The Austrian e-card System
The 56th revision of the ASVG (Allgemeines Sozialversicherungsgesetz, Law on General Health Insurance) assigned the task to the Association of Austrian Social Insurance Institutions to create an e-card as a foundation for an electronic administration system (ELSY). Originally produced as a substitute for the health insurance voucher nowadays the e-card system does much more. Step-by-step paper-based processes were replaced by electronic solutions, cutting out unnecessary steps for patients and bringing administrative facilitation to healthcare providers. The Austrian e-card also contains signature applications and can be used as a citizen card.
Requirements to System and Cards
The main characteristic of the Austrian e-card is its keycard principle. The e-card does not contain software functions, it only holds identification data which are the access key for applications. Other design requirements of the system include:
- Online system with high availability
- Loadability of future applications
- Heterogeneous platform to connect all partners independently of their software
- Extendable interface to medical practice software
- Citizen card functionality
- Acceptance of other cards with citizen card functionality in the medical practices.
Data on the e-card
Only the cardholder’s administrative data is stored on the e-card i.e. name, academic title, insurance number, card serial number, sex and user group identification.
On the reverse of the e-card is the European Health Insurance Card (EHIC). The EHIC replaces the international health insurance voucher (form E111) for the claim of medical treatment during temporary visits (e.g. holiday) in member states of the European Union, the European Economic Area, Switzerland, Macedonia Serbia, Montenegro as well as Bosnia and Herzegowina.
Additionally, the e-card contains signature applications.
Replacement of Health Insurance Vouchers
Within the scope of the application “replacement of health insurance vouchers,” the e-card serves as the patient’s proof of claim with the physician or hospital and replaces all forms of the traditional health insurance vouchers. For the cardholder medical treatment is accessible without administrative barriers and without paper documents.
Patients have to show their e-cards whenever visiting a doctor or hospital. By reading the e-card the doctor checks via the secure data network – the so called health information network – if a person is insured and which health insurance institution has to pay for the medical treatment. This data is not stored on the card but is requested online from the e-card system.
Medication Approval Service (ABS)
In Austria some special drugs have to be approved by so called „controlling doctors“ of the social insurance institutions. This request and approval process is also carried out via the e-card system.
The electronic way of approval has a lot of advantages for patients:
- Short response time
- Short waiting time
- Close and practicable medical care
- Undisturbed therapy and continuous approval process
- Best possible coordination between prescribing physician, controlling doctors and patients.
Nearly all hospitals in Austria are connected to the e-card system. They use the so called VDAS (Insured Data Query Service). Using this service hospitals get online information from the e-card system about a patient’s insurance status which results in a high increase of quality for patients as well as for the hospital administration. The Medication Approval Service is also used by hospitals.
Electronic Temporary Disability Report (eAUM)
With the so called electronic temporary disability report a standardized procedure was introduced for all insurance institutions. Instead of a paper based process the temporary disability report is transmitted directly from the physicians‘ software via the e-card infrastructure to insurance institutions. The patient gets an Austrian-wide standardized certification for the employer. The advantages of this service are a fast and secure transmission without losing time, less administrative effort and a standardized certificate for all patients.
Electronic Communication Service (eKOS)
The electronic communication service ensures the electronic administration of the total prescription process:
- prescription of an examination (e.g. CT, MRT)
- approval of health insurance institution (if necessary)
In a first step the following examinations are covered with eKOS:
- computer tomography (CT)
- magnetic resonance tomography (MRT)
- nuclear medicine examinations
- human genetics examinations
- clinical psychological diagnosis
- bone density measurement
The long-term target is the replacement of all paper-based forms within the prescription process. The advantages:
- Patients don’t have to submit their applications personally.
- The unique identification number of the application makes it easier to arrange an appointment for the examination.
- Patients receive the information about the approval of their application by SMS or e-mail and can check the status of their application online.
Pre-operative Questionnaire (PROP)
PROP is an assessment tool via the e-card system for pre-operative diagnosis in case of planned operations. Physicians have the possibility to fill in relevant medical history data and to generate a list with the necessary examinations.
PROP is based on the national quality guidelines for integrated care of adults for pre-operative diagnosis for planned operations (BQLL PRÄOP) and can be used by physicians having a contract with Social Insurance Institutions via the e-card system since May 2014.
Prescription Fee Limit (REGO)
In Austria each insured person has to pay prescription fees up to a limit of 2% of his net income per year. The Austrian Social Insurance administrates a special prescription fee account for each insured person. As soon as the 2% limit is reached the release is indicated in the medical practice after reading the e-card. The physician or his assistant notes the release on the prescription so that the insured doesn‘t have to pay the prescription fee in the pharmacy.
Electronic Transmission of Preventive Medical Check-up Documents (DBAS)
This service is used for the electronic acquisition, encryption and transmission of documentation forms for preventive medical check-up and disease management programmes and contains:
- general documentation form
- documentation form PAP test
- findings form colonoscopy
- documentation form disease management programme „Therapie Aktiv DM2“
Each authorized physician has the possibility to
- fill in the documentation forms step by step
- export and import the forms
- transmit the forms the e-card system
- print the forms
- request and store the receipt notice
e-medication is a function of the Electronic Health Record (ELGA). After inserting the e-card into the card reader, e-medication makes sure that all prescribed and dispensed prescription drugs are displayed to the medicating doctor and the pharmacist. On demand of the patient the pharmacist may add potentially interactive OTCs to the e-medication list. On basis of this information checks concerning potential interactions, dosage and contra-indications are possible. In the e-medication list prescribed and dispensed drugs are displayed in a structured way. Via the ELGA-Portal the patient gets access to his medication list after login with mobile signature or citizen card.
Citizen Card Function
The citizen card function of the e-card is part of an Austrian e-Government Strategy and stands for a modernization of Austria’s administration.
In addition to the Social Insurance Signature (used for applications within the field of social insurance) the e-card contains “sleeping” signature applications according to e-Government Law.
The activation of the citizen card function can be carried out easily either by registering at one of the registration outlets provided by the social insurance institutions or via the social insurance website. After registration, the card holder is provided with the secure data for his citizen card. These data are stored on the e-card (certificate and identity link parameters). The electronic signature (the certificate) can be activated by the citizen himself. The activation code is provided by the registration outlets or via registered mail.
Austrian Social Security institutions already provide several e-services on their websites such as information on insurance data (data on insurance periods, insurance status, old age pension account). Further applications in the e-government sector include the annual tax declaration, child allowance and student allowance applications, criminal records and residence registration confirmation.
Components of the System
The e-card system is an IT-System which consists of the basic elements: smart cards, the medical practice unit and the LAN chip card readers for the medical practice, the central system, the health information network and the call centre.
MPU and LAN Card Reader
The medical practice unit (MPU) contains the application-software and operates business procedures in the medical practice. It is a security, application and transaction monitor and the interface to the IT-Systems of health professionals. For the processing of the e-cards and the administrative professional cards a LAN chip card reader is connected to the MPU Hospitals use a server based MPU.
The e-card is the central component of the system and the access key to system-based services and data. This is possible due to the design of the e-card as an electronic signature card. Identification data for reading access and the signature mechanism are stored on the card.
The administrative professional card (admin-card) is also designed as a key card and is the physician’s authorization card. Only both “keys” together open the access to services and data.
e-card Server Centre
The central system consists of a consultation system and a card system. The consultation system handles the communication with the medical practice units in the medical practices. The card system handles all transactions between smart card production and the card service clients.The administration of e-cards and admin-cards is executed in the component “card system”. The certificates for the signature of the consultations are generated and provided by the Trust Centre.
The consultation system is responsible
for checking the insured parties’ requirements. For security reasons the e-card server centre is set up at two locations in Vienna.
Healthcare Information Network (GIN)
All communications are sent via the Healthcare Information Network (GIN), which can only be accessed by authorized users from the healthcare system. The GIN meets the highest requirements for security, availability, and quality.
Additional Services for Healthcare Providers
Using the Peering Point as a central platform, the health information network provides additional services such as secure e-mail, secure access to internet and transmission of findings for healthcare providers. The appropriate secure data transmission with priority control for each application is carried out by the IT-equipment of the Peering Point Company which is owned jointly by the Austrian Camber of Physicians and the Main Association of Austrian Social Security Institutiions.
The e-card Serviceline is single point of contact for insured people and healthcare providers. The agents of the e-card Serviceline deal with general questions of insured and provide technical support for healthcare providers.