Germany leads the way with e-health

Germany is poised to introduce its next generation e-health card in 2006. The new version, set to replace the existing insurance card – holding only the patient’s name, address and insurance number – will be the latest example of smart card technology to hit the market in Europe. It will be able to store prescription information and might even be used as the standard card for a digital signature – the key to modern eGovernment applications.

Germany’s Fraunhofer-Gesellschaft unveiled the technology solutions behind the country’s much-discussed project to introduce next-generation electronic medical passes. Coinciding with the recent international CeBIT technology fair, scientists close to the project stressed the special data security features in the new smart cards.

Germans already carry slightly ‘dumb’ smart cards that hold key health insurance information, such as their name, address and insurance number. Now the government plans to introduce a new e-health card which, in addition to holding personal data, could also store emergency data, including the holder’s blood group, known allergies to drugs and so on.

To cut red tape and streamline the health system, the Germans decided to include prescriptions on the card, which can store several A4 pages of typed text. No final decision has been taken whether the e-health card, which will have all the security features of today’s smart card technology, could also carry a digital signature – a fundament of modern eGovernment applications, including filing tax declarations electronically.

Smart cards are not new to Germany, or Europe for that matter. Mobile telephony introduced the use of ‘smart security’ systems – personal identification numbers (PIN) that safeguard the owner’s account details – to the masses. Credit card companies are also putting smart technology in their cards to cut out the huge problem of fraud.

The Fraunhofer-Gesellschaft, a leading European research organisation, unveiled the proposed technology and architecture behind the new e-health card to the German Federal Ministry of Health and Social Security, which commissioned the research. The unveiling took place during a special press conference at the CeBIT technology event in Hannover (DE). Fraunhofer researchers explained the structure and significance of the core technology underpinning the smart card, which the government plans to introduce by next year.

Special emphasis was put on its data security functions. Part of the ‘architecture’ ensures that only health professionals, such as doctors, dentists or pharmacists, would be able to access patient records using a special ‘health professionals’ pass. This principle is already employed in France’s Sesam heath card system.

“Security issues were a key consideration when developing the solution architecture,” insists project coordinator Herbert Weber of the Fraunhofer Institute for Software and Systems Engineering (ISST). Scenarios were developed to ensure that healthcare processes would still run smoothly even when faced with technical glitches. During the pass’s introductory phase, for instance, back-up printouts of electronic prescriptions will be available so that patients can still get their medication even if there is a power failure.

The health pass, say the Fraunhofer experts, gives the cardholder full control to decide which of the available healthcare services to use and when to make his or her data available, and to whom. This can be done through info-terminals which would be located in a secure environment – not unlike cash dispensing machines. This process uses an e-ticket which controls access to medical documents, such as the diagnosis, prescription, or medication record, assigned to it.

The system architecture will be subject to public consultation by experts and stakeholders and, subsequently, tested in selected regions – and adapted if necessary – before being rolled out nationally in Germany.

In a related development, Austria plans to roll out its own e-health card, called the ‘eCard’, in the coming weeks. Using a special reader, health professionals can access patient data stored in a central health information network. For Austrians, the eCard will be the first smart card technology in their wallet, while their German neighbours have been carrying the ‘dumbed down’ version, the health insurance card, since the late 1990s.

‘e-Health issues and Telematics’ technology are also major research themes in the EU’s Information Society Technologies (IST) programme, one of several thematic priorities of the Sixth Framework Programme (FP6) for research and technological development.

http://europa.eu.int