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1 Adaptations for e-kiosk systems to develop barrier-free terminals for handicapped persons Authors: Manuel Zwicker, RMIT University Juergen Seitz, DHBW Heidenheim Nilmini Wickramasinghe, RMIT University Agenda Concept of the German e-health card (ehc) Advantages and disadvantages (ehc) Data protection and data security (ehc) Electronic kiosks(e-kiosks) Specification for barrier-free e-kiosk terminals Additional benefits through an e-kiosk Discussion Conclusion 2 1

2 Implementation steps of the ehc Step1 (compulsive): Enrollee data EHIC administrative functions 3 Step 1: compulsive Enrollee data Information about the insurance agreement Data about the care provider Personal information about the enrollee Lifelong valid insurance number European Health Insurance Card (EHIC) Insurance coverage within the European Union Requirement: social agreement 4 2

3 Implementation steps of the ehc Step1 (compulsive) Enrollee data EHIC Step2 (compulsive) electronic prescription administrative functions 5 Step 2: compulsive Electronic prescription (e-prescription) Removes the nearly 700 million paper-based prescriptions Proceeding 1. Doctor stores the e-prescription on the ehc/ server 2. Doctorgenerateshissignature with his electronic health professional card (HPC) 3. Enrollee gives his ehc to the pharmacist 4. Pharmacistchecksthee-prescriptionandvalidity of the doctor s signature (pharmacist uses his HPC) 5. Pharmacist or another authorized staff presents the medicine and hand the medicine over to the enrollee 6. The e-prescription will become invalid and the data will be transmitted to the pharmacy s data center 6 3

4 Implementation steps of the ehc Step1 (compulsive) Enrollee data EHIC Step2 (compulsive) electronic prescription Step3 (optional) storage of personal health data administrative functions medical functions 7 Step 3: optional Storage of personal health data Documentation of medicine Avoid interdependencies between the individual drugs Emergency data of the enrollee in case of emergency Doctor can medicate purposefully and effectively Doctor can take allergy or chronic illness through the patient s therapy into consideration 8 4

5 Implementation steps of the ehc Step1 (compulsive) Enrollee data EHIC Step2 (compulsive) electronic prescription Step3 (optional) storage of personal health data Step4 (optional) Electronic Health Record administrative functions medical functions 9 Step 4: optional Electronic Health Record(EHR) Patient s data can be accepted, processed and attended centrally Patientsdemographics, problems, medications, vital signs, past medical history, immunizations, laboratory data, progress notes and radiology reports Improve quality of care Promote evidence-based medicine Reduction of cost 10 5

6 Agenda Concept of the German e-health card (ehc) Advantages and disadvantages (ehc) Data protection and data security (ehc) Electronic kiosks(e-kiosks) Specification for barrier-free e-kiosk terminals Additional benefits through an e-kiosk Discussion Conclusion 11 Advantages and disadvantages (ehc) Advantages Enrollees Qualitative higher therapy Patient`s data faster available Redundant examinations and administration of inappropriate drugs can be avoided Patients have a better overview of their health status Service providers (doctors/ pharmacists) Fast and extensive overview of the patient s health status Avoids redundant examinations Former examinations from other service providers can take into account of the diagnosis Optimized workflow saves time Cost units (health insurance companies) Cost savings Avoids unauthorized usage of medical services Disadvantages Very high implementation costs of approximately 1.7 billion Euros 150 million Euros running costs each year 12 6

7 Agenda Concept of the German e-health card (ehc) Advantages and disadvantages (ehc) Data protection and data security (ehc) Electronic kiosks(e-kiosks) Specification for barrier-free e-kiosk terminals Additional benefits through an e-kiosk Discussion Conclusion 13 Data protection and data security (ehc) Paragraph 291a SGB V Only medical care data is allowed to be saved Patients have the highness about their data (storage, chancelation, restriction of access) Data access to the patient`s personal data security container will be realized with the two-key-principle (exeptions: e-prescriptions/ recordsof emergencydata) Two-key principle 1. First key: HPC of the doctor or pharmacist 2. Second key: ehcwith the personal PIN of the patient 14 7

8 Data protection and data security (ehc) Last 50 accesses to the ehcwill be registered and stored on this e-health card Misuse of the ehcthrough a third party will be prosecuted criminally Paragraph 307 SGB V: regulations for fines were enhanced Paragraph 307a SGB V: creates new elements of an offense in connection with the ehc 15 Agenda Concept of the German e-health card (ehc) Advantages and disadvantages (ehc) Data protection and data security (ehc) Electronic kiosks(e-kiosks) Specification for barrier-free e-kiosk terminals Additional benefits through an e-kiosk Discussion Conclusion 16 8

9 Electronic kiosks(e-kiosks) Enrollees have the highness about their medical data Health insurance companies have to install e-kiosk terminals all over the country An e-kioskisis a primary system for the maintenance of applications and data through an enrollee (gematik mbh) 17 Electronic kiosks(e-kiosks) Functions of an e-kiosk Enrollee can remove e-prescriptions and administrate access rights for doctors Enrollee can activate or deactivate the voluntary applications Enrollee can update his personal information E-kiosks can take cost-free pictures of an enrollee Problem: barrier-free e-kiosks are not defined so far 18 9

10 Electronic kiosks(e-kiosks) 6.9 million Germans were 2007 seriously disabled (degree of disability > 50%) 20% 25% 9% 10% 14% 4% 5% 13% Source: Statistisches Bundesamt 2008 Viscera Backbone and body Affected by hardness of hearing, disturbance of equilibrium or speech disorder Cerebral disordered Restricted leg and arm functions Blind or visual impairment Mentally disordered Unknown 19 Electronic kiosks(e-kiosks) Type of handicap Requirements for e-kiosks Viscera Restricted leg and arm functions Backbone and body No adaptations necessary Adjustable in height for people with wheelchairs Switch to control height adjustments electronically Adjustable in height for people with different sizes Place of depositforbags/ baggage 20 10

11 Electronic kiosks(e-kiosks) Type of handicap Blind or visual impairment Requirements for e-kiosks Telephone receiver, which reproduces the data to the patient by synthetic voice Acoustic warning signals Braille keyboard and a Braille computer software Speech recognition software Changeable font size E-kiosks has to be isolated in special prepared areas (Data protection and Data security) 21 Electronic kiosks(e-kiosks) Type of handicap Affected by hardness of hearing, disturbance of equilibrium or speech disorder Mentally disordered Requirements for e-kiosks No adaptations necessary No adaptations necessary Cerebral disordered Illiterates (around 4 million Germans) No adaptations necessary Telephone receiver Speech recognition software 22 11

12 Electronic kiosks(e-kiosks) Further requirements/ ideas for e-kiosks Personal adjustments (height, font, etc.) will be stored and automatically loaded, when the enrollee inserts his ehc Integrated printer Integrated camera Information about for example the city, actual events and weather forecasts 23 Agenda Concept of the German e-health card (ehc) Advantages and disadvantages (ehc) Data protection and data security (ehc) Electronic kiosks(e-kiosks) Specification for barrier-free e-kiosk terminals Additional benefits through an e-kiosk Discussion Conclusion 24 12

13 Discussion Evaluation of thisprogramin termsof thee'sof e-health Efficiency Enhancingqualityof care Evidence based Empowerment of consumers and patients Extending the scope of healthcare Avoidingduplicative orunnecessary diagnostic or therapeutic interventions Electronic HealthRecord, emergency data => improve the qualtity of care The internet helps in the achieving of the necessary support of a diagnosis or treatment decision By making the knowledge bases of medicine and personal electronic records accessible to consumers In a geographical sense and a conceptual sense (providing healthcare services to places where it may otherwise be difficult or impossible to do) Discussion Evaluation of thisprogramin termsof thee'sof e-health Education of physicians and consumers through online sources Ethics Equity Physicans= continuing medical education; consumers = health education, tailored preventive information for consumers New challenges andthreats to ethical issues such as privacy and security issues => laws, two-key-principle Decrease rather than increase the gap between haves and have nots (access and familiarity with the technology is important) => therefore barrier-free e-kiosk terminals

14 Agenda Concept of the German e-health card (ehc) Advantages and disadvantages (ehc) Data protection and data security (ehc) Electronic kiosks(e-kiosks) Specification for barrier-free e-kiosk terminals Additional benefits through an e-kiosk Discussion Conclusion 27 Conclusion The ehcbrings a lot of new functions, which are partly compulsive and partly voluntary Patients medical data are very sensitive information Data security / data protection play an important role Enrollees have the highness about their medical data and need therefore e-kiosks Germany has 6.9 million seriously handicapped persons and around 4 million illiterates Specifications and requirements for barrier-free e-kiosks need to be defined 28 14

15 Thankyouverymuchfor your attention! Questions? 29 References BMG Bundesministerium für Gesundheit, 2008, Spezifikation der elektrischen Gesundheitskarte, Retrieved on from Festlegungen_20fuer_20die_20Testverfahren/Spezifikation_20elektronische_20Gesundheitskarte/Teil-3- Aeussere-Gestaltung,templateId=raw,property=publicationFile.pdf/Teil-3-Aeussere-Gestaltung.pdf BMG Bundesministerium für Gesundheit, 2010, Rechtliche Grundlagen, Retrieved on from Gesundheitskarte/Rechtliche-Grundlagen.html CW Haarfeld, 2010, Stufenweise Einführung der Funktionen der elektronischen Gesundheitskarte, Retrieved on from Doebert M., Hubertus P., Bundesverband Alphabetisierung e.v., 2000, Ihr Kreuz ist die Schrift Analphabetismus und Alphabetisierung in Deutschland, 1. Aufl. Erst Klett Verlag GmbH, Stuttgart EU-Info Deutschland, 2010, Die europäische Krankenversicherungskarte, Retrieved on from European Commission, 2010, The European Health Insurance Card, Retrieved on from gematik Gesellschaft für Telematikanwendungen der Gesundheitskarte mbh, 2006a, Einführung der Gesundheitskarte - Glossar, Retrieved on from

16 References gematik Gesellschaft für Telematikanwendungen der Gesundheitskarte mbh, 2006b, Endbericht zur Kosten-Nutzen-Analyse der Einrichtung einer Telematik-Infrastruktur im deutschen Gesundheitswesen, Retrieved on from v.info%2fgkv%2ffileadmin%2fuser_upload%2fprojekte%2ftelematik_im_gesundheitswesen%2fkna_end bericht.pdf&ei=qhons_epfiaqmgpryvzbag&usg=afqjcngzyrocq_t16toflpskzu8oy0feta gematik Gesellschaft für Telematikanwendungen der Gesundheitskarte mbh, 2010a, Elektronisches Rezept, Retrieved on from Pflichtanwendung en erezept.gematik gematik Gesellschaft für Telematikanwendungen der Gesundheitskarte mbh, 2010b, Notfalldaten, Retrieved on from Freiwillige_Anwen dungen Notfalldaten.Gematik gematik Gesellschaft für Telematikanwendungen der Gesundheitskarte mbh, 2010c, Vorteile für Versicherte, Retrieved on from gematik Gesellschaft für Telematikanwendungen der Gesundheitskarte mbh, 2010d, Vorteile für Leistungserbringer, Retrieved on from ematik 31 References gematik Gesellschaft für Telematikanwendungen der Gesundheitskarte mbh, 2010e, Vorteile für Kostenträger, Retrieved on from tik gematik Gesellschaft für Telematikanwendungen der Gesundheitskarte mbh, 2010f, Gesetzliche Grundlagen, Retrieved on from gematik Gesellschaft für Telematikanwendungen der Gesundheitskarte mbh, 2010g, whitepaper Sicherheit, Retrieved on from GVG Gesellschaft für Versicherungswissenschaft und gestaltung, 2004, Managementpaper Elektronische Patientenakte, Retrieved on from Institute of Medicine, 2001 "Crossing the Chasm-A New Health System for the 21st Century, (National Academy Press, Washington, DC: Committee on Quality of Healthcare in America) JMIR (Journal of Medical Internet Research) Monetos Independent Information and Research on the European Private Financial Sector, 2010, Gesetzliche Krankenversicherung, Retrieved on from

17 References PKV Private Krankenversicherungen.de, 2009, Zahl der privat Versicherten erreicht neuen Höchststand, Retrieved on from Hoechststand.php Scheer A.-W., Bitkom Bundesverband Informationswirtschaft, Telekommunikation und neue Medien e.v., 2009, Wie stehen die Deutschen zur elektronischen Gesundheitskarte?, Retrieved on from Senatsverwaltung für Inneres in Berlin, 2008, Katalog der Anforderungen an barrierefreie Kassenautomaten, Retrieved on from maten/rs_wtf_08_02_tabelle_anforderungen_iii.doc Statistisches Bundesamt Deutschland, 2008, 6,9 Millionen schwerbehinderte Menschen in Deutschland, Retrieved on from ,templateId=renderPrint.psml TrustTerminal AG, 2010, egk-trustterminal, Retrieved on from Verband der privaten Krankenversicherung e.v., 2010, Die elektronische Gesundheitskarte in der privaten Krankenversicherung, Retrieved on from egk.pdf 33 17

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