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The NETC@RDS eServices

From Pioneering to Sustainability ?

eHEALTH Week 2011

Budapest, 10th May 2011

By Noël Nader, GIE SESAM-Vitale, France

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Delivering the Service to Citizens at the

Point of Care

www.netcards.euwww.netcards.eu

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Description of the Service• As of 1st June 2004 the European Health Insurance –eye-

readable- Card (EHIC) is a proof of entitlement to non planned health care abroad but inside the EU/EEA. In case of EHIC no show or the EHIC is expired a Provisory Replacement Certificate (PRC) can be delivered by the competent institution.

• The NETC@RDS service is based on the following use case: “the EHIC dataset is optically captured from the EHIC by the HCP at the point of health care delivery. In case of EHIC no show or the EHIC is expired, then the national HIC/IDC can be accepted by Health Care Providers, based on an online proof of entitlement.”

• The EHIC dataset is processed for both statistic purpose and back office e-billing reconciliations

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Patient entitlement on-line

EHIC or Smart Card

Transaction Log Transaction Log

NETC@RDS Portal

FRANCE

NETC@RDSPortalITALY

NETC@RDS trustworthy EHIC dataset is forwarded to the local competentInstitution

Card defect list and/or

entitlement repository

Example: Italian patient receiving health care in France

Internet SSL V3

Secure Internet

Or Intranet

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PROJECT BACKGROUND

From Market Validation to the Initial Deployment Phase

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Investment

PHASES Budget (M€)

E.Ucontribution (M€)

Market Validation phase (A1)

0,50 0,25

Market Validation phase (A2-A3)

on phase (A2

4,88 2,44

Initial Deployment phase (B)

14,04 3,26

ETIC (phases A.x + B)*

19,42

5,95

* Not including exploitation and maintainance costs

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A pan-European consortium of Investors and Sponsoring Partners

• 30 partners + sponsors and observers from 16 EU Member and other states*:– 20 Health Insurance Organizations (HIO) or

Regional Health Care Authorities– Technical Organizations acting on behalf of the HIO– Hospitals and Health Professional Associations– Sponsors from the smart card industry

*AT, BU, CZ, DE, FI, FR, IT, GR, HU, NO, NL, LI, PL, RO, SL, SK + CH

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16 National Access Points

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621 Service Points in 323 Hospitals

www.healthcareabroad.eu

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Transaction log & monitoring

139 132 168 184

551

425 433

318 349439 403 401

570 595 610

740

983

485

369 335 313424

236 269876 100811761360

19112336

27693087

34363875

42784679

5249

5844

6454

7194

81778662

90319366

967910103

1033910608

0

200

400

600

800

1000

1200

Apr09

May09

Jun09

Jul09

Aug09

Sept09

Oct09

Nov09

Dec09

Jan10

Feb10

Mar10

Apr10

May10

Jun10

Jul10

Aug10

Sept10

Oct10

Nov10

Dec10

Jan11

Feb11

Mar11

0

2000

4000

6000

8000

10000

12000

monthly flows

total flows

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card type for NETC@RDS achieved transactions (December 09 to March 11)

9%

53%

38%

smart card

ehic Netc@rds PC

EHIC Netc@rds NPC

Transactions breakdown by card type

(EHIC, HIC)

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HIC/EHIC Cases in Service Points

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Outlook on the Way Forward• Lessons learnt from NETC@RDS are useful at both national and

European levels, e.g:– in BU, the NETC@RDS know-how is helpful to let the HIO specify the

domestic ehealth insurance infrastructure and the related solutions – in FR, domestic solutions for on-line verification of patient

entitlement to health care have been adapted in hospitals for local patients

– In SK, GHIC HIO decided to adapt HCP authentication mechanisms from NETC@RDS to epSOS pilots

– At EU level, the EHIC Provisory Replacement Certificate could be downloaded via EESSI (Electronic Exchange of Social Security Information) from the competent institution back-office alike the NETC@RDS form, …

• After 10 years of Eu-funding the contract with the EC is about to close

• Several Health Insurance Organisations (AT, DE, LN, NL, CZ, PL, SK) decided to continue to deliver the service beyond the EU-funding period:– in this aim, a new agreement has been prepared by the NETC@RDS

consortium as a legal framework in addition to the General Agreement which binds the participating HIO on a permanent basis

– A mature Business Plan has been completed as a roadmap for implementation of pan-European online and Web eHealth services

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Oustanding Issues• Although the Initial Deployment of the service met the project

objectives, the criterias for a long term sustainability are adressed in the Business Plan:– A full integration of the service in the front desk applications should

help to avoid parallel -manual and electronic- procedures– Cross-border on-line verifications requires that the corresponding

back offices/repositories in the home country are ready and on-line– Since non-planed care could not be foreseen only a large scale

deployment would help to cover most of the cases– While real-time on-line control can pay-off at the back-office level both

the break-even point and ROI may be reached for the front desk applications provided that they are fully integrated in the local information system

– Since starting positions and national/regional contexts may dramatically vary from one country to the other some countries might decide to implement on-line controls sooner than others, therefore:

• The NETC@RDS-like or similar solutions should remain scalable and adaptable to the domestic context

• Announced delivery of the EESSI infrastructure should be considered as the legal framework for innovative and cost-effective eHealth Insurance solutions

• Country specific portable documents (e.g. smart cards) should not be an obstacle to cross-border interoperability. Alternative solutions (.e.g. by Web Services) should be considered as well

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Conclusion

• During the past decade, the NETC@RDS project has been capitalizing a lot of knowledge and experience with respect to the electronification of the EHIC dataset and the design of new « real time » pan-European services

• Lessons learnt and know-how have been suitable to the specifications of electronic solutions for both:– cross-border e-Health/e-Gov services (.e.g. eEHIC CWA,

reports from ad hoc and working groups mandated by the CASSTM/TC, …)

– National/domestic applications if the health insurance sector

• Some of the investors (HIO, Industry sponsors, …) decided to continue to provide the service Beyond the EU-funding period, thus, paving the way for full deployment at later stage and in a different context .e.g. EESSI, …