D3.6: Study on ID Documents

Title: GERMAN E-HEALTH CARD

Coordinated by the Federal Ministry of Social Affairs and Health the introduction of an e-health card in Germany is planned for 2006. In eight so-called “Modellregionen” pilot implementations and prototypes of the e-health card are being tested until end of 2005. In 2005 it was decided to have a second, extended testing phase in 2006 within the same “Modellregionen”. The project of the “Modellregion” in the Federal Land of Schleswig-Holstein is called “Gesundheitskarte Schleswig-Holstein”.

The project “Gesundheitskarte Schleswig-Holstein” currently is the farthest developed “Modellregion” within the pilot phase of the e-health card in Germany. Main target of the project is the digital support of already established processes in the health sector which are mainly done on paper today. Important examples are: 

• Identification of a patient as insurant of the public health system at the office of a medical doctor or in hospital (today already supported by a chip card) 

• Transfer of information which is stored on paper today such as allergy data, permanent medications, blood type and immunisation certificates if needed by the medical doctor 

• Referral to other medical doctors 

• Prescriptions and purchase of medicine at a pharmacy 

Access to emergency data currently is impossible even in cases when they are needed by a medical professional. The introduction of emergency data on the e-health card is a functional enhancement compared to the situation in Germany today. 

The storage of data from the medical doctor’s file on patient data (such as history of visits, diagnoses etc.) on the card is not planned. In addition the card is not integrated in the invoice procedures of the medical doctor to the insurance companies; these procedures are mainly electronic today and remain unchanged. 

Apart from the authentication and the emergency data all the data stored on the card is encrypted and secured by a PIN under control of the user. The user has unrestricted reading access to all the data stored on his card (e.g. by using an own card reader or a public terminal). If used to transfer data such as referrals or prescriptions, a health professional card is needed to access the data on the e-health card of the patient. Such health professional cards are held by medical doctors and pharmacists. The health professional card is equipped with an electronic signature to sign, e.g., prescriptions. Emergency data on the e-health card is encrypted, but may be accessed by taking a health professional card without needing the PIN of the e-health card holder. 

An abstracted view on the data stored on the e-health card is shown in . In addition to the storage on the card in some cases the data are stored in a post box on a central server. This post box essentially is a transfer directory from which the data can be received and processed by the corresponding recipients (e.g. medical doctors or pharmacists). The concept to store information concerning organ donation and maternity for a longer period is not finally decided yet.

Figure : Concept of the storage of data in the German e-health card

Currently more than 1,000 e-health cards are issued within the pilot project. It is planned to extend the number up to 10,000 within 2006. Currently numerous medical doctors organised in the “Gesundheitsnetzwerk Flensburg”, numerous pharmacies, two hospitals in Flensburg and a number of partners from industry are integrated into this project. The server structure and a secured network for data transfer purposes is available, together with PKI infrastructure and interfaces for a number of software systems used by medical doctors, pharmacies, and hospitals. The introduction of the “Gesundheitskarte” is planned for 2007. 

In this project a number of positive factors can be observed, that will likely result in a broad success of this project. Among them are: 

• Focussing of the concept on existing workflows and broadly accepted procedures 

• Decentralised storage of data on the card under the control of the user where ever possible 

• Intensive technical field testing in two phases and eight “Modellregionen” and laboratory testing (so called “Hacker Tests”) 

• Integration of responsible Privacy Commissioners on a central and local level; for example the ”Gesundheitskarte Schleswig-Holstein” is observed by the Privacy Commissioner of the Federal Land of Schleswig-Holstein.