HPRO Card: An Overview of Health Professionals’ Identity Management within Europe

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HPRO Card: An Overview of Health Professionals’ Identity Management within Europe. Cimino M. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

Transcript of HPRO Card: An Overview of Health Professionals’ Identity Management within Europe

  • 1.Contribution to: Interoperability of health professionalsauthentication in EuropeBarcelonaMarch 16, 2010 Mariane Cimino, HPRO Card, ASIP-sant, France

2. General overview Phase 0 Phase 1 Phase 2 Phase 3Phase 4 Work on professional PresentationHPROPilots and HPRO Card qualificationsto EPimplementation Oct. 2007DirectiveHPRO Card with aAccess management2005/36/CE harmonizedto applicationsEuropean face Competent authorities Governance (ex. Electronic HealthExisting H Pro systems HCP identity federation Record,Possible architecturesframeworke-prescription)Interoperability issues Pilot epSOS, STORKPast situation PresentFuture situation 3. HPRO Card workpackages WP1 : Identification of the competent authorities forhealth professionals in EU WP2 : Identification of health professionals cards inEurope WP3 : Conditions for implementation of strongauthentication of health professionals WP4 : Interoperability between different healthprofessionals authentication systems WP5 : Project management WP6 : DisseminationFrom March 2008 to November 2009 4. Interoperability levelsJurisdiction # 1Jurisdiction # 2Function A Function ATop-DownPolitical / LegalPolitical / Legal IOp Agreement Interface; Mapping;Translation ...Organisational OrganisationalSemantic Semantic Bottom-upTechnicalTechnicalEducation & Awareness raising 5. Interoperability levels in ID management Legislation,Political / Legal nomination of responsible authorities,definition of covered entities OrganisationalRegistration procedures,verification proceduresData models,Semanticidentifiers, numbering systems Certificates,Technical ID-tokens (e.g. cards),directory databases, networkinginfrastructure 6. Electronic certificates productionRegistrationCertificationPublication authoritiesauthorities authorities5 professions PKIDatabases or27 state-members Validation authoritiesRepositories 893 Competentauthorities Access profiles 7. Competent Authorities Directive 2005/36 (5 health professions)Identification of thecompetent authoritiesProcess of registration 8. ResultsHow 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 insuranceDepending on the administrational and political organization of each country, they can be organized at the:- National level (Sweden )- Regional level (Germany )- Local level (Italy ) 9. For example: Workflow for Estonia Conclusion for Estonia :Competent Authorities = Health Care Board HP Diplomas Right to practiseIdsSanctions HP cardsprovider provider provider provider providerUniversity(Initial procedure or training 2 Health care colleges**** changes in the professional situation) diplomaHealth Care Board*Professional associations** registration documents Statesanction / no sanction Agencyright to practice / or notNationalHealth Care Board* Automatic calculation of thelevelCode in the registry (Kood) registration documentsidentifierId Card (for all citizens***) with :Name, Surname, Id Code, Date of birth, Date of validity registration documents * governmental agency, which started operations on 1st of January 2002 under the jurisdiction ofHP cardthe 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 10. For example: Workflow for SpainConclusion for Spain :Competent Authorities for Doctors = OMCHP Diplomas Right to practise Ids SanctionsHP cardsprovider providerproviderproviderprovidertraining Universities CGCOM** : (Initial procedure or Central Registration Databasechanges in the professional situation)52 / Central Ethics Commission diplomaRegional Medical Councils*Regional Medical Councils* registration documents CGCOM** 52 / Professionalsanction / no sanction organizaright to practice / or not tionsRegional Medical Councils Regionalregistration documentsin coordination with CGCOM**52 / level identifier Regional Medical Councils3*** in coordination with CGCOM** registration documents: smart cards* 52 Regional Medical Councils in the 17 autonomous regionsHP card dental surgeons ?? pharmacists ??, nurses ??, midwives ?? ** CGCOM : El Consejo General de Colegios Oficiales de Mdicos : 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 11. For ex: Workflow Czech RepublicConclusion for Czech Republic- Pharmacists, dentists and physicians : national chambers-Nurses and midwives : Ministry of Health HP DiplomasRight to practiseIds SanctionsHP cards provider provider provider providerprovider (Initial procedure orUniversities changes in the professional situation)trainingdiplomaMinistry of health **Ministry of health **registration documents Chamber *Chamber * Mixedsanction / no sanction Natureright to practice / or notMinistry of health ** Chamber * National registration documents Health insurancelevel identifier registration documents No documentHP card * : for pharmacists, dentists and physicians ** : for nurses and midwives 12. Results How many professionals in EU ?WHOs 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 EuropeHPRO Cards database 10 to 35% of discrepancies between WHO and HPRO databasese.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) 13. Health 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 14. Existing health professionals smart cards Austria Pharmacists (Apothekerausweis) Doctors in contract with social insurance (Ordinationskarte or o-card) France All professions (Carte de Professionnel de Sant CPS) Germany Doctors (Arztausweis) Hungary Doctors Italy (Lombardy) All professions (Carta SISS) Netherlands All professions (UZI-pas) Portugal Dentists SloveniaAll professions (Profesionalna kartica) Spain (3 regions) Doctors (Carn de mdico colegiado) Sweden All professions (SIS card and SITHS card) UK All professions (NHS CRS smartcard) 15. Projects 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 16. e-Identity cards for health professionals 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 17. Proposed architectureHPRO-Card.esHPRO-Card.fr 3. Verification of access rightsPKI Validation CR demand/responseL 4. Secured access on2. Validation of the certificatethe right application 1. AuthenticationApplication 18. Technical materials on 23 different systems 19. Health professionals databases Some online examples :Austria: doctorsCzech republic : doctors, dentists and pharmacistsEstonian: doctors and pharmacistsFrance: all regulated professionsLithuania : all regulated professionsIreland: nurses and midwivesNorway : all regulated professionsPoland: doctors and dentistsPortugal : dentistsSpain: doctorsUK: doctors and pharmacists 20. Health professionals databases 21. Health professionals databases Evidenn slo: Evidence number Jmno a pjmen: Name and surname Msto vkonu povoln: Instead profession Odbornost: Expertise Licence: LicenseIn the register there are additional information (non public ones) : date of birth address 22. Use Case 1 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 ? 23. German demonstratorCountry A Country BAuthentication Authenticationsignaturesignature 24. MiddlewaresApplications? Citizen card Own software PKCS#11 Konnektor PKCS#11 With the UZI- Classic Client G&DCommon CSP middlewarespezifikation card the5.1.7 - 004SafeSign 2.2 (Cryptographic MS CAPI that originsstandardfor ZZZSSoftware fromCDSASafeSignProvider) who eGovernment Identity Client understands programmesmiddleware is PKCS#15 file provided from + coop with A.E.T. CSP provider Europe B.V (SecMaker and for Windows, their application MacOS X NetID) : both and Linux. client and server additional functions, such as Single-sign- on Austria Austria FranceGermanyItaly Netherlands Slovenia SpainSwedenWorkstation + reader 25. Use Case 2 A health professional has to access medical data of a foreign patient in the patients country of origin Studied issue : at which conditions he can authenticate himself and receive the access rights ? 26. SpanishFrench medicaldemonstrator consultationSpanish patient Form and signature (PDF)Spanish hospital Reply Verification requestSpanish Medical Chamber Reply Verification request French Order of doctorsPhase 1 Phase 2 Phase 3 27. Access for foreign doctors to Xarxa Sanitria i Social de Santa Tecla 28. e-signature of the patient to give access to a foreign doctor 29. e-Signature of the foreign doctor 30. Verification of the foreign doctorHPRO.esFrench doctorHPRO.fr 31. Belgium demonstrator 22 1 11 1 1Belgium pharmacist cardFrench pharmacist card French health French pharmaceutical assurance card record (