eHealth smart card project, good for patients and healthcare professionals


The German eHealth initiative was established to help secure an efficient IT infrastructure for health care professionals and patients. Besides the backend databases, the card terminal as the ‘gateway’ to the entire process is the key to this project’s environment.

The eHealth initiative is one of the most ambitious smart card projects in the world – designed for approximately 80 million patients and 1.8 million health care workers.

The initiative is in its trial phase, which means that 10,000 patients, a limited number of physicians, pharmacies and hospitals, as well as a number of software and hardware vendors, are looking closely at the technology.

Cost reduction in the public healthcare sector is one of the main drivers of the project. Other goals include better collaboration between healthcare professionals, which will mean better services for the patients. It’s also important to gain the acceptance of all of the main project stakeholders – both patients and professionals. Since there has been no finalization, or decision, on the centralized components of the infrastructure, the test phase will be carried out primarily with prototypes of the decentralized components. This will include a new generation of smart card terminals, a so-called ‘connector’ as well as new microcontroller-based smart card for patients and professionals.

With this infrastructure, the connector – often based on internet router technology – acts as the central communication hub. The connector communicates with the front end software, as well as to the smart card terminal and to the centralized components. To allow complex access rules in distributed databases, the technology infrastructure includes PKI-based authentication mechanisms. This way, data that is required offline, such as medical emergency information can be stored on the card, while data such as insurance and billing information, medical histories and findings, prescriptions or referrals information will be stored in the backend infrastructure, allowing a seamless and thorough exchange of this vital information between healthcare professionals.

Communication between all components – centralized and decentralized – are being designed to be carried out via TCP/IP.

A new standard for Secure Interoperable Chip Card Terminals (SICCT) for the communication between connector and terminal has been defined by TeleTrust, a non-profit organization.

Core elements of this standard include:

  • A chip card terminal including a display and PIN pad with smart card interfaces.
  • One for the patient card.
  • One of the health professional card.
  • SIM-sized slots for terminal identity and secure communication.
  • Service discovery function to exchange information about the terminal abilities.
  • An Ethernet port to allow SICCT-based communication via TCP/IP.