Germany's Fraunhofer-Gesellschaft unveiled the technology solutions behind the country's much-discussed project to introduce next-generation electronic medical passes. Coinciding with the recent international CeBIT technology fair, scientists close to the project stressed the special data security features in the new smart cards.
Germans already carry slightly "dumb" smart cards that hold key health insurance information, such as their name, address and insurance number. Now the government plans to introduce a new e-health card which, in addition to holding personal data, could also store emergency data, including the holder's blood group, known allergies to drugs and so on.
To cut red tape and streamline the health system, the Germans decided to include prescriptions on the card, which can store several A4 pages of typed text. No final decision has been taken whether the e-health card, which will have all the security features of today's smart card technology, could also carry a digital signature, a fundament of modern eGovernment applications, including filing tax declarations electronically.
Smart cards are not new to Germany, or Europe for that matter. Mobile telephony introduced the use of "smart security" systems - personal identification numbers (PIN) that safeguard the owner's account details - to the masses. Credit card companies are also putting smart technology in their cards to cut out the huge problem of fraud.
The Fraunhofer-Gesellschaft, a European research organisation, unveiled the proposed technology and architecture behind the new e-health card to the German Federal Ministry of Health and Social Security, which commissioned the research. The unveiling took place during a special press conference at the CeBIT technology event in Hannover (DE). Fraunhofer researchers explained the structure and significance of the core technology underpinning the smart card, which the government plans to introduce by next year.
Special emphasis was put on its data security functions. Part of the "architecture" ensures that only health professionals, such as doctors, dentists or pharmacists, would be able to access patient records using a special "health professionals" pass. This principle is already employed in France's Sesam heath card system.
"Security issues were a key consideration when developing the solution architecture", insisted project co-ordinator Herbert Weber of the Fraunhofer Institute for Software and Systems Engineering (ISST). Scenarios were developed to ensure that health care processes would still run smoothly even when faced with technical glitches. During the pass's introductory phase, for instance, back-up printouts of electronic prescriptions will be available so that patients can still get their medication even if there is a power failure.
The health pass, according to the Fraunhofer experts, gives the cardholder full control to decide which of the available health care services to use and when to make his or her data available, and to whom. This can be done through info-terminals which would be located in a secure environment, not unlike cash dispensing machines. This process uses an e-ticket which controls access to medical documents, such as the diagnosis, prescription, or medication record, assigned to it.
The system architecture will be subject to public consultation by experts and stakeholders and, subsequently, tested in selected regions and adapted if necessary before being rolled out nationally in Germany.
In the solution architecture, medical data can be stored either on the patient's medical pass or on servers where the application services reside. Access to the application services takes place via a secure communications infrastructure made up of numerous virtual private networks (VPNs) that cater for different sectors of the health care system, such as doctors or pharmacists. The communications infrastructure is protected by access and service gateways, ensuring that only authorized persons can gain access to the infrastructure and thus also to the application services and ultimately, the data.
The decentralized data storage devices are kept separate from the application services by a cross-application common access and integration layer (ZIS). "The ZIS not only enables transparent distribution of data, but above all it ensures that the only people who can access the data are those who have been authorized by the pass holder to do so", explained Jörg Caumanns, the Fraunhofer ISST man in charge of the overall architecture. "To achieve this, the ZIS employs a ticket technique that operates with cryptographic methods and allows a time lapse between the granting of rights and their actual use. Only in this way can specific requirements such as the issuing of repeat prescriptions or the use of mail-order pharmacies be implemented in a manner which neither undermines the common security concept nor transforms individual applications into a collection of special cases."
A key building block of the new architecture is the "connector", which links the systems of service providers - doctors, dentists, pharmacists, etc. - with the telematic infrastructure. The doctor can access the patient's medical records via the connector regardless of whether they are stored in a hospital or in another consultant's office.
"As the secure endpoint of communications, the connector combines all the functions needed for safe handling of the medical data", stated Jörg Kunsmann of the Fraunhofer Institute for Industrial Engineering IAO in Stuttgart. "Encryption, signature and authentication functions ensure that data can be saved securely and that confidentiality is maintained, even though the data are stored at distributed locations." Working in conjunction with the access gateways, the connector ensures that the communications infrastructure can only be used by authorized persons.
In a related development, Austria plans to roll out its own e-health card, called the "eCard", in the coming weeks. Using a special reader, health professionals can access patient data stored in a central health information network. For Austrians, the eCard will be the first smart card technology in their wallet, while their German neighbours have been carrying the "dumbed down" version, the health insurance card, since the late 1990s.
"e-Health issues and Telematics" technology are also major research themes in the European Union's Information Society Technologies (IST) programme, one of several thematic priorities of the Sixth Framework Programme (FP6) for research and technological development.