Crossroads Bank for Social Security & eHealth platform How federal institutions support Belgian...

Crossroads Bank for Social Security & eHealth platform

How federal institutions support Belgiansocial and health care sector

2 November 5th, 2009Frank Robben

Model & Principles

• Development of a vision and a strategy – for the organization of effective, efficient and secure electronic

services and information exchange, with due regard to the protection of privacy

– with well defined goals• social sector: effective social protection, fraud prevention and detection

• health care sector: quality and continuity of health care delivery and patient safety

• optimization of the processes between various autonomous actors with respect for their autonomy and competences

• simplification of the administrative formalities

• substantial policy support

– in close consultation with the various public and private actors involved


Model & Principles

• Concerted determination of useful ICT-related functional and technical norms, standards, specifications and basic architecture

• Establishment of a cooperation platform for secure electronic exchange of information and basic services– conception, development and management by a public institution– no centralized registration of personal data

• Task division, definition of quality norms and verification of their application– data collection, registration, management, supply, security and quality


Model & Principles

• Use of a unique identification key to guarantee the unique identification of the persons concerned in every phase of the personal data exchange

• Coordination, stimulation and organization of the model consigned to a service integrator acting as a crossroads

• Promoting and coordinating the realization of programs and projects– using the norms, standards, specifications, basic services– leading to the creation of integrated added value services


Model & Principles

• Service integrator in charge of– training, coaching and change management– managing a reference directory serving as a basis for the

organization of electronic information exchange between the actors in a sector

• Intervention of the public institution as a trusted third party for encoding and anonymizing personal data, on behalf of certain autorized entities and in support of policy making and scientific research


Application in the Belgian social sector

Belgian social sector– > 10,000,000 citizens concerned– > 220,000 employers involved– about 3,000 public and private institutions (actors) active at several

levels (federal, regional, local) dealing with• collection of social security contributions

• delivery of social security benefits: child benefits, unemployment benefits, benefits in case of incapacity for work, benefits for the disabled, reimbursement of health care costs, holiday pay, old age pensions, guaranteed minimum income, …

• delivery of supplementary social benefits

• delivery of supplementary benefits based on a person’s social security status


Application in the Belgian health care sector

• Belgian health care sector– > 10,000,000 citizens– > 100.000 health care providers (physicians, dentists, clinical labs,

pharmacists, physiotherapists, home nurses, …)– > 300 health care institutions (hospitals, rest homes, nursing homes, …)– sickness funds– public institutions

• federal level (Federal Public Service for Public Health, National Institute for Health Insurance, Belgian Health Care Knowledge Centre, …)

• regional level


Expectations in the Belgian social sector

• effective social protection

• effective support of social policy

• effective fraud prevention and detection

• integrated services

– attuned to the concrete situation of the citizens and companies, and personalized when possible

– delivered at the occasion of events that occur during their life cycle (birth, going to school, starting to work, move, illness, retirement, starting up a company, …)

– across government levels, public services and private bodies

• attuned to their own processes

• if possible, granted automatically


Expectations in the Belgian health sector

• optimal health care quality • optimal patient safety• adequate support of health policy• patient centric care and empowerment of the patient• integrated services

– multidisciplinary– holistic– continuous– across health care institutions and health care providers

• remote care (monitoring, assistance, consultation, diagnosis, operation, …), a.o. home care

• quickly evolving knowledge => need for reliable, coordinated knowledge management and accessibility


Common expectations in both sectors

Electronic services

• with minimal costs and minimal administrative burden• with active participation of the user (self service)• well performing and user-friendly• reliable, secure and permanently available• accessible via a channel chosen by the user (direct contact, phone,

PC, …)• with adequate information security and privacy protection


Implementation within the Belgian social sector

• Creation in 1990 of the Crossroads Bank for Social Security as a coordinator and service integrator, with cooperative governance

• No central data storage• A network between all 3,000 social sector actors with a secure

connection to the internet, the federal MAN, regional extranets, extranets between local authorities and the Belgian interbanking network

• A unique identification key– for every citizen, electronically readable from an electronic social

security card and an electronic identity card

– for every company

– for every establishment of a company


Implementation within the Belgian social sector• Creation of a reference directory, showing

– which persons/companies have personal files in which social security offices for which periods of time, and in which capacity they are registered

– which information/services are available at any social security office depending on the capacity in which a person/company is registered at each social security office

– which kind of information/service can be accessed, in what situation and for what period of time depending on in which capacity the person/company is registered with the social security office that accesses the information/service

– which users/applications want to automatically receive what services in what situations for which persons/companies in which capacity



• An agreed division of tasks between the actors within and outside the social sector with regard to collection, validation and management of information and with regard to electronic storage of information in authentic sources

• 225 electronic services for mutual information exchange amongst actors in the social sector, defined after process optimization– nearly all direct or indirect (via citizens or companies) paper-

based information exchange between actors in the social sector has been abolished

– in 2009, 806 million electronic messages were exchanged amongst actors in the social sector, which saved as many paper exchanges



• 42 electronic services for employers, either based on the electronic exchange of structured messages or via an integrated portal site– 50 social security declaration forms for employers have been abolished– in the remaining 30 (electronic) declaration forms the number of

headings has on average been reduced to a third of the previous number

– declarations are limited to 4 events• immediate declaration of recruitment (only electronically)• immediate declaration of discharge (only electronically)• quarterly declaration of salary and working time (only electronically)• occurrence of a social risk (electronically or on paper)

– in 2009, 21 million electronic declarations were made by all 220,000 employers, 98 % of which from application to application



• Electronic services for citizens– maximal automatic granting of benefits based on electronic information

exchange between actors in the social sector– 12 electronic services via an integrated portal

• services to apply for social benefits• services for consultation of social benefits

– about 30 new electronic services are planned

• An integrated portal site containing– electronic transactions for citizens, employers and professionals– simulation environments– information about the entire social security system– harmonized instructions and information model relating to all electronic

transactions– a personal page for each citizen, each company and each professional



• An integrated multimodal contact centre supported by a customer relationship management tool

• A data warehouse containing statistical information with regard to the labor market and all branches of social security



• The approach of e-government in the Belgian social sector, with the creation of the Crossroads Bank for Social Security, and the projects the CBSS has either coordinated or participated in, are regularly rewarded. These recognitions are awarded on a national as well as on an international level United Nations Public Service Award 2006 European Public Service Award 2007 Special Mention Award for Data Protection Best Practices in European

Public Services 2009 Front Office Employment: European eGovernment Awards finalist at the

5th European Ministerial E-government Conference 2009


Implementation within the Belgian health care sector

• Creation in 2008 of the eHealth platform as a coordinator and service integrator, with cooperative governance and with the following legal assignments– to develop a vision and a strategy for effective, efficient and secure

electronic services and information exchange in health care, with respect for privacy protection and in close cooperation with the various public and private actors in the health care sector

– to establish useful ICT-related functional and technical norms, standards, specifications and basic architecture for using ICT in order to support this vision and strategy

– to check whether software packages for managing electronic health records comply with the established ICT-related functional and technical norms, standards and specifications, as well as to register those software packages


Implementation within the Belgian health care sector

• Creation in 2008 of the eHealth platform as a coordinator and service integrator, with cooperative governance and with the following legal assignments– to create, to manage and to develop a cooperation platform for secure

electronic data exchange with useful basic services (see hereafter)

– to agree on a distribution of tasks with regard to the collection, the validation, the storage and the availability of data exchanged over the cooperation platform and on the quality norms those data have to meet, and to verify whether the quality norms are met

– to promote and to coordinate the realization of programs and projects which reflect the vision and strategy and use the cooperation platform and/or its basic services


The solution in the health care sector

• Creation in 2008 of the eHealth platform as a coordinator and service integrator, with cooperative governance and with the following legal assignments– to manage and to coordinate ICT-related aspects of data exchange with

regard to electronic health records and electronic care prescriptions– to act as an independent trusted third party (TTP) for coding and

anonymizing personal health care data for certain organizations, listed in the law in order to support scientific research and policy making

– to conduct the necessary changes in order to execute the vision and strategy

– to organize the cooperation with other public services in charge of the coordination of electronic service delivery



• No central data storage• A well secured virtual private network based on the internet with

end-to-end encryption of personal data between all 100,000 health care actors

• A unique identification key– for every citizen, electronically readable from an electronic social

security card and an electronic identity card– for every health care provider– for every health care institution

• Multidisciplinary, high quality electronic patient records• Care pathways



• Basic services offered by the eHealth platform on its own ICT infrastructure– orchestration of electronic subprocesses– portal environment including a content management system and a

search engine– integrated user and access management– logging– system for end-to-end encryption– personal electronic mailbox for each health care provider– time stamping– coding and anonymizing for certain organizations, listed by the law– reference directory (what, about whom, where – no content!)



• basic service– a service developed and made available by the eHealth platform, which

can be used by an added value service provider for developing and offering an added value service

• added value service (AVS) (Currently: 24 AVS online)– a service put at the disposal of the patients and/or the health care

providers– the entity that develops and offers an added value service can use the

basic services offered by the eHealth platform for this purpose

• validated authentic source (VAS)– a database with information used by the eHealth platform– the database administrator is responsible for the availability and (the

organization of) the quality of the information made available


Basic architecture

Crossroads Bank for Social Security & eHealth platform How federal institutions support Belgian...

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