Taking its cue from a German pilot project, the Bulgarian National Health Insurance Fund is kicking off a 1,000-patient trial that could lead to a national electronic health card.

According to the lead project partner, Walldorf, Germany-based IntercomponentWare, the Bulgarian demonstration project will include one muncipality, three general practitioners and five pharmacies.

San Jose, California-based Cisco is also participating in the project, providing the necessary network and connections between project participants. ICW is responsible for providing all softwares and integrating the GPs, pharmacies and other medical service providers.

During the pilot phase, the main objectives of the project will be to establish insurance status and issue electronic prescriptions. When visiting a physician, patients will dientify themselves with the cards. The system automatically establishes a secure online connection to verify the patient's insurance coverage and his or her presence in the patient list of the physician.

According to ICW, this alone will reduce administrative overhead for physicians and also prevent the possibility of fraud or misuse.

If needed, the card can also carry digitally signed electronic prescriptions (the prescription itself is stored on a separate prescription server) from the physician to a participating pharmacy. Future functionality could include drug interaction and contraindication checks to reduce medical errors.

According to ICW spokesman Dirk Schuhmann, data security and privacy are among the highest priorities of the project.

"Only administrative data will be stored on the Bulgarian card," Schuhmann said. "This includes encrypted access keys to the corresponding personal health record."

This is where Cisco's expertise comes in, he says. "The secure online connection will be established using state-of-the-art VPN technologies provided by the Cisco Healthcare Router that was developed in cooperation with ICW," Schuhmann explained. "Therefore, the Internet will only be used as a means for the transportation of encrypted data."

The project traces its lineage to an ongoing health card project currently undergoing field testing in Germany, but adapted to the particular needs and specific workflows of the Blugarian healthcare system.

The German project has recently stated the first official field tests in two regions, and plans to add five additional regions with 10,000 patients each this year. Once completed, two more regions of 100,000 patients each will be added prior to full national rollout.

"We are testing a more sophisticated system in Walldorf," Schuhmann noted. "This system does not only enable electronic prescriptions and the online verification of administrative patient data [as currently tested in the official national tests], but also includes a personal health record. Hence, a full drug interaction and contraindication check is possible and physicians are able to access extensive health information on their patients."

The cost of the Bulgarian pilot project has not yet been disclosed.