Project Context and objectives

The European Health Insurance Card (EHIC) was launched in June 2004. The EHIC is handed out in more than 20 nations to the insured. These cards are currently used as eye-readble cards without magnetic strip or data chip. Once this entitlement card has been presented the individual patient data need to be captured manually. This procedure is time-consuming and error prone, especially when registering the insured and sickness fund identification number.

A strong political motivation supports the introduction of an electronic EHIC (eEHIC)which shall pave the way for more efficient access procedure and post-processing of administrative and reimbursement data to achieve financial benefits, trigger IT-modernisation and ensure basic interoperability between health telematic infrastructures of member states.

NETC@RDS is a pan-European project supported by the EU’s eTEN Programme. Since September 2002, the NETC@RDS project is developing services for capturing the data for eEHIC processes, providing better alternative to physical processes.

The NETC@RDS is aimed at:

• Providing reliable and interoperable solutions for the European Health Insurance Card electronification.
• Enhancing interstate data exchange while using secure IT network software applications incorporating professional and personal smart cards with PKI and Digital Signature.
• Contributing to mobility and skills convergent policy while improving Health Care Access for Mobile citizens.
• Achieving initial deployment of an on-line service for the eEHIC.

The key measure is that any “mobile” European citizen with his/her card and in need of non-planned medical treatment can benefit from the NETC@RDS service. Using the NETC@RDS application and an Optical Card Reader or a Smart Card Reader, healthcare facility staff read administrative data from the EHIC or national health insurance card. Eligibility is then verified within a few seconds by checking the administrative data via two NETC@RDS portals against the database of the relevant health insurance authority. The electronic data set is processed and used as a proof of entitlement and guarantee of cross-border reimbursement.

Under the eEHIC system, access to healthcare in another EU Member State could be authorised either via an eye-readable EHIC, or a national health insurance electronic card, or via certain national eID chip cards issued by the responsible government authorities of the participating partners. An on-line verification procedure will provide the assurance needed to support acceptance procedures for both health insurance and healthcare providers.

In line with EU rules, all Member States and the EFTA countries are already issuing the EHIC as a replacement of the former E111 paper forms which allow EU citizens access to healthcare services in other Member States during temporary stays. The NETC@RDS project aims to provide reliable pan-European, interoperable solutions for the electronic version of the EHIC.

Services to be offered

The NETC@RDS service for eEHIC serves three distinct processes:

1. automated data capture for identification based on a common set of data elements
2. on-line verification of entitlement rights via national portals, and
3. minimal data provision which can contribute to subsequent back-office interstate-billing.

The specific content of the NETC@RDS service is predicated on the patient EHIC data and verification data in the national health insurance databases. The specification of this data is provided by the European regulatory bodies.

The common area of interest is in mutual use and recognition of the pan-European standardised eEHIC as a means of validating entitlement to unplanned health care. In addition two other cases are included: optical recognition of existing EHIC cards, and data capture of an eEHIC identification data set, incorporated in a national e-ID from specific member states of the participating partners.

The NETC@RDS project utilises state of the art technologies, directly suited to the requirements of the service in the following areas:

• web interfaces
• end-to-end security over network of national service portals
• data repositories and access point workstations
• data protection
• individual authentication and provision for back-end integration and auditing services.

Each portal can be connected to one registry or multiple national/regional registries in order to provide an online checking service. The overall system architecture is that developed and proven during the market validation phase of the project.
The specific technology components are:

• A secured portal of services for each nation;
• An optional repository connected to the national portal;
• A client workstation; Secured connections between those elements over the internet.

Areas of deployment

The EU NETC@RDS project, which is preparing the ground for the planned eEHIC, has entered its initial deployment phase which will see the further extension of the existing service.

In awareness of Europe growing together, the NETC@RDS project is aiming to improve access to the health care systems in different regions within 16 European countries: Austria, Czech Republic, Finland, France, Germany, Greece, Hungary, Italy, Liechtenstein, Netherlands, Norway, Poland, Romania, Slovak Republic, Slovenia and Switzerland (associated).

The existing service, already successfully tested during a market validation phase in 85 pilots across ten EU Member States, has been progressively extended to enable easy access to healthcare for European citizens on temporary stays in any other EU country.

The project service sites are health care facilities (hospitals, ambulatory care offices) where the NETC@RDS services is being deployed and made operational. The total number of service providers to be equipped is 305 with a deployment of 566 workstation units (so-called NETC@RDS “service points”) enabling "non-planned" health care for European citizens who provide evidence of entitlement.

Evidence of entitlement can be provided through the eEHIC card in any of the 305 project service sites across the 16 participating European countries. Currently (end 2008) around 120 NETC@RDS service points in 11 countries have been properly equipped with a Smart Card Reader and the associated middleware environment.  The list of the service points and their locations is updated on a permanent basis through the a Google Map Web site. The list is linked to the project web site (www.netcards.eu) or could be directly seen at the following URL address: http://www.sesam-vitale.fr/programme/netcards_sites_gmap.asp. Of particular interest for the their trans-border implication, due to the territorial contiguity amongst the regions involved the following sites are to be highlighted: those launched in the Lörrach area (Germany, French/Swiss border) and those inaugurated during EURO 2008 football championships in the Basel region (Switzerland).

Impact

Based on NETC@RDS partners’ investigation of country/region conditions, an extensive range of benefits accrue from use of NETC@RDS:

1. Ease of use and direct access benefits for citizens: increasing acceptance and level of application of medical provision needed on the basis of benefits in kinds in Europe according to European regulation 1408/71 and 574/72.
2. Financial benefits for citizens: EU Regulation stipulates statutory health practitioners will apply the same rate for health care costs delivered to EHIC holders as they would apply for the national or local insured citizens. Indeed, in case no social insurance entitlement would be shown by foreign visitors then higher rates may be applied by health practitioners. In view of this differential and the NETC@RDS service availability, the acceptance of the eye-readable EHIC is fostered and more citizens will likely receive treatment in accordance with minimum legally applicable tariffs.
3. Costs savings and time Benefits for health care providers: provision of quick and efficient registration process in all health care provider receptions optimises allocation of human resources whilst avoiding later labour-intensive collection of the information required to issue the bill.
4. Quality Benefits for health insurance organisations: improving control and monitoring of cost for health care provision.
5. Costs savings for health insurance organisations: reducing EHIC fraudulent usage and improving interstate reimbursement thanks to the NETC@RDS trans-European interoperable infrastructure.
6. An additional potential advantage for European citizens is the possible contribution of NETC@RDS to enable interoperable e-Health application relying on its infrastructure, such as transmission of limited clinical data.

Fostering and speeding-up the development of the European industry of e-Health services on the European market (call for tenders) thanks to broad acceptance of industrial standards based on the NETC@RDS certification

Future perspectives

The central positioning of the project is to serve as an experimental test bed for the electronification of the EHIC and its results are now proposed for consideration for European regulatory bodies. In this frame, communication with the EU/EFTA working bodies (i.e. CASSTM/TC Task Force ad hoc Group eEHIC, CEN WS eEHIC) is regular and driving to a relevant cooperation at European and national level. In addition, more perspectives will raise in the light of the decision of the NETC@RDS partners to include the developed services in the EESSI (Electronic Exchange of Social Security Information) framework, aimed at ensuring that Member States exchange data electronically once the new, modernised and simplified European Regulations coordinating social security, which require the transmission of data between institutions to be carried out by electronic means under a common secure network, begin to apply in 2009.

Duration of the Project

June 2007 – May 2010

Funding source

Public funding EU, Public funding national, Public funding regional

Project size

Implementation: Larger than €10,000,000

Yearly cost: €1,000,000-5,000,000

Links

• Website
• eTEN portal
• ePractice portal

Themes

• eid
• mobility
• insurance

Contacts: