1. OVERALL PROJECT DESCRIPTION
The NETC@RDS Project aims to improve the access of mobile european citizens to the national health care systems using advanced smart card technology. It also aims to implement and evaluate technical solutions for the European Health Insurance Card electronification and for improving additional services such as the inter-european health costs clearing/billing processing.
Current Phase A2 is the second of four project steps (initial market validation, full market validation, initial deployment, full deployment), and it aims to establish and demonstrate new improved health care administration services for mobile citizens across the E.U.. It also addresses the recommendations from the European Commission to evaluate technical solutions for European Health Insurance Card electronification and for additional services such as health costs clearing/billing processing.
Phase A2 will establish and evaluate a number of large scale “e-EHIC advanced demonstrators”. Phase A2 will build on the initial market validation work already conducted by the main Health Insurance Providers and the national clearing houses from Austria, France, Germany and Greece under NETC@RDS Phase A1. The result will be a Full Market Validation/Evaluation and preparation of a consolidated final Business Plan based on live applications in pilot regions within the 10 E.U Member-States (Austria, Finland, France, Germany, Greece, Italy, Czech Republic, Slovak Republic, Slovenia and Hungary).
In this respect, Project Phase A2 will simultaneously define, demonstrate and evaluate new associated administrative processes for use by public health insurance and health care service providers (e.g. hospitals, ambulatory care) when providing necessary health care and/or immediate care services to European Member State residents travelling or temporarily resident outside their home country but inside the E.U. It will also establish and demonstrate practical technical interoperability for use of different national cards at the NETC@RDS pilot sites. The expected benefits include:
- simplified health care access for those with health insurance evidence of entitlement to receive health care while abroad in NETC@RDS pilot regions
- reliable source of information for health care provider front office staff checking insured entitlement or initiating interstate billing/clearing procedures
- development and use of Common Administrative electronic dataset for improved health insurance providers back office billing/clearing workflow applications and further modernization of post-processing activities.
- valuable lessons from this advanced demonstrator for the foreseen Phase 3 implementation (i.e. electronification) of the European Health Insurance Card
The NETC@RDS pilot project regions will accept as proof of entitlement any of the following:
- an eye-readable European Health Insurance Card ,
- an EHIC compliant NETC@RDS dataset either issued from existing Health Insurance smart card and/or downloaded from secure server.
Technically the NETC@RDS services will be implemented as an extension of existing health information systems including smart cards and/or networking software applications in pilot regions of Austria, France, Germany, Greece, Italy, Finland.
Greece (Athens and Thessaloniki) during the Olympic Games in Summer 2004 was the venue for the first of the envisaged pilots. Services provided to users in the pilot regions will be delivered in the frame of the EHIC regulation and in accordance with the General Agreement from NETC@RDS Phase 1 and signed by the authorised parties (i.e. health insurance and the clearing/billing liaisons offices of Member-States) participating in the project.
1.2. DESCRIPTION OF SERVICE
The NETC@RDS services offered to the above listed users are:
1. Simplified health care access for mobile citizens.
2. Reliable source of information for health care provider front office staff checking insured entitlement or initiating interstate billing/clearing procedures
3. development and use of Common Administrative electronic dataset for improved health insurance providers back office billing/clearing workflow applications and further modernization of post-processing activities.
The NETC@RDS approach is taking into account the existing infrastructure and services that were deployed by governments or public Organizations for the local (national or regional) specific needs. During Project Phase A2 the NETC@RDS consortium will provide the necessary technical means –i.e. the NETC@RDS services- for modernising the paper-based procedure by paving milestones for a trans-European network of e-Health services for mobile citizens.
1.2.1. THE NETC@RDS SCENARIOS
The NETC@RDS services address the following steps as part of the service to be validated:
1. Providing an electronic evidence of entitlement for the insured person (from within a smart card or from server).
2. Keying-in entitlement information from the insured person’s EHIC or reading/downloading the electronic evidence of entitlement at hospital when health care are needed. In both case, the captured information will contain the personalised NETC@RDS electronic common dataset.
3. Processing the NETC@RDS electronic common dataset for further billing/clearing workflow.
Every Health Insurance Service provider willing to implement the NETC@RDS services will do it on the basis of one of the four technical scenarios above described. As first milestone, data capture of insured administrative information from various existing media (e.g. visual EHIC, health smart cards, downloadable e-form) will be implemented in software applications that will be delivered by the NETC@RDS Health Insurance Service Providers during NETC@RDS project Phase A2 implementation. The eye-readable European Health Insurance Card –shown in the above figure– will be onsidered as well in the context of the following NETC@RDS scenario cases. The NETC@RDS services will be delivered in pilot hospitals on the basis of any of the scenario cases drawn in the above picture. It is up to the Health Insurance Service Providers to apply their preferred scenario chosen amongst the four possible cases.
Four possible cases outlined below can be considered for each NETC@RDS software implementation and set-up:
CASE 1 Case 1 is a full off-line scenario case. The NETC@RDS dataset is captured from smart card memory by off-line software application for further processing. Scenario Case 1 could improve existing relatively poor off-line eye-readable security by requiring the insured to keyin a user PIN-code.
CASE 2
Case 2 scenario combines both smart cards and IT network applications. The NETC@RDS dataset is thus downloadable from server when required. In scenario Case 2 the smart card application applies first for secure network connection to the relevant Health Insurance Provider server for on-line authentication. Insured dataset would be downloaded after successful completion of smart card authentication. However, the dataset could be stored in the card as well for back-up solution in case server would be out of order or remote connections are down. This would be the preferred scenario.
CASE 3
This is the full on-line scenario. The NETC@RDS dataset is downloaded from remote server when manually typing-in insured ID data and password at hospital. Data privacy could possibly be enhanced by use of health professional authentication certificate.
CASE 4
Case 4 is a full off-line scenario case that will apply when none of the other scenario cases could be available. In Case 4, insured information will be captured either from eye-readable European Health Insurance plastic cards that are foreseen after 1st June 2004 or from certificates provisionally replacing the visual European Health Insurance Card6. Typing-in data from E-111/E-111+ paper forms as intermediate or temporary solutions for electronic dataset completion will be / is also considered at early stage of the EHIC deployment. It has to be noted that any insured citizen from any E.U Member-States could receive the service provided with Case 4 in the NETC@RDS pilot hospitals –i.e. not only insured from the Regions in Member-States participating to the project.
1.2.2. BUILDING UP THE NETC@RDS DATASET
The information captured after the completion of one of the above described scenarios will then be structured in a NETC@RDS electronic common dataset for further data processing. The NETC@RDS minimal dataset will apply the requirements of the –eye-readable- European Health Insurance Card dataset as it is specified by the CASSTM/Technical Commission7. However, the dataset could be enhanced according to the specific needs of the NETC@RDS stake holders (e.g., Health Insurance Service Providers, Health Care Services Providers, Liaison Offices). In this regard, additional information to indicate the procedural status and processing authority could be possibly provided within the dataset according to the needs expressed by the Health Insurance providers clearing houses and their national liaison office for further interstate billing/clearing procedure.
1.2.3. PROCESSING THE NETC@RDS ELECTRONIC DATASET FOR FURTHER BILLING/CLEARING STEPS
After its successful capture and completion at a hospital (for example) the NETC@RDS electronic dataset will then be forwarded to the local health insurance back office for further processing. Later on, invoice (cost claims) will be sent by Hospital to the health insurance to initiate the billing/clearing procedure. It has to be noted that the design of the NETC@RDS offer has taken into account the current requirements of EC Regulation 1408/71 and 574/72 which co-ordinates the social security schemes of the European Member States as well as the relevant Decisions from the Administrative Commission for Social Security of Migrant Workers (CASSTM). It is the intention of the members of the NETC@RDS consortium to keep the NETC@RDS services and processes aligned to the evolution of the Regulations and relevant Decisions, in particular with regards to the evolutions of the E-Forms as well as the outcome of the mandate of European Council of Barcelona on the European Social Insurance Card.
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