Patient Identification in

Europe –

From EHIC to eEHIC

Andreas Grode

Head of Technology & Innovation, gematik, Germany

Overview

• EHIC: Current content and usage

• From EHIC to eEHIC: Who was/is involved...

• Some technical details...

• Current status and next steps

• Limitations of (e)EHIC as patient identifier

EHIC: Principle layout

EHIC: Current content and usage

The European Health Insurance Card

• replaced the paper forms E111, E110,

E128 and partly E 119

• is a eye-readable only plastic card

• provides a unique insurant number

• is in use: ~200 Mio cards active

According to regulation 1408/71, all persons insured under the

legislation of a member state are entitled to healthcare during a

temporary stay in another member state.

• The EHIC certifies this entitlement.

From EHIC to eEHIC...

• Responsible European Body is „CA.SS.TM“ • „Administrative Commission on Social Security for Migrant

Workers”

• Since 2007 two groups have prepared the introduction of the eEHIC• AdHoc-Group eEHIC (Rapporteur Andreas Grode)

• examined the legal, functional and technical basics

• examined the added value

• Issued the Final Report 2009/06

• CEN Workshop eEHIC• created an eEHIC standardized profile: CEN CWA 15974:2009

• describes the technical feasibility of an eEHIC which takes into account the diversity in Europe

• includes the technical specifications for eEHIC

Objectives of electronification

• From an administrative point of view:

• Providing citizens with an easier and better accepted way to

proof their entitlement to receive care when travelling abroad

• From a technology point of view:

• Providing an automated, more reliable data entry and

transmission system for insured person’s identification data

• From an innovation point of view

• Providing opportunities for new services, i.e. remote access to

other data (administrative or even health-related)

Technical Basis: CEN CWA 15974

• In a nutshell the CWA:

• provides the definition of the EHIC dataset

• specifies the eEHIC interoperability interface between the smart

card and the Client Application of the HCP residing on the

Workstation or Card Accepting Device (CAD) itself

• specifies a logical format for exchange of eEHIC information

between Healthcare Providers and Competent Institutions

• provides the definition of the metadata schemas that ensure

interoperability

• provides a method to identify and to access to the (specific)

EHIC data set on the citizen’s smart card.

Technical specifications

allow flexible implementations

• CWA objective: freedom in implementation decision

• 4 possible types of cards can be issued1.New card with EHIC data set on-card

2.A card with a “pointer” where the EHIC data is stored (outside the card)

3.An existing card being able to add the EHIC data set as defined for type 1

4.An existing card carrying all the information of the EHIC dataset but differently than as per type 1

• The card reading infrastructure can accept all types of cards

• MS can include additional services for eEHIC without impacting the infrastructure of the other MS

CEN CWA eEHIC: 4 generic types

HCP

HCP

HCPHCP ?

= eEHIC data

= “Pointer” to eEHIC Data

Current Status and next steps

• CA.SS.TM is discussing how to introduce the

eEHIC (next meeting 2010-03-17)

• Usage of CEN CWA 15974 as the technical basis

• Which types of card have to be supported ?

• Is the introduction of the eEHIC affected by other

(ongoing) projects (and vice versa) ?

• How to integrate with EESSI

The Future... (about reimbursement)

Home Member State

EESSI Network

Host Member State

eEHIC

Social Security Institution

Health Care Professional

National (Social Security) Network

National (Social Security) Network

Social Security Institution

Limitations of (e)EHIC as patient

identifier

• Patient and Insurant may differ

• eEHIC is currently only used to support

reimbursement between Member States

• eEHIC needs to be accepted as identifier to

access medical data

• not always permitted (national legislation)

• no common process to access data from abroad

Thank you! Questions?