eHealth Card
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Motivation
Configuration
Trays
Universal ID
Quantity structure
Process of ePrescription
Health Professional Card
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 1
eHealth Card
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 2
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 health
http://www.die-gesundheitskarte.de/
Worzyk
FH Anhalt
http://www.worldcongress.com/events/NW615/presentations/Harald%20Flex%20-%20EHR%20and%20IT%20Innovation%20Summit.pdf
Telemedicin WS 09/10
eHealth Card 3
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
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 4
Medical Applications
voluntarily
• 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 )
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 5
Medical Applications
voluntarily
• 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
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 6
configuration
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 7
configuration
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 8
configuration back side
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 9
Content
Segmentation 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
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 10
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
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 11
Content
Segmentation in trays
• Security tray (if desired, for example Viagra, Methadon, HIVdrugs)
- 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
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 12
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
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 13
Content
Segmentation in trays
• introspection / additional information
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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
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 14
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
Worzyk
FH Anhalt
http://www.heise.de/newsticker/meldung/57276
Telemedicin WS 09/10
eHealth Card 15
Worzyk
FH Anhalt
http://www.telemed-berlin.de/telemed2005/programm.html
Telemedicin WS 09/10
eHealth Card 16
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 17
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 18
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
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 19
Medical data
legal 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
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 20
ePrescription
constraints
• 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
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 21
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
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 22
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
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 23
Prescriptio
n
Session key
ePrecription
HPC
Physician
~~~~
Signature
Encrypted Prescription
/ DatenID
PukPat\Session key
Secret S
PukPat (S)
Ticket
eGK
Patient
~~~~
Ticket
Encrypted Prescription
Signature
DatenID
~~~~
Signature
Session key
Prescriptio
n
Worzyk
FH Anhalt
Ticket
HPC
Pharmacist
Telemedicin WS 09/10
eHealth Card 24
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?
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 25
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)
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 26
Losing and theft
The data are stored in a file system,
The Child ID is ciphered with the public key of the patient
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)
Additionally the data can be linked with the public key of an alternate
eHealth 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.
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 27
Potential attacks
against the data
DataID is located on the eHealth Card
DataID 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.
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 28
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 29
HPC
Synonyme
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Health Professional Card
Arztausweis
elektronischer Heilberufsausweis
Heilberufsausweis
Heilberufskarte
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 30
Health Professional Card
Worzyk
FH Anhalt
Telemedicin WS 09/10
eHealth Card 31