Electronic health card trial to begin in Germany

Tags: A GP Informatics Information iS Office

25 Jan 2006

Germany is to start trialling an electronic health card at the end of April that will contains basic patient data such as name, age, next of kin and insurance details, as well as electronic prescriptions.

The Gesundheitskarte ('good health card') will contain information in a Chip-and-PIN style microchip on the side of the card, as well as a photograph and human-readable information. It replaces Germany's existing health insurance card.

The back of the card will double as an European Health Insurance Card, which replaced E111 forms at the start of the year for all EU citizens and will enable all holders to receive healthcare in other countries in Europe.

Electronic prescriptions can also be issued using the card. A GP can upload the prescription data onto a chip in the card and sign it electronically, and the medication data can be read at the pharmacy. For security, there is a signature strip on the back of the card that the pharmacist must validate before handing over medication. The German health ministry already projects that 700million prescriptions per year will be issued in this way.

According to the BMJ, patients will also have the opportunity to include their own health information on the card, and log in via a PIN number. Healthcare professionals, including insurance companies, will need to use another electronic card to log in and read and change patients' card details.

Testing for health professionals' access cards began in December. Dr Udo Helmbrecht, president of the federal office for IT security, said that both the patient and professional cards were crucial to the security of the healthcare informatics system.

The patient's electronic health card had been scheduled to be in widespread use at the beginning of 2006 but the programme has falled behind schedule.

Ulla Schmidt, the German federal minister for health, said that after the trial is successful the card will be expanded to cover 100,000 users by the end of 2006.

Links

Die Gesundheitskarte (in German)

Readers Comments

Interesting system

markmccartney@doctors.org.uk

25 Jan 06 09:34

This system might have great potential, though I dont quite understand how the prescription is issued, through a central server or on the card? Could e-health please provide some more information on this system please

ePrescribing on server or card

marc.lange@ehtel.org

27 Jan 06 08:03

Actually, both are still under consideration and will be tested in pilots. More details on ePrescribing in europe at www.ehtel.org (NGO)

Health information stored on the card?

27 Jan 06 12:59

While this is a very interesting topic, a few doubts have been raised in my mind relating to the way in which the article suggests that the data is stored on the card, and a number of questions have popped into my mind.

1) Is the data stored on the card itself, or is this a simplified way of saying that the card will enable access to centralised data store that holds the information about the patient?

2) If the card does indeed hold the data directly, what are the implications of losing it and what safeguards have been put in place to ensurethat nobody other than the person to whom the data relates can access it?

3) How robust is the chip on the card? For example, is it sensitive to magnetics (EG: If it rubs against your keys will it a) be physically damaged and/or b) be magnetically corrupted?)

Just some thoughts which have (hopefully) already been considered and solved by those leading the project.

Answers to various questions raised

armin.scheuer@so2say.biz

01 Feb 06 12:38

The German website on the Gesundheitskarte provides the following information:

Q: Is the data stored on the card itself, or is this a simplified way of saying that the card will enable access to centralised data store that holds the information about the patient?

A: Data is stored on the card itself. In the first step, the card will hold personal information including name, date of birth, sex and address. It will also include information on the holder's insurance company and policy. All holders who have passed 15 years of age, need to have a photograph on their card, to avoid abuse. The first step will also include the insurance note for foreign countries as well as the electronic prescription, which will be mandatory for all insurance holders from the very beginning.

Holders have the option to add further information on a voluntarily basis, including their history of prescribed drugs. This allows doctors to check a patient's drug record when prescribing new pharmaceuticals.

An advanced optional application will allow uploading data for emergency treatment - including blood type, allergies and drug incompatibilities.

The holder can decide to delete all optional data from the card at any time.

Q: What are the implications of losing it and what safeguards have been put in place to ensure that nobody other than the person to whom the data relates can access it?

The data can be accessed only by holders of an electronic certificate which identifies them as doctors, pharmacists or dentists. In addition, the card holder has to enter a PIN to enable access to the data on the card. The holder's picture on the card further avoids abuse.

Only the information for emergency treatment can be accessed without a PIN to ensure proper treatment in case the card holder is not addressable. This information however is optional and it is up to the holder to decide which information he uploads to the card.

A card-holder can also edit and print-out the information on the card at his GP or pharmacy.

Q: How is the prescription is issued, through a central server or on the card? A: In both ways. This is how it is supposed to work:

1. The doctor generates an electronic prescription on his computer. # 2. He signs the prescription with his digital signature, for which he needs the "medical certificate" mentioned above. 3. The prescription is either saved on the card or on a central ePrescription server. 4. The doctor has the option to print out medication information for the patient, but this is for information only and does not replace the ePrescription. 5. The pharmacy (including online pharmacies) can access the prescription directly on the card or, through the card, on the ePrescription server. 6. To access the prescription the pharmacist needs to fulfil the access requirements described above. 7. The pharmacist checks the digital signature, hands out the medication and deletes the prescription on the card or the server.

This information has been compiled by www.so2say.com.