October 2011

After intensive preparation, the statutory health insurance funds commenced with the distribution of the electronic health card in 2011. Prior to this, new reading devices, which are capable of processing both the new electronic health card and the health insurance cards hitherto in use, were installed in hospitals as well as in medical and dental practices.

The new electronic health card contains, first of all, the same administrative data as the old health insurance card. These include: name, address, date of birth, gender, health insurance number as well as insurance and co-payment status. It also contains the technical prerequisites to enable, at a further developmental stage, medical data such as emergency data and references to advance health care directives or organ donation pledges to be stored at your request. The aim is to enable a better and more secure exchange of medical information among health care providers in the future. The patients will benefit through improved quality of care.

The photograph – a safeguard against abuse

The most striking innovation is a personal photograph. With the electronic health card, each person insured with the statutory health insurance now receives a card bearing his/her photograph. This is intended to prevent the abuse of benefits and services. Children under the age of 15 and persons in need of intensive nursing care, who are unable to participate in the making of a photograph, do not require one.

Increased data security thanks to the processor chip

The technical advantage which the electronic health card has over the health insurance card lies in the fact that it contains a processor. This will make it possible, in the future, to encode sensitive information and store it on the health card, safe from unauthorised access.

The European insurance card is integrated

Most of the health insurance funds will incorporate the European insurance card on the rear side of the electronic health card. This will enable the unbureaucratic provision of medical care in all 27 EU states, as well as in Iceland, Liechtenstein, Norway and Switzerland.

Additional applications are planned

The health cards currently being distributed are prepared to be equipped with medical applications. These applications can – if desired – be gradually added without the need to change the card. The prerequisite for this is that the new applications pass the tests to which they are being subjected and are able to meet stringent security requirements. For example, in addition to emergency data, advance patient decisions and organ donation pledges, medication history, vaccination history or an electronic patient record are all conceivable.

Everybody can decide which medical data is stored on the card

Even though many of the possible applications will only be installed gradually, one thing is already certain: security and data protection will have to meet the highest standards for the electronic health card. At any rate, the patients are the ones who decide which medical data are to be stored on the card. Only administrative data are compulsory. Also in the pipeline is the setting up of patient terminals where the patient will be able to see for himself what data are stored on the card.

Access rights are strictly regulated

Medical information which is stored on the electronic health card can only be decoded and read by doctors and other health professionals if the patient and his/her doctor agree. The patient's key is his/her electronic health card while the doctor's is his or her electronic health professional card. Both parties must insert their individual cards into the card terminal, whether at the doctor's practice or at the hospital (two-key principle). Furthermore, the patient must agree to grant access to the medical data by typing in the PIN code. This works somewhat like with a bank card. The only exception here relates to the emergency data which must be accessible even without the participation of the patient.

Data protection takes priority

Access is authorised only for the purpose of providing medical care. Neither an employer nor a health insurance fund will have access to the patient’s medical data. The protection of sensitive health data, and the use of technical means to achieve the requisite protection, is established in law. In order to maintain the highest possible degree of security, data protection and security experts are closely involved in the implemented measures.

At a glance: The different stages in the expansion of the electronic health card

gematik GmbH is responsible for introducing the electronic health card. gematik's associates – including the important partners which comprise the self-administration of the health insurance system – have agreed on the following steps for its introduction:

Issue of the electronic health card at the moment:

• Photograph
• European health insurance card

Subsequent steps:Online-updating of the insurance master data

• Incorporation of emergency data and indication of the existence of personal decisions by the insured person such as organ donation pledges
• Supporting the linkage of electronic case records to improve co-operation between the in-patient and out-patient sectors
• Establishing secure doctor-to-doctor communication

Perspectives:

• Medicinal products documentation
• Electronic prescription
• Patient records

Additional information on the electronic health card

• www.bundesgesundheitsministerium.de/eGK
• www.gematik.de