Health Project Group
The Health Insurance Smile Project
The healthcare insurance-specific requirements consists of data elements, object classes and processes. In order to realise this objectives and get the users involved we distinguish three phases:
There are actually two healthcare projects launched within the eEG7 work in April 2003:
Scope of Healthcare Project 1 and 2
To add legacy insurance healthcare data and additional insurance healthcare requirements to the existing eEG7 SMILe repository by:
Joint working group for continuation of the CEA/'Health Entitlement and Reimbursement Data Sets' (HERDS) Working Group's work
The HERDS Working Group
The CEA's Health Insurance Committee authorised a study of the data structures underlying private health insurance in Europe. The work was carried out with the help of an extended group of about 30 experts from national Associations and their member companies, and by a core group of analysts from four countries.
Purpose of the analysis.
Systems within the health care sector need increasingly to recognise health cover and claims across national borders. In some countries, there is also a growing need for interoperability between systems run by different agencies – for example, private insurers and State provider infrastructures.
The CEA HERDS group aimed to establish the types and structure of relevant data common to many health finance systems across Europe. With these documented in a standard way, European health insurers and providers should be better able to design future systems which have the maximum ‘interoperability'.
That will be important where cross-border cover is offered, where cross-border provider bills have to be paid, or where private systems interface with other agencies – even within any one country (between State and private insurance systems, for instance). A path for evolution of existing entitlement and reimbursement systems with an insurance base can thus be available.
The work is not about the personal information contained in ‘data banks' nor is it about ‘smart cards'. The results could however be useful to health insurers designing any new systems they require, if wider European compatibility is an objective – for example if interoperability with the new European Health ‘Insurance' Card (‘E111') becomes possible nationally.
Transition to the Joint Working Group of eEG7 and EEG9
The work was brought to a certain result. The group recommended that the analytical work should be extended, in common with similar work from other insurance sectors, within the framework of ‘eBES'. Therefore it was proposed that eEG7 and EEG9 as relevant eBES-Groups should be requested to collaborate jointly, to adopt and advance the HERDS analysis and to ensure that the results are integrated with the on-line directories and repositories officially authorised.
The CEA's Health Insurance Committee then decided in October 2004 to hand over the results to the Joint Working Group.
The Entitelment and Reimbursement Data Model
The main project output has been a ‘class-diagram' showing in ‘UML' conventions the highest level of ‘data objects' which are common to all and any European health insurance systems. Evidently, not all features shown in the diagram are present in all national systems. Some systems will have additional features, and it is intended that the generalisations of the diagram should be compatible with these additions too – when necessary, new uses can be incorporated and the diagram can evolve.
This implies that the model looks at the health insurance system from an insurers perspective. Since some of the classes are not insurance specific but specific to other parts of the health care systems, like hospitals or other health care professionals, these classes will not be defined by eEG7 but will be brought in from EEG9.
The model as it is has been taken from the CEA/HERDS Working Group is the basis for the work of the Joint Working Group. It has to be made consistent with the eEG7 Insurance Data Model. The result of this work will not duplicate the existing models, for instance the HL7 Model, but will define requirements to ensure the model will provide interoperability.
Participation by healthcare insurance experts who are required to bring forward their data requirements is welcome, please contact the project convenor (Mr. Andreas Schultz, DKV, Germany) for details.