hpro card: an overview of health professionals’ identity management within europe
DESCRIPTION
HPRO Card: An Overview of Health Professionals’ Identity Management within Europe. Cimino M. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)TRANSCRIPT
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BarcelonaMarch 16, 2010
Contribution to:
Interoperability of health professionals’ authentication in Europe
Mariane Cimino, HPRO Card, ASIP-santé, France
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General overviewGeneral overview
HPRO Card with a harmonized
European face
Phase 1 Phase 3Phase 2
HPROPresentationto EP
Oct. 2007
• Governance• HCP identity federation framework • Pilot epSOS, STORK…
HPRO Card
Phase 4
Pilots and implementation
Access managementto applications(ex. Electronic Health Record,e-prescription)
Work on professional qualifications
Directive2005/36/CE
Phase 0
•Competent authorities•Existing H Pro systems•Possible architectures•Interoperability issues
Future situationPast situation Present
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HPRO Card workpackagesHPRO Card workpackages
• WP1 : Identification of the competent authorities for
health professionals in EU
• WP2 : Identification of health professionals cards in
Europe
• WP3 : Conditions for implementation of strong
authentication of health professionals
• WP4 : Interoperability between different health
professionals authentication systems
• WP5 : Project management
• WP6 : Dissemination
From March 2008 to November 2009
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Jurisdiction # 1 Jurisdiction # 2
Function A
Organisational
Semantic
Technical
Political / Legal
Function A
Organisational
Semantic
Technical
Political / LegalIOp A
greement
Interface; Mapping;
Translation ...
Top-Down
Bottom-up
Education & Awareness raising
Interoperability levels
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Organisational
Semantic
Technical
Registration procedures, verification procedures
Data models, identifiers, numbering systems
Certificates, ID-tokens (e.g. cards), directory databases, networking infrastructure
Political / LegalLegislation, nomination of responsible authorities, definition of covered entities
Interoperability levels in ID managementInteroperability levels in ID management
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Electronic certificates’ productionElectronic certificates’ production
5 professions
27 state-members
893 Competent
authorities
Certification
authorities
Publication
authorities
Registration
authorities
PKI
Validation authorities
Databases or
Repositories
Access profiles
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Competent AuthoritiesDirective 2005/36 (5 health professions)Competent AuthoritiesDirective 2005/36 (5 health professions)
� Identification of the competent authorities� Process of registration
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ResultsResults
How many competent authorities in EU ?
about 893 competent authorities identified
� They can be classified in two main categories :- Professional organizations: Orders, Chambers, Associations …- State organizations: Ministry of Health, Agencies,- Health insurance…
� Depending on the administrational and political org anization of each country, they can be organized at the:
- National level (Sweden …)- Regional level (Germany …)- Local level (Italy …)
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For example: Workflow for Estonia
HP Diploma’s provider
Right to practise provider
Sanction’s provider
Id’s provider
HP card’s provider
training
diploma
registration documents
right to practice / or not
registration documents
identifier
sanction / no sanction
registration documents
HP card
(Initial procedure or changes in the professional situation)
University2 Health care colleges****
Health Care Board*
* governmental agency, which started operations on 1st of January 2002 under the jurisdiction of the Ministry of Social Affairs, according to the Health Services Organization Act ** one association by profession, the sanctions are not registered (due to regulation on privacy)
*** there is no plan to issue professional cards**** for nurses and midwives
Conclusion for Estonia :
Competent Authorities = Health Care Board
Professional associations**
Health Care Board*Automatic calculation of theCode in the registry (Kood)
Id Card (for all citizens***) with : Name, Surname, Id Code, Date
of birth, Date of validity…
State Agency
National level
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For example: Workflow for Spain
HP Diploma’s provider
Right to practise provider
Sanction’s provider
Id’s provider
HP card’s provider
training
diploma
registration documents
right to practice / or not
registration documents
identifier
sanction / no sanction
registration documents
HP card
(Initial procedure or changes in the professional situation)
Universities
Regional Medical Councils*
* 52 Regional Medical Councils in the 17 autonomous regionsdental surgeons ?? pharmacists ??, nurses ??, midwives ??
** CGCOM : El Consejo General de Colegios Oficiales de Médicos : The Spanish Medical Association groups together all Autonomous and Regional Medical Councils, and is the responsible of the relations with State Government and at the international level.*** Barcelona, Girona and national level
Regional Medical Councils
in coordination with CGCOM**: smart cards
Regional Medical Councils*CGCOM**
CGCOM** :• Central Registration Database • Central Ethics Commission
Regional Medical Councils
in coordination with CGCOM**
Conclusion for Spain :
Competent Authorities for Doctors = OMC
52 …/…
52 …/…
52 …/…
3***
Professional
organizations
Regional level
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HP Diploma’s provider
Right to practise provider
Sanction’s provider
Id’s provider
HP card’s provider
training
diploma
registration documents
right to practice / or not
registration documents
identifier
sanction / no sanction
registration documents
HP card
(Initial procedure or changes in the professional situation)Universities
Chamber * Chamber *
* : for pharmacists, dentists and physicians** : for nurses and midwives
Chamber *
Ministry of health **Ministry of health **
Ministry of health **
Health insurance
No document
For ex: Workflow Czech Republic
Conclusion for Czech Republic- Pharmacists, dentists and physicians : national chambers
-Nurses and midwives : Ministry of Health
Mixed Nature
National level
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ResultsResults
How many professionals in EU ?
� WHO’s database• Physicians: 1 543 500
• Dental practitioners: 303 900
• Pharmacists: 341 000
• Nurses: 3 488 400
• Midwives: 100 900
5 777 700 healthcare professionals in Europe
� HPRO Card’s database• 10 to 35% of discrepancies between WHO and HPRO databases
e.g. this represents a difference of 24000 HCP in Belgium, 169000 HCP in Poland
• 52% of discrepancies for Spanish nurses (= 110000 nurses)
• 87 % of discrepancies for Swedish pharmacists (= 2500 pharmacists)
Different dates, different definitions (active/non active persons…)
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Health professionals’ identity documentsHealth professionals’ identity documents
• Some countries have no card. For example, Poland issues a professional passport and Luxembourg has a paper
certificate
• Some have plastic or paper cards. For example, France or
Ireland
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Existing health professionals’ smart cardsExisting health professionals’ smart cards• Austria
• Pharmacists (Apothekerausweis)• Doctors in contract with social insurance (Ordinationskarte or o-card)
• France• All professions (Carte de Professionnel de Santé CPS)
• Germany• Doctors (Arztausweis)
• Hungary• Doctors
• Italy (Lombardy)• All professions (Carta SISS)
• Netherlands• All professions (UZI-pas)
• Portugal• Dentists
• Slovenia• All professions (Profesionalna kartica)
• Spain (3 regions)• Doctors (Carné de médico colegiado)
• Sweden• All professions (SIS card and SITHS card)
• UK• All professions (NHS CRS smartcard)
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Projects of health professionals’ cardsProjects of health professionals’ cards
• Belgium (2010)• Pharmacists
• Finland (2011)• All professions
• Hungary (2011)• Doctors• Dentists• Pharmacists
• Ireland• Pharmacists
• Italy (Latina)• Doctors• Dentists
• Luxemburg• All professions
• Slovakia (2010)• All professions
• Spain• Pharmacists
• Switzerland• Doctors
• …
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• eID card used by the doctors, for instance in Estonia
• Belgium eID card used on the eHealth platform
• Potential eID card used by doctors in Norway
e-Identity cards for health professionals
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HPRO-Card.fr
Application
CRL
HPRO-Card.es
Validation demand/response
Proposed architecture
1. Authentication
2. Validation of the certificate
3. Verification of access rights
4. Secured access on the right application
PKI
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Technical materials on 23 different systems
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Health professionals’ databases
• Some online examples :� Austria: doctors
� Czech republic : doctors, dentists and pharmacists
� Estonian: doctors and pharmacists
� France: all regulated professions
� Lithuania : all regulated professions
� Ireland: nurses and midwives
� Norway : all regulated professions
� Poland: doctors and dentists
� Portugal : dentists
� Spain: doctors
� UK: doctors and pharmacists
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Health professionals’ databases
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•Eviden ční číslo : Evidence number •Jméno a p říjmení: Name and surname •Místo výkonu povolání : Instead profession •Odbornost : Expertise •Licence : License
In the register there are additional information (non public ones) : •date of birth•address
Health professionals’ databases
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• A health professional wants to practice in another EU State Member for a temporary
providing of services.
• Studied issue : at which conditions he can use the workstation + card reader + application of
the foreign country ?
Use Case 1
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German demonstratorGerman demonstrator
Country A Country B
Authentication signature
Authentication signature
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Citizen card middleware that origins from eGovernment programmes
Own software Konnektor spezifikation
PKCS#11
MS CAPI
CDSA
PKCS#11 With the UZI-card the standard SafeSign Identity Client middleware is provided from A.E.T. Europe B.V for Windows, MacOS X and Linux.
Classic Client 5.1.7 - 004 for ZZZS
Common CSP (Cryptographic Software Provider) who understands PKCS#15 file
+ coop with CSP provider (SecMaker and their application – NetID) : both client and server additional functions, such as “Single-sign-on”
Workstation + reader
Applications
G&D SafeSign 2.2
?
Austria France Germany Italy Netherlands Slovenia Spain SwedenAustria
Middlewares
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Use Case 2
• A health professional has to access medical data of a foreign patient in the patient’s country of
origin
• Studied issue : at which conditions he can authenticate himself and receive the access
rights ?
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Reply
Spanish demonstrator
French medical consultation
Spanish hospital
Form and signature (PDF)
Phase 1 Phase 2Phase 3
Verification request
Reply Verification request
Spanish Medical Chamber
French Order of doctors
Spanish patient
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Access for foreign doctorsto Xarxa Sanitària i Social de Santa TeclaAccess for foreign doctorsto Xarxa Sanitària i Social de Santa Tecla
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e-signature of the patient to give access to a foreign doctore-signature of the patient to give access to a foreign doctor
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e-Signature of the foreign doctor e-Signature of the foreign doctor
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Verification of the foreign doctorVerification of the foreign doctor
HPRO.es
HPRO.fr
French doctor
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Belgium demonstrator
1
1 12 11
2
French health assurance card
Belgium pharmacist card
French pharmacist card
French pharmaceutical record (4 months-history of delivered medicines in every French pharmacies)
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Use Case 3
• A health professional wants to be recognized as a health professional in another country
• Studied issue : how can we verify the authenticity of his card ?
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Result
Belgium demonstrator Website
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Perspectives and orientationsPerspectives and orientations
Cartography of health professionals ID tools and databases
How to provide an infrastructure to interoperate at the EU level ?