June 2005 IHE-Europe1

ID Cards in GermanyID Cards in Germanyand Integrated Careand Integrated Care

Niki Wirsz – Siemens Medical SolutionsIHE Europe Committee

Andreas Kassner – VHitG Projectmanager Telematics

– Summary –

June 2005 IHE-Europe2

Movements in germanyMovements in germany

2 significant movements:

‘bIT4health’ process (better IT for healthcare) Rollout of new Electronic Health Card and Health Professional Card (ID Card for doctors) Focussing the mandatory Issues of existing laws Leaded by national gematik (Organization of

“Selbstverwaltung”)

Initiative by the industry Development of new Business Cases of Integrated Care Focusing the Voluntary issues VHitG, Association of Health industry, ~30 companies

June 2005 IHE-Europe3

bit4health-General Remarksbit4health-General Remarks

Starting 2006 the Electronic Health Cards will replace the current health insurance card (70 Mio citizens)

Designed to incorporate administrative functions – also added health data

Chip card suited to support: Authentication Encryption Electronic Signature

to ensure a high degree of data security

Patient photograph imprinted for easier identification

Implementation of new ID Card for Doctors and related persons (Health Professional Card for ~ 2.3 Mio Users)

June 2005 IHE-Europe4

Contents of the Electronic Health CardContents of the Electronic Health Card

Administrative Functionalitye.g. for handling electronic prescriptions

Medical Data –Only patient can enable use of its medical information

“European flip-side” for health service providers in European member states

June 2005 IHE-Europe5

GoalsGoals

Improve quality of health services, e.g. medication safety

Preserve patient data confidentiality

Empower patient in making healthcare decisions

Improve efficiency and „transparency“ of services in healthcare

Optimize healthcare processes

Enable statistics on health information

June 2005 IHE-Europe6

Applications of the Electronic Health CardsApplications of the Electronic Health Cards

Administrative Part (MANDATORY): Insurance data including billing status Allowing medical care in other European countries Paperless transmission of prescriptions

Medical Part (VOLUNTARY) Documentation of medication administration Emergency information (blood type, chronic diseases, allergies, heart

conditions, dialysis, asthma) Additional health information (e.g. current diagnosis, surgery, vaccination

and x-ray procedures) Possibility to record medical reports (Arztbrief) Possibility to store invoices/bills for the patient on provided services and

costs Patient enables access to data: blood sugar level for diabetics, patient

availability

June 2005 IHE-Europe7

Applications of the Electronic Health Cards Applications of the Electronic Health Cards (continued)(continued)

Data recorded either on the card (e.g. emergency information) or on servers (links on card)

Functionality to be implemented in a phased approach

1. Electronic prescription (mandatory application)

2. In order to improve quality of health services:include emergency information and documentation of medication administration

June 2005 IHE-Europe8

Data SecurityData Security

Data security and confidentiality – high priority

Patient can decide IF and WHICH information can be recorded or deleted and WHO has access to it

Strictly associated with the Health Professional Card with electronic signature (with very few exceptions ?!)

Patient can view and print data from the card

In association with another „signature“ card patient can also administer own health data

Audit trails for all transactions – last 50 are always on record

June 2005 IHE-Europe9

BenefitsBenefits

Patients Better access to critical information (e.g. emergency and when

changing physicians) Improved quality of care and avoiding prescribing wrong medication Patients better informed on their health status (vaccination, allergies,

disease status, prevention) – patient own initiative and influence

Healthcare Professionals Fast access to patient‘s conditions and health data Optimized work processes (automatic transmission of data in and out

of own records) – more time for the patient Avoiding redundant procedures

June 2005 IHE-Europe11

Timeline bIT4healthTimeline bIT4health

2004 ‘bIT4health’ framework by industry-consortium

End of 2004 new solution by Fraunhofer and new organisation protego.net

2005 expected final version by gematik (old concepts are obsolete)

Tender for Infrastructure Components End of 2005

End of 2005 first Testlabs

Beginning of 2006 Roll out eCard/HPC in small areas

Mid 2006 roll out national wide

-Less political pressure because of reelection discussion

-Parallel conceptualisation of nation wide EHR by health ministry and (independently) gematik

June 2005 IHE-Europe12

References:BMGSS: http://www.die-gesundheitskarte.deDIMDI: http://www.dimdi.de/de/ehealth/karte/index.htmbIT4health: http://www.bIT4health.de

Sources

June 2005 IHE-Europe13

Industry ViewIndustry View

Big pressure on industry for integrated care solutions Hospitals and GPs founding regional ‘health networks’ Foundation of ‘medical centers’ with GPs at a hospital

More online communication needed between GP and hospital to optimize processes

bIT4health will not serve any solutions for voluntary services and interoperability beyond mandatory services

Initiative of VHitG to push interoperability movement in germany

June 2005 IHE-Europe14

VHitG initiativeVHitG initiative

Focus on communication between hospitals, local GPs

Need to extend existing standards

Working together with national standardization groups (HL7, SCIPHOX [using CDA], IHE-D)

No conflict with bIT4health, it’s an extension Compatible to future infrastructure requirements like

authentication, encryption etc.

companies are investing human resources and money

2 working packages. Not public and can be changed: Patient identification, HL7 v3 Reports from inhouse medical care, CDA Release 2

June 2005 IHE-Europe15

Timeline VHitGTimeline VHitG

Mid 2005 project starts

End of 2005 publishing parts of the new profiles

Testlab in spring

Mid 2006 presentation of results on ITeG Congress

June 2005 IHE-Europe16

Questions?Questions?