Smart Cards Are Used Widely in Healthcare in Europe

Smart Cards Are Used Widely in Healthcare in Europe

Smart cards are credit card alike, embedded with microprocessor that holds important information of the person who holds them. Seen as one of the most interesting and recent revolutions in the computing arena, smart cards store data, calculate, process, manage data, safer than magnetic strip cards, and execute encryption algorithms, via a smart card reader. They were first used in France. Healthcare is the third largest sector in the world to deploy smart ards into their applications, only next to pay phones and GSM applications.

Smart cards are of two basic types – contact and contact-less smart cards. While the prior requires a smart card reader to be of some use, the latter requires only an antenna near-by. Contact smart cards have a small gold chip instead of a magnetic strip, while contact-less ones have a microprocessor chip and an antenna coil inside that makes them work faster than contact cards. Apart from these two basic types, there are two more types, based on the microprocessor connectivity – combi cards and Hybrid cards. Combi cards have a single chip card with a contact and contact-less interface, while hybrid cards have two chips, each with its respective contact and contact-less interface. Healthcare is one of the biggest users of smart cards, especially in Europe. This article attempts to give a snapshot of the smart card usage in the European healthcare sector.

Smart Cards for Healthcare Market in Europe

Smart cards are being increasingly applied by the European healthcare sector. Both the patients and healthcare providers use smart card. There are nation-wide health card initiatives in Europe, including the Versichertenkarte project in Germany [it was upgraded to eGesundheitskarte piloting April 2006]and SESAM Vitale and SESAM Vitale 2 projects in France. Most of the smart cards are built with 64kb in-built memory, except Germany, where the smart cards have memory up to 72 kb. European healthcare employs smart cards to ensure user authentication, identification, proof of entitlement and emergency data access. The European smart card market is growing with new technologies such as RFID cards, USB enabled cards and integrated SIM cards. But the market growth is curbed on the other end by factors such as varied European standards and laws, data protection and privacy issues and interoperability issues.

Europe is the biggest consumer of smart card technology in the world and the European healthcare sector is shifting its smart card applications from mere administrative to clinical solutions. The International Organization for Standardization (ISO) defines the complete characteristics of smart-card technology. The European health cards are required to satisfy the security requisites of EU Member States’ legislation and EU laws on data privacy, security, and access rights.

Smart Cards for Healthcare Market in the United Kingdom

There are several smart card deployments in the UK such as the health insurance card (HIC), patient data card (PDC), health professional card (HPC) and a multi-application card where health application is part of a National ID. Though UK is not one of the forerunners in deploying smart cards for healthcare, there are Government initiatives, such as the plan to make e-ID cards mandatory from 2013. There are laws that already exist with respect to electronic signatures – the Electronic Communications Act 2000.Some pilot projects testing the use of smart cards already exist. The NHS Care Records Service (NHS CRS) and related Connecting for Health (CfH) project deploy NHS CRS smartcards that help control the authority and levels of access to NHS CRS. With over 600,000 existing users, these easily portable smartcards are more secure than a chip and PIN banking card. The NHS runs trials piloting contact-less smartcard readers, which help avoid the physical presence of the patient at the point of care, thus reducing time and effort. CfH has issued a tender for about 100,000 smartcard readers – 30.0% of which is to be delivered over the first year and remaining across the second year. Besides this, Occupational Health Smart Cards (OHSC) was introduced in the UK in 2001. These cards offer rationalized, reliable and secured means of occupational health data capture, storage and sharing, thus ensuring quality of healthcare services.

Smart Cards for Healthcare Market in Germany

Germany passed a law on the “Versichertenkarte” (German Insurance card) in 1989 and delivered the cards to about 73 million people in 6 years. These smart cards are beneficially financially as well as functionally. For instance, the waiting time for the reimbursement has been reduced by about 58.0% in 2008. In 2007, a new card the “Gesundheitskarte” [also called the electronic health card (eGK)] was introduced. However, the introduction of the e-health card system was shelved after costing about $2.0 Billion in three years. This project was seen as the most extensive e-health communication project in the world.

Smart Cards for Healthcare Market in France

The smart cards were first used in France. Two health card projects namely the Sesame Vital and the Sesame Vital 2 were introduced in 1998 and 2007 respectively. Through the Sesame Vital, 55 million cards were issued to the citizens in 3 years. More than 20 card system experiments have been implemented in France, including Social Security’s SESAM project. Santal is the most advanced health Smart Card application in France. Carte Vitale – the French Health Insurance Card entitles the holder, healthcare service for free or at reduced costs.

Smart Cards for Healthcare Market in Italy

Italy’s first electronic identity card, the ‘Carta d’Identità Elettronica’ (CIE) was introduced in March 2001 and in about an year and a half 50,000 cards were issued round 83 cities. National Centre for Information Technologies in Public Administration (CNIPA) was responsible for the automation and computerization in all public sector organisations. The number of cards issued was expected to increase to 50 million by 2008, but it was delayed due to technical issues. The current Italian ID card contains ICAO MRZ [The International Civil Aviation Organization – Machine Readable Zone] for border crossing. This card has replaced the Italian fiscal code card for all citizens who are entitled to benefits of the Italian National Health Service and fitted with tax code.

Smart Cards for Healthcare Market in Spain

Spain is one of the forerunners in the world to have a law on electronic signatures. One of the initial health card projects in Spain is the Tarjeta de Afiliaci a la Seguridad Socia (TASS) card project in the nineties. It was a combination of health and social security card that used biometric identification. The use of biometrics for secure identification was also envisioned within this project, in the early 2000. There is a nationwide Public Key Infrastructure (PKI) in Spain. Currently, the European Health Insurance Card (EHIC) entitles the holder to emergency healthcare cover in Spain.

Smart Cards for Healthcare Market in Scandinavia

In the Nordic region, Finland is the leader in the implementation of the electronic identity concept. The first national electronic identity cards (FINEID) were issued to about 26,000 Finns by 2004. The card was also an official travel document for Finnish citizens in the EU member states. Demark is another leader in adopting smart healthcare cards. The European Health Insurance Card (EHIC) enables the card holder to access public healthcare at a reduced cost or sometimes free. Only the EHIC holder is entitled for a reimbursement, in the Swedish healthcare refund system.

Smart Cards for Healthcare Market in Benelux

A new electronic identity card in Belgium was introduced in 2001 and the law has passed by the Senate in 2003. By 2008, about 8 million eID cards were issued. The Belgian Health Insurance Card (SIS) empowers the card holder to medication, prescription and access to medical network services. In the Netherlands, the Act on Electronic Signatures was enforced by 2003. From 2007, there was a smart card based e-ID solution in place that replaced other identity documents. Luxembourg has adopted the EU directive for Electronic Signatures since the 2000. The government of Luxembourg initiated the eLuxembourg initiative which followed the eEurope2005 program, as a part of which unique ID cards were issued to the citizens.


Smart cards for healthcare sector are widely well accepted in Europe, compared to the rest of the world. The smart cards have been proved to provide great value to the healthcare service. It provides authentication and identification for the users and the healthcare provider, besides increasing patient safety and speed of service. Spain and Scandinavia are one of the fastest adopters of smart card technology into their healthcare sector. In years to come, the healthcare smart cards would have increased adoptions and applications.

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