"093_PPP ON LINE Health Insurance Card_ Alenka Jerse"
ON-LINE HEALTH INSURANCE CARD SYSTEM IN SLOVENIA Alenka Jerše, office of Information commissioner, Slovenia Urban Brulc, office of Information commissioner, Slovenia • National health insurance card system implemented since 2000 • Slovenia one of the first European countries to introduce national system of health care insurance card • 2.061.659 e-health insurance cards are in use and 20.607 professional cards (as of 31.12.2007). • The e-health care card is the only valid document in Slovenia for exercising the rights arising from health insurance . Health Care Provider Health Care Provider Health Care Provider Provide data on commercial (optional) insurance Provides data and financing HEALTH INSURANCE INSTITUTE OF SLOVENIA Provides general personal data Patient Patient Patient Central Registry Commercial Insurance Company Commercial Insurance Company Commercial Insurance Company PERSONAL INSURANCE CARD (belongs to a patient) Simultaneous use PROFESSIONAL CARD (belongs to health care personnel) “Fresh” data is stored on IC at SELFSERVICE TERMINALS provided by HEALTH INSURANCE INSTITUTE OF SLOVENIA CARD READER (Patient needs to validate IC every 3 months) SOFTWARE SUPPORT Personal insurance card is a BEARER OF PERSONAL DATA = personal data is stored on microprocessor E-health insurance card system • The system stores personal data off-line • Data visible on the card: name, family name, date of birth, card number, individual’s health insurance number • Other data accessible from microprocessor (16 kB of memory) E-health insurance card system Data accessible from microprocessor (16 kB of memory): • data on card holder (name, address, sex, date of birth); • data on health insurance payer – legal or natural person (registration number, purpose of insurance, address, type of payer of the insurance); • data on obligatory health insurance (validity); • data on voluntary health insurance (insurance company, type of insurance, validity); • data on chosen personal doctor (general practitioner/pediatrician, dentist, gynecologist); • data on medical accessories prescribed; • data on voluntary decision to be cell or tissue donor post mortem; • data on medicines prescribed. IDENTIFICATION of a patient* OFF-LINE ACCESS to a limited number of personal data*** CHECKING VALIDITY of health insurance** Identification data data on health insurance payer data on obligatory and optional health insurance data on personal doctor(s) data on tissue donation data on prescribed medicines and medical accessories SOME QUESTIONS ARISING FROM USAGE OF OLD IC • * of IC holder. to lack of photo complete due ation with IC is in isuse of IC. The identific a illegal use or m This can lead to in practice? nificant problem NO sent a sig Does that repre • ** tion, but: ealth care institu alth care in a h Patient seeks he ged IC or omes with dama -c d it at home or that could not fin - claims s not work. - card reader doe ss patient’s on can not acce tuti Health care insti YES e data. health insuranc necessary data t to access the n have the righ e other way? h care institutio Does a healt Slovenia in som e Institute of Health Insuranc from SOME QUESTIONS ARISING FROM USAGE OF OLD IC holder, ed to a card e prescrib ines that wer dic lated to ata on all me medicines re es AND iatric IC includes d ent or psych lated medicin tment re f HIV pati ding HIV trea n diagnosis o data on ta o inclu ccess to the eatment. Da IC tr ho has a nt they PSYCHIATR to anyone w what treatme revealed to know Act nor ent could be want anyone pati Health Care ple do not Field of any peo g Data in the medicines. M e this. . Managin the cases lik articipating in were p lution in not offer a so do Rules on IC t do? Based on the opinion of can a patien hat W Commission of medical ethics the patient can decide whether he/she wants these sensitive data to be processed or not! *** Personal insurance card is NOT A BEARER of personal data (personal data is NOT stored on microprocessor) = PERSONAL INSURANCE CARD becomes a KEY to access the data stored in central database DATABSE processed by HEALTH INSURANCE INSTITUTE OF SLOVENIA DIRECT ACCESS HEALTH CARE PROVIDER SOME QUESTIONS ARISING FROM ESTABLISHING THE NEW SYSTEM • • • • • • • • * Who besides patient has REA Do they really need ING RIGHTS ? These administrative stuff at are: Health Insurance Inst itute of Slovenia and co companies mmercial insurance personal doctor (gener al practitioner, dentist , gynecologist, pediatric doctor on secondary ian), and tertiary level, administrative stuff at health care provider (re ception service), psychologist, ambula nce car driver, physio therapist coordinator for transpl antation procedure pharmacist, pharmac eutical technician optician, funeral direct or access to ALL PERS ONAL DATA from ce nt ral database? DING / WRIT NO! Therefore a MODULAR ACCESS is established! (each person has access only to the personal data that are necessary or needed) MAIN PURPOSE STAYS THE SAME Accuracy and up-todatedness of personal data Wider sets of data / more insurance and health data Right of a patient to be informed on his/her own personal data (IC is access key to his/her own data) Prevention of unauthorized use of health care service in the event of non-arranged insurance Simplifying procedures for accessing to personal data OFFERS A WHOLE VARIETY OF NEW APPLICATIONS . • PERSONAL DIGITAL CERTIFICATE Personal and professional card will contain a personal digital certificate • e - DOCUMENTS Professional card will contain a digital certificate for secure electronic signing of health care documents (prescriptions, orders, medical referrals…) Prescriptions will not be issued in paper form any more! • BASIS FOR DATA EXSCHANGE BETWEEN HEALTH CARE PROVIDERS First stage of Electronic Health Record • NEW DATA SET BY PATIENT`S RIGHTS ACT DURABLE POWER OF ATTORNEY FOR HEALTH CARE LIVING WILL PROHIBITION OF GIVING A CONSENT BY PEOPLE AUTHORISED BY LAW • INSURANCE CARD WILL BE COMBINED WITH PERSONAL IDENTIFICATION CARD (“Two in one”) Picture ily Name, ame, Fam N Address er tion Numb l Identifica insurance Persona r of health on numbe Registrati Identity Card Act allows photocopying of identity card to certain data controllers (…) Act on Patients Rights allows access to registration number of health insurance of third persons who are on the waiting list for doctors appointment or surgery etc. This means that Registration number of health insurance will be accessible to wide range of individuals allowing identification of the holder of specific health insurance number (that are on the waiting list). This is against the purpose of the Act on Patients Rights. How to solve this problem? Data protection related Access also through identity card Which data should be seen on the card How will the security be technically assured Who has access to which data Should all data be registered (for example for all medicaments, not for HIV treatment drugs) • Possibility of prohibiting access by the decision of the insured person • • • • • Data protection –Working party 29 Working Document on the processing of personal data relating to health in electronic health records (EHR) • Respecting self determination • Identification and authentication of patients and health care professionals • Authorization for accessing EHR in order to read and write in EHR • Use of EHR for other purposes • Organizational structure of an EHR system Data protection –Working party 29 Working Document on the processing of personal data relating to health in electronic health records (EHR) • Categories of data stored in EHR and modes of their presentation • International transfer of medical records • Data security • Transparency • Liability issues • Control mechanisms for processing data in EHR Data protection –Working party 29 • EHR systems additionally have the potential not only to process more personal data (e.g. in new contexts, or through aggregation) • But also to make a patient’s data more readily available to a wider circle of recipients than before. • The members of the Working Party are of the opinion that all data contained in medical documentation, in electronic health records and in EHR systems should be considered to be “sensitive personal data”. Directive 95/46/EC Article 8 (3) allows for the processing of sensitive personal data under three cumulative conditions: • the processing of sensitive personal data must be “required”, and this processing • takes place “for the purposes of preventive medicine, medical diagnosis, the provision of care or treatment or the management of health-care services” and the personal data in question • “are processed by a health professional subject under national law or rules established by national competent bodies to the obligation of professional secrecy or by another person also subject to an equivalent obligation of secrecy”. Data protection –Working party 29 • Essential principle concerning access to an EHR must be that – apart from the patient himself – only those healthcare professionals/authorized personnel of healthcare institutions who presently are involved in the patient’s treatment may have access. • If feasible and if possible – that is with a patient present and able to act – the patient should be given the chance to prevent access to his EHR data if he so chooses. Portorož Declaration www.ehealth2008.si Three key initiatives must now begin to operate over the next ten-year period: • The first crucial area is the need to plan to deploy telemedicine and innovative ICT tools for chronic disease management. • Second, but equally important, is the need to introduce an enhanced focus on new research opportunities. • Third, is the need for a transparent legal framework. It would help to define the responsibilities, rights and obligations of all the different subjects involved in the eHealth process. Special attention should be paid to exploring existing legislation that affects eHealth significantly, especially the Data Protection Directive, e-Privacy Directive and e-Commerce Directive. Portorož Declaration Combining standardization and safety in e-Health The Commission plans to issue a recommendation on cross-border interoperability of electronic health record systems, laying out clear guidelines for arriving at the keenly anticipated scenario of enabling patients to access electronic health records anywhere any time. There is a need to emphasize the improvement to patient safety that ICT can facilitate, especially as a result of the enhanced interoperability of systems. Thank you! www.ic-rs.si (eng.) www.ip-rs.si (slo.)