phase B: Initial Deployment Visual EHIC Phase 2 : Deployment French HIC Vitale 1 Lombardia Health Smart Card 2006 e-ehic Phase 3 : Deployment French HIC Vitale 2 e-german Health Card Austrian HIC Full Deployment Lombardia New Health Smart Card Full Deployment Slovenian Health Insurance Card Upgrading with EHIC data & functions

12 eehic in process model viewpoint 1. Access / Data capture the individual data must be available on the health care site completely and correctly 2. Identification the concordance of the ID-data with the patient are verified 3. Verification the entitlements rights of the person are checked Access Data capture Identification Verification Trustworthy dataset

13 Definition An electronic European Health Insurance Card (eehic) is a process with the result of a trustworthy data set for entitlement at the healthcare provider.

14 In favour: Zentralinstitut für die kassenärztliche Versorgung High rate of errors by manually typing in data Typing inconvenient for users Standardized carrier (visual EHIC specification) Standard software existing in high-volume applications (e.g. banking) Visual EHIC generally available in Europe Against: Scanning of visual EHIC with optical character recognition Results are empirical and influenced by various factors Algorithms require learning No integrity checksums yet implemented Optical scanners relatively expensive

15 Flexible architecture for verification Hospital Workstation Internet Centralized European Localisation Server (Code List-DB) network Routing, Authentification, Security, Protocols German Health Insurance data servers French Health Insurance data servers Austrian Health Insurance data server

16 XML interface proposal Hospital related information Patient related information Name, insured-id, card validy date etc... Admission Information Diagnosis Information Operation codes Co-payment information Discharge Information Reimbursement claim data Health Insurance 1-3 Hospital XML-File Electronic Transmission for domestic cases

17 Electronic post-processing of eehic data XML data (v2.0)

18 Summary Fostering mobility of European citizens Simplified access to foreign healthcare systems Contribution to interoperability of emering ehealth schemes Cost-effective extension to new card schemes Online verification of entitlements rights Interoperable dataset to foster electronic post-processing Replacement of paper forms