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BeHealth as a driving force of electronic cooperation in the Belgian health care sector, based on th

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... vis l'article 140 des lois sur la comptabilit de l'Etat, coordonn es le 17 ... 13. Frank Robben. 30th January 2008. Policy Enforcement Model. User ... – PowerPoint PPT presentation

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Title: BeHealth as a driving force of electronic cooperation in the Belgian health care sector, based on th


1
Be-Health as a driving force of electronic
cooperation in the Belgian health care
sector, based on the experience in the social
sector
Frank Robben General manager Crossroads Bank for
Social Security CEO Smals Sint-Pieterssteenweg
375 B-1040 Brussels E-mail Frank.Robben_at_ksz.fgov.
be Website CBSS www.ksz.fgov.be Personal
website www.law.kuleuven.ac.be/icri/frobben
2
Structure of the presentation
  • objectives
  • building blocks
  • what Be-Health will NOT do
  • intended Be-Health platform
  • existing Be-Health platform
  • network
  • basic services
  • existing validated authentic sources and added
    value services
  • possible new added value services
  • critical success factors

3
Objectives
  • what ?
  • optimize the quality and the continuity of health
    care delivery
  • optimize patient safety
  • avoid unnecessary red tape for all actors in the
    health care sector
  • support studying and policymaking in health care
  • how ?
  • through a well organized electronic information
    exchange between all actors in the health care
    sector
  • with the necessary guarantees with regard to
    information security and privacy protection

4
Building blocks
  • a cooperation platform for secure electronic
    exchange of information about patients, provided
    care and the results of the provided care, and
    for the exchange of electronic care prescriptions
    between all relevant actors in the health care
    sector
  • network
  • basic services
  • functional and technical interoperability
    standards
  • adequate access channels for the users

5
Building blocks
  • an institution, called Be-Health, managed by
    representatives of several actors in the health
    care sector that
  • manages the cooperation platform
  • organizes electronic services and information
    exchange between the actors in the health care
    sector
  • develops functional and technical
    interoperability standards
  • a Sectoral Committee of the Privacy Commission
    that regulates (electronic) exchange of personal
    health data in cases not regulated by law
  • an appropriate legal framework

6
What Be-Health will NOT do
  • change the actual division of tasks between the
    actors in the health care sector
  • store information in a central way
  • monopolize electronic service delivery to the end
    users
  • carry out studies or deliver policy support with
    regard to health care
  • be driven by technology, rather than by creation
    of added value for the actors in the health care
    sector

7
Existing legal basis
  • artikel 4 wet van 27 december 2006 houdende
    diverse bepalingen
  • Binnen de Federale Overheids-dienst
    Volksgezondheid, Veiligheid van de Voedselketen
    en Leefmilieu wordt voor het beheer van het
    elektronisch dienstenplatform ten bate van de
    uitwisseling van gezondheidszorggegevens, een
    Staatsdienst met afzonderlijk beheer zoals
    bedoeld in artikel 140 van de wetten op de
    rijkscomptabiliteit, gecoördineerd op 17 juli
    1991, Be-Health genaamd, opgericht.
  • De Koning bepaalt, bij een besluit vastgesteld
    na overleg in de Ministerraad, de opdrachten en
    de nadere regelen voor het beheer en de
    exploitatie van deze Staatsdienst voor
    afzonderlijk beheer.
  • article 4 de la loi du 27 décembre 2006 portant
    des dispositions diverses
  • Un service de l'Etat à gestion séparée, tel que
    visé à l'article 140 des lois sur la comptabilité
    de l'Etat, coordonnées le 17 juillet 1991,
    dénommé "Be-Health" est créé au sein du Service
    public fédéral Santé publique, Sécurité de la
    Chaîne alimentaire et Environnement en vue de la
    gestion de la plate-forme électronique de
    services relative à l'échange de données de soins
    de santé.
  • Le Roi détermine, par arrêté délibéré en Conseil
    des ministres, les missions et les modalités de
    gestion et d'exploitation de ce Service de l'Etat
    à gestion séparée.

8
Sectoral Committee to be installed
  • composed of
  • representatives of the Privacy Commission
  • independent health care specialists appointed by
    the House of Representatives
  • mission
  • authorizing (electronic) exchange of personal
    health data in cases not regulated by law
  • defining information security policies related to
    the processing of health data
  • delivering advise and recommendations related to
    information security and privacy protection
    issues related to health data
  • handling complaints with regard to violation of
    security or privacy protection related to health
    data

9
Be-Health platform
Patients and care providers
Portal SS
SVA
SVA
SVA
AVS
Portal RIZIV
Portal BeHealth
MyCareNet
SVA
SVA
SVA
AVS
SVA
SVA
SVA
AVS
Users
Platform with basic services
VAS
VAS
VAS
VAS
VAS
VAS
Suppliers
10
Be-Health platform
  • basic service
  • a service that has been developed and made
    available by Be-Health and that can be used by
    the supplier of an added value service
  • added value service (AVS)
  • 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 Be-Health for this purpose
  • validated authentic source (VAS)
  • a database containing information used by
    Be-Health
  • the administrator of the database is responsible
    for the availability and (the organization of)
    the quality of the information made available

11
Existing platform and basic services
  • use of the existing network infrastructure
    (internet, social security extranet, FedMAN, ...)
    with end-to-end encryption of the information
    (concept of virtual private network - VPN)
  • actual basic services
  • integrated user and access management
  • orchestration of electronic processes
  • portal environment including a content management
    system and a search engine (https//www.behealth.b
    e)
  • personal electronic mailbox for each health care
    provider
  • logging
  • basic services being developed
  • time stamping
  • coding and anonymizing
  • reference directory

12
User and access management
  • authentication of the identity according to the
    security level required
  • electronic identity card
  • user number, password and citizen token
  • user number and password
  • verification of characteristics and mandates
    access to validated authentic sources
  • authorization to use an added value service
    management by service supplier
  • elaborated on the basis of a generic policy
    enforcement model

13
Policy Enforcement Model
14
Architecture
Non social FPS (Fedict)
Be-Health
Social sector (CBSS)
USER
USER
USER
APPLICATIONS
APPLICATIONS
APPLICATIONS
Authorisation
Authen
-
Authorisation
Authen
-
Authorisation
Authen
-
tication
tication
tication
PEP
PEP
PEP
WebApp
WebApp
Role
Role
Role
XYZ
XYZ
Mapper
Mapper
Mapper
Role
Role
Mapper
Mapper
DB
DB
PDP
Role
PAP
PDP
Role
PAP
PAP
Provider
Role
Provider
Role
Kephas
Kephas
Kephas
DB
Provider
DB
Provider
PIP
PIP
PIP
PIP
PIP
PIP
Attribute
Attribute
Attribute
Attribute
Attribute
Attribute
Provider
Provider
Provider
Provider
Provider
Provider
Provider
Management
DB
DB
Management
Gerechts- deurwaar- ders
DB
DB
DB
DB
UMAF
XYZ
XYZ
XYZ
VAS
Mandaten
Mandaten
VAS
15
Reference directory
  • content
  • indicates, on demand of the patient, which type
    of information with regard to the patient, the
    provided care and the results of the provided
    care is available at what places
  • on the one hand, table with fixed care relations
    between health care providers and their patients,
    the nature of the relation, the starting date and
    final date of the relation
  • on the other hand, a table indicating the places
    where, without a fixed care relation, electronic
    information is available about patients
  • preferably a multi-stage and decentralised
    implementation a general reference directory
    that refers to specific reference directories for
    each group of health care providers or each
    health care institution
  • no personal information !!!

16
Reference directory
  • functions
  • preventive control on the legitimacy of the
    access to the information regarding a patient
  • routing of information requests to the places
    where the information about the patient is
    available
  • possibility of automatic communication of
    information to certain health care providers

17
Existing validated authentic sources
  • register of health care providers
  • administrator FPS Public Health
  • contains information about the diploma and the
    specialization of a health care provider
    identified through his social security
    identification number (SSIN)
  • database with recognitions of the National
    Institute for Sickness and Invalidity Insurance
    (RIZIV)
  • administrator RIZIV
  • contains information about the RIZIV recognition
    of health care providers identified through their
    SSIN
  • database with persons authorized to act on behalf
    of a health care institution
  • administrator NOSS (part of the user management
    for companies)
  • contains information about which persons,
    identified through their SSIN, are authorized to
    use which applications on behalf of a health care
    institution

18
Existing added value services
  • in production
  • input into and consultation of the cancer
    register
  • Medattest on line ordering of care prescription
    forms
  • being tested
  • electronic declaration of birth (eBirth)
  • third party billing
  • being developed
  • Medic-e entering the evaluation of disabled
    persons electronically into the information
    system of the FPS Social Security
  • support of electronic care prescription in
    hospitals
  • support of coding and anonymizing for RIZIV and
    sickness funds

19
Input in cancer register
  • supplier Cancer Register
  • users oncologists in health care institutions
    and labs
  • functionality electronic input of information
    into the cancer register and access to the
    registered information
  • basic services used
  • identification and authentication of the identity
    of the user (eID)
  • verification of the status of medical doctor with
    RIZIV recognition
  • electronic mailbox (publication of documents)
  • logging

20
Medattest
  • supplier RIZIV
  • users medical doctors, dentists,
    physiotherapists, nurses, speech therapists,
    orthopedists, health care institutions and their
    mandataries
  • functionality on line ordering of care
    prescription forms
  • basic services used
  • identification and authentication of the identity
    of the user (eID or user number-password-citizen
    token)
  • verification of the status of users
  • verification of the mandate of users
  • logging

21
Third party billing
  • supplier National College of Sickness Funds
  • users nurses, their groupings and
    representatives
  • functionality send third party billings
    electronically to sickness funds
  • basic services used
  • identification and authentication of the user's
    identity (eID or user number-password-citizen
    token)
  • verification of the status of users
  • verification of the mandate of users
  • electronic mailbox (publication of documents)
  • logging

22
Electronic declaration of birth
  • suppliers Fedict, Crossroads Bank for Social
    Security, National Register
  • users medical doctors, nurses and midwifes in
    hospitals
  • functionality electronic declaration of the
    birth of a child
  • basic services used
  • portal
  • identification and authentication of the user's
    identity (eID or user number-password-citizen
    token)
  • verification of the status of nurse with RIZIV
    recognition
  • verification of the mandate of users
  • logging

23
Medic-e
  • supplier FPS Social Security
  • users medical doctors who evaluate disabled
    persons
  • functionality enter the evaluation of disabled
    persons electronically into the information
    system of the FPS Social Security
  • basic services used
  • identification and authentication of the user's
    identity (eID or user number-password-citizen
    token)
  • verification of the status of medical doctor with
    RIZIV recognition
  • electronic mailbox (publication of documents)
  • logging

24
Electronic care prescription in health care
institutions
  • analysis of required functionalities
  • functionalities before a prescription can be
    processed
  • authentication of the identity of the person who
    writes the prescription
  • verification of the status of the person who
    writes the prescription
  • system to ensure that the prescription cannot be
    modified unnoticeably after applying the methods
    to guarantee the integrity and the electronic
    time stamping
  • authentication of the identity, verification of
    the status of the person who has written the
    prescription, guaranteeing the integrity and
    electronic date is needed for each individual
    prescription
  • the time necessary for authenticating the
    identity, verifying the status and guaranteeing
    the integrity must not exceed ¼ of a second per
    prescription
  • a person that writes prescriptions must be able
    to switch between prescription devices without
    overhead
  • local validation that the prescription has not
    been modified after applying the methods to
    guarantee the integrity and the electronic time
    stamping

25
Electronic care prescription in health care
institutions
  • analysis of required functionalities
  • functionalities during the processing of the
    prescription
  • the electronic time stamping must be requested
    immediately after applying the method to
    guarantee the integrity and must be placed within
    30 seconds after the request
  • organizational requirements
  • velocity of replacing an authentication tool when
    useless
  • traceability of who has done which processing at
    which moment for the creation of a prescription
    (must be kept during a certain period)
  • traceability of the content and of the exact date
    and time of each request and processing of a
    request to revoke an authentication tool
  • point of special interest
  • avoid that care institutions have to work with
    different systems for the authentication of the
    identity, the verification of the status, the
    guarantee of the integrity of documents,
    electronic time stamping, … for different types
    of processes

26
Electronic care prescription in health care
institutions
  • possible solution
  • the authentication of the identity and the
    verification of the status are performed at the
    local level using at least a user-id, a password
    and something one possesses, on condition that
    each person that writes prescriptions signs a
    document stipulating that he is responsible for
    everything that is authenticated in terms of
    identity and status through his user id, his
    password and the possessed element
  • the prescriptions are hashed
  • the hashing results (not the content of the
    prescription itself !) receive an electronic time
    stamp from Be-Health
  • clear organizational rules concerning the
    management of user-ids, passwords and the
    possessed elements, based on the results of
    Elodis, are incorporated in an royal decree
    implementing article 21 of the royal decree n 78
  • a regulation is being elaborated that indicates
    under which conditions postscriptions are possible

27
Some possible new added value services
  • reduction of red tape for health care providers
    and health care institutions
  • electronic access by health care providers and
    health care institutions to the insurance status
    and other relevant administrative information
    regarding the patient
  • well co-ordinated, unique collection, across
    public services at several government levels and
    sickness funds, of information necessary for
  • getting authorized to provide particular care
  • policy support
  • a standardized content, format and methods for
    legally valid electronic care prescriptions in
    the ambulatory sector
  • Be-Health as a trusted third party for coding and
    anonymizing
  • gradually, a minimal content of health care files
    that can be exchanged electronically and a
    permanent, decentralized availability and
    accessibility of the minimal electronically
    communicable content of health care files

28
Access channels for the users
  • several devices
  • PC and laptop
  • PDA
  • cell phone
  • …
  • for each target group preferably developed by the
    actual service providers of that target group (no
    monopoly of Be-Health !)
  • for each target group at least one free and
    generally accessible application for integrated
    access to the services and the information, if
    necessary built by Be-Health as a web application
  • maximal integrated services across service
    providers and information sources

29
Need for an appropriate legal framework
  • creation of Be-Health as an organization, with an
    adequate legal basis determining its mission, its
    management committee and its user committee and
    their composition
  • possibility to use a common patient
    identification number
  • probative value of electronic prescriptions,
    processes and information exchange
  • management of the reference directory
  • methods for determining functional and technical
    interoperability standards
  • adaptation of specific regulation in function of
    specific projects

30
Critical success factors
  • cooperation between all actors in the health care
    sector, based on a division of tasks rather than
    on a centralization of tasks
  • trust of all stakeholders in the preservation of
    the necessary autonomy and the security of the
    system
  • firstly the development of the exchange platform
    and the creation of the necessary institutions
    (Be-Health and its management and user
    committees, Sectoral Committee, ...) and then
    further elaboration of processes between these
    institutions
  • quick wins in combination with a long term vision
  • legal framework

31
Some possible useful initiatives of EU
  • common and reliable patient identification
    methods
  • cross-border user and access management based on
    the policy enforcement model
  • common functional and technical standards and
    specifications as a basis for interoperability
  • quality standards in health care delivery in
    order to stimulate cooperation between actors in
    the health sector

32
More information
  • portal Be-Health
  • https//www.behealth.be
  • website Crossroads Bank for Social Security
  • http//www.ksz.fgov.be
  • personal website Frank Robben
  • http//www.law.kuleuven.ac.be/icri/frobben

33
Th_at_nk you ! Any questions ?
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