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eHealth Card

• Motivation• Configuration• Trays• Universal ID• Quantity structure• Process of ePrescription• Health Professional Card

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eHealth Card

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Motivation• Improvement of the quality of health care,

among other things pharmaceutical drug safety

• Improvement of patient-oriented services• Improvement of personal responsibility,

cooperation and activity of patients• Improvement of cost effectiveness and

transparency in health care• Improvement of operating processes• Supply of up to date statitical information

concerning public healthhttp://www.die-gesundheitskarte.de/

http://www.worldcongress.com/events/NW615/presentations/Harald%20Flex%20-%20EHR%20and%20IT%20Innovation%20Summit.pdf

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Administrative Applications

obligatory

• Specification of the state of insurance including extra payment

• Warranty to be treated in the foreign countries of Europe

• Paperless transmission of prescriptions

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Medical Applicationsvoluntarily

• Documentation of taken drugs • Emergency information (for example

blood type, chronic disease, allergy, heart disease, dialysis, asthma)

• additional health information (for example current diagnoses, surgery, immunizations or X-ray examination )

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Medical Applicationsvoluntarily

• Possibility to store electronic messages like discharge letter

• Receipt about medical treatment and their costs (in Germany the statutory health insurance covers the costs and the patient normally doesn‘t know the fee)

• Data provided from the patient (for example blood sugar level or Health Care Directive http://www.cmanet.org/publicdoc.cfm/7

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configuration

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configuration

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configuration back side

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ContentSegmentation in trays

• Tray for drugs = all drugs of the patient including self-medication. Input by physician, pharmacist or clinician

• Emergency information (European emergency document of identification) = Name, address, etc., medical data to the health status such as bloods type, allergies, chronic organ suffering, heart disease , asthma or diabetes

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Content Segmentation in trays

Additional Healthcards = Additional information, special disease related information , for example OncoCard, DIABCARD, QuaSi-Niere, DENTcard, DEFICARD, immunisation card, x-ray card

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Content Segmentation in trays

• Security tray (if desired, for example Viagra, Methadon, HIV-drugs)

- only exceptional reading access - automatic test of interactions - in the case of yes, warning signal to

the physician • ePrescription replaces the paper as transportation

medium, supports medical prescription with drug documentation and drug information

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Content Segmentation in trays

Electronical medical report = transport of discharge letter, referral and hospitalisation, other reports. Data can be used without media discontinuity

Pointer - Pointer to reports on special

examination like X-ray examination

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Content Segmentation in trays

• introspection / additional information – tray for input by the patient, (card owner)– chronic disease – additional information for emergencies – Health Care Directive– organ donor – implants

• Health insurance company– Membership – State of additional payment – Warranty to be treated in the foreign

countries of Europe

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Universal Card

The federal cabinet has decided that the eHealth card should be equipped with a digital signature. Then it can be used with e-Government applications like electronic tax computation, bank transfers or online-shopping

http://www.heise.de/newsticker/meldung/57276

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http://www.telemed-berlin.de/telemed2005/programm.html

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Costs and Benefits

• 1,7 Billion € costs for eHelth card• 500 – 700 Million € economy per

year• 10.000 to 30.000 dead persons per

year caused by interactions of drugs

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Medical datalegal constraints

• Mapping between data and persons is only allowed to authorized users (The system administrator is no authorized user)

• Tracing of data that allows conclusions concerning owner or content has to be avoided

• A central directory that allows combinations with other databases has to be avoided

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ePrescriptionconstraints

• The prescription is a secret that is only known to – Physician, Patient, Pharmacist

• The Prescription is fraud-resistant• The Physician does not know the

Pharmacist• The Pharmacist does not know the

Patient

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Hybride ciphering

• Data are ciphered first with a symmetric session key.

• The session key is ciphered with the public key of the patient.

• To decipher, the patient first has to get the symmetric session key with his private key

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Challenge - response

• A challenged or a mystery is stored with the data and only the owner can solve it.

• The challenge is a random number which is ciphered with the public key of the patient. Only he can solve it by deciphering it with his private key

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ePrecriptionPrescription

HPCPhysician

~~~~

Signature

eGKPatient

~~~~

Signature

Encrypted PrescriptionTicket

~~~~

Signature

Prescription

Encrypted Prescription

HPCPharmacist

DatenID Session key Secret S PukPat (S)

Ticket

/PukPat\

Session key

Session key

Ticket

DatenID

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Virtual file system

• How does an authorized person find his data?

• How can it be assured that a public / private key belongs to that person?

• How the data can be retrieved if the keys are changed?

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Virtual file system

• Each object gets a unique object ID• Each object gets a non ciphered

parent ID• Each object gets a ciphered child

ID (ciphered with the public key of the patient)

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Losing and theft

001

root PukPat(101) PukAlt(101)

002

101 ePrescription PukPat(102) PukAlt(102)

003

102 Prescription 15.9.06 PukPat(103) PukAlt(103)

004

102 Prescription 20.9.06 PukPat(104) PukAlt(104)

005

101 eHealth Record PukPat(105) PukAlt(105)

006

105 X-Ray: Foot Left PukPat(106) PukAlt(106)

007

105 High blood pressure PukPat(107) PukAlt(107)

008

107 Diagnosis PukPat(108) PukAlt(108)

009

107 Plan for treatmaen PukPat(109) PukAlt(109)

The data are stored in a file system, The Child ID is ciphered with the public key of the patient

Additionally the data can be linked with the public key of an alternateeHealth card.When the card is lost, the alternate eHealth card can be used.When the card is stolen, the link of the root is deleted.

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Potential attacks against the data

DataID is located on the eHealth CardDataID and random number are ciphered

with the public key of the patient.

Trial and error with all public keys of the 80 million insured persons:DataID and random number are ciphered

with a second random number SeKT and stored as Hash value.

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HPCSynonyme

• Health Professional Card • Arztausweis• elektronischer Heilberufsausweis• Heilberufsausweis• Heilberufskarte

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Health Professional Card