BarcelonaMarch 16, 2010
Contribution to:
Interoperability of health professionals’ authentication in Europe
Mariane Cimino, HPRO Card, ASIP-santé, France
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
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
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
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
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
Competent AuthoritiesDirective 2005/36 (5 health professions)Competent AuthoritiesDirective 2005/36 (5 health professions)
� Identification of the competent authorities� Process of registration
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 …)
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
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
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
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…)
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
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)
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
• …
• 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
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
Technical materials on 23 different systems
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
Health professionals’ databases
•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
• 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
German demonstratorGerman demonstrator
Country A Country B
Authentication signature
Authentication signature
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
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 ?
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
Access for foreign doctorsto Xarxa Sanitària i Social de Santa TeclaAccess for foreign doctorsto Xarxa Sanitària i Social de Santa Tecla
e-signature of the patient to give access to a foreign doctore-signature of the patient to give access to a foreign doctor
e-Signature of the foreign doctor e-Signature of the foreign doctor
Verification of the foreign doctorVerification of the foreign doctor
HPRO.es
HPRO.fr
French doctor
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)
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 ?
Result
Belgium demonstrator Website
Perspectives and orientationsPerspectives and orientations
Cartography of health professionals ID tools and databases
How to provide an infrastructure to interoperate at the EU level ?
More information
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