Ebook: Health Cards '97

Health Cards '97 is the fourth international congress on patient data cards and health professional cards. Previous congresses took place in Barcelona (1991), Marseille (1993) and Frankfurt (1995).

The congress is held from November 12-14 at the facilities of the RAI in Amsterdam, and is accompanied by an international industrial exhibition with over 50 exhibitors, promoting their latest products.

Since Health Cards '95 in Frankfurt and after the successful implementation of the German ‘Versichertenkarte’, a number of countries also started projects for nation-wide introduction of smartcards. France, Spain and Belgium seem to be leading the way. France and Germany are working closely together on issues of interoperability.

Large scale implementation and harmonisation are some of the main issues of Health Cards '97. The importance of confidentiality and security is also stressed extensively. The closing forum discussion deals with the introduction of the European Health Passport.

In addition you will find information on the following subjects: interoperability, financial aspects, legal aspects, project reports and technical issues. Both the results of the European CARDLINK-project and the developments in North America will have their own special session.

The importance of the congress may be deducted from the presence of Mrs. Else Borst, Minister of Health, Welfare and Sport of The Netherlands, who will open Health Cards '97. During the bi-annual Health Cards congress, which is the meeting place for everyone involved in the use of cards in health care, many high-ranking officials from all over the world will present their views and visions. Not only are there plenty of opportunities to exchange experiences, it also gives an outlook on things to come in the near future.

More than 70 contributions are concentrated in this volume. Great jobs have been done by Astrid Klaassen, who chased a number of speakers for their contribution, and by Lia Termijn and Madeleine Koudstaal, who finalised the layout of the papers in order to produce these proceedings.

Schiedam, October 1997

Laurens van den Broek and Annet J. Sikkel

Ever since we started in 1991 in Barcelona with Health Cards Conferences in Europe, the dissemination of a variety of card systems in health administration as well as in Health Care has progressed rapidly. The decisive impulse for this development was doubtless the delivery of 75 Million administrative Health Insurance Cards in Germany from 1993 until 1995. The political reforms in Eastern European Countries and the ongoing reorganization of their Health Care Systems was the reason for their engagement in Health Cards. Various trials and pilot projects have been performed as well in the USA, Canada and the Asian rim states. Another impulse was the decision of the G7 countries to motivate their citizens to recognise and adopt the advantages of an information society. Nevertheless, the international breakthrough of patient data cards is yet to come. The need for international agreements on standards in the design of card systems, interfaces and security infrastructures is pointed out. A concerted action of all major international projects under one umbrella would significantly increase their impact on modern medicine.

Card Systems have been in use world-wide as well as in most of the Asian countries for more than 30 years. In Asia these systems have been used with great success in different fields such as transportation, posts, telecommunications, banking, and education. Recently, card systems have also started to play an important role in health care.

With a short excursion into the history of Medical Informatics the fatal role of too far reaching promises is analysed. Famous persons and funding projects finally failed because they could not deliver. Especially leading-edge research and system developments risk to initiate new funds by promising routine availability much too early. While this can be excused for the first three decades of post-war development, it cannot be accepted that even today naive vendors and scientists looking for funding promise too much and thus endanger strategic developments.

On April '96, the French Government took a few special law-decrees (called “Ordonnances”) that deeply reformed the French Social Security. Concerning healthcare, the Ordonnance of April 24th, is aimed at the creation of a real nation-wide information system. According to the Ordonnance, healthcare professionals and health insurance Funds shall use teletransmission for reimbursement forms before the end of 1998, and everyone will receive a smart card before the end of the century.

The motivation of the French Government is both the containment of healthcare expenditure and the improvement of healthcare provision. This document presents the new French healthcare information scheme and explains its consequences on both accounts.

During and after the introduction of a Health Insurance Card in the years 1993/1994 very animated discussions on the sense and the use of Smart Cards with medical data came up in Germany. As a result, a lot of different field trials with Patient Cards have been started. In the meantime, some of them disappeared and others have been started. The following survey describes the current situation in Germany.

The Québec Minister of Health and Social Services, Dr. Jean Rochon, announced in September 1996 that his government plans to replace the current Health Insurance Card with a new Patient Smart Card in 1998. This report highlights the administrative and clinical conditions leading up to the planned replacement (sections 1 and 2). It also reviews future directions that the deployment of the Health Smart Card System will take, in the light of three main goals of the Québec health care system: day-today management of health insurance programs, clinical decision-making and strategic management of health services (section 3).

This paper is intended to show an overview of the ongoing National-Identification (N-ID) Card and Health Card Project in Korea. The N-ID Card will be provided to all of the 37 million Korean adults over the age of 18 from the September 1999. Seven existing cards such as the personal identification card, the medical insurance card, the driver s licence card, and the social security card will be merged into a single IC Card by this project. Essential information from electronic patient records as well as medical insurance information will be included in this N-ID Card. In order to establish a successful country-wide implementation of this health card system, we have considered the security, privacy and confidentiality of private medical information. Contents access managing application software for each of the private information and a Java applet enabling cross-platform usability of the N-ID Card will be embedded in the N-ID Card. Both software technologies with the private key card role of the N-ID Card will secure access to medical information and efficient build-up of a health care networking system. The N-ID Card will act as a personal lifelong health care record which is expected to facilitate the standardization of medical information and the migration of a current hospital-based medical information system towards a patient-based one.

The resolution by the Health Insurance Institute of Slovenia, to introduce the health insurance card, involves a lot more than merely equipping the insured population with plastic card mounted chips to serve as means of identification and evidence of the status of insurance at the physicians' and pharmacists'. Actually, we are dealing with the initial phases of introducing card technology into health insurance, and, subsequently, into health care service. This implies the creation of a new communication and information system for this field, introducing numerous foreseeable changes, and probably even some that are yet not even envisaged.

Since 1995 there are intensive activities in the health cards area in the Czech Republic. An experimental application is running since 1996 in one district of the CR. With support of the EC Phare Programme a plan was created for extension and continuation of the project. This experiment is one road to the Information Society in the health sector in this country.

The Spanish Ministry of Labour and Social Affairs is working jointly with the Healthcare Services in implementing radical changes in administration by introducing a Social Security Card for all individuals in Spain. The card is to be used in all transactions with Social Security and Healthcare and contains personal and biometric information that will be used for secure identification.

Improvement in patient management and information flow between different health care institutions is a challenge. Norway is now about to establish an electronic network in health care. The aim is to ensure correct, fast and safe flow of information at reduced costs and higher quality. Electronic patient records is currently used by 90% of all primary care doctors and the hospitals are now installing electronic patient record systems. The upcoming electronic network communication is likely to result in an explosion in the amount of medical data available about a patient, and thereby a high risk of information overflow. In particular, the records of elderly patients and patients with chronic diseases may store large amounts of data which may obscure the physician's overview of the medical history. Thus, a core part of the medical record needs to be defined. It must contain clinical key information about the patient. Besides being stored in the ordinary medical record, this core record may also be stored on a smart card which the patient may carry on him. We think the primary care, personal doctor, should be the editor of the core record. The smart card may serve as an information bridge between various electronic record systems and may be used as an ID card whereby the patient gives the doctor access to the information contained in the card and probably also to distant databases which contain medical data about the patient.

Insurance cards are considered to be the first step towards a more ambitious application of chip cards in the area of health care. In Germany, the nation-wide implementation of health insurance cards is gaining importance as part of a medium term cost reduction strategy. Increased usage of this technology is not a question of feasibility but of economic efficiency. The federal associations of doctors, pharmacists, and health insurance funds are preparing for the use of electronic prescriptions instead of conventional paper forms. This marks the next phase of their common initiative to cut costs in the complex data flow within the health care system.