The French Experience on Smart Cards in Health Sector

1
The French Experience onSmart Cards in Health
Sector

• Jacques SAURET
• French Ministry of
• Health and Social Affairs
• jacques.sauret_at_sante.gouv.fr

2
Agenda

• Objectives
• System Design
• Roll Out
• Perspectives
• Feed back on French situation

3
Objectives
4
Objectives

• Government Objectives Create a real National
  Information System in Healthcare Sector
• Medical control of the evolution of Health Care
  expenses
• Transfer of medical information between HP and
  HIF
• Computers are needed for such sophisticated IS
• Cards are needed for security and reliability
• Enhance quality of care through a better
  coordination between HP
• Direct access to emergency information
• Remote access to medical databases in a secure
  way (regarding habilitation and privacy)
• Secure messaging between HP

5
Objectives

• HIF Objectives
• The government ones
• Reduction of administrative costs
• Return on investments (better care management)
• Enhance the quality of their databases
  (identification of protected persons and HP)
• Definition of best practices

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Objectives

• HP Objectives
• An opportunity to reorganise relationships
  between HP (e.g. GP vs. specialists)
• Production of medical statistics (self
  evaluation) and access to medical statistics
• Negotiate the introduction of cards (cards are
  seen as imposed, HP do the administrative job
  of HIF)

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System Design
8
System Design

• HP are free to chose their computers
• Open Systems
• Compatibility with de facto standards (Internet)
  and off the shelf products
• Lack of control on evolutions (market driven)
• Anticipation in system design
• Terminals should be reusable for other
  applications (e.g. health, payment, e-commerce)

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System Design

• Network
• RSS as a Public Service (QoS, security, etc.)
• Dedicated to HP for all traffic (electronic
  reimbursement claims, personal mails, EDI, access
  to remote servers / databases, etc.)
• Compatibility with Internet de facto standard
• Close integration with Smart Cards
• RSS in competition with other ISP's

10
System Design

• Registration Authorities
• Government
• Health Insurance Funds
• HP councils
• Certification Authorities
• GIE SESAM-Vitale for patients information
• GIP CPS for HP information
• Directories, CRL's
• GIP CPS
• GIE SESAM-Vitale

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System Design

• Justification for Patient cards
• Insured persons identification (NIR unique
  national number first name last name)
• Entitlement to care
• Medical Information (emergency and more detailed
  data) not a complete record
• Portability

12
System Design

• Justification for smart cards (patient and HP)
• Security tool
• Data integrity
• Cost (cards, infrastructure)
• Evolutions
• Reusability (e.g. other administrations) if the
  card is reliable (technology, content) security
  evaluation

13
Roll Out
14
Roll Out

• Patient Data Card Vitale 40 Million cards
  (insured persons) by May 99
• Smart card (M9 OS, 3-4 KB EEPROM)
• Chips from Thomson and Motorola
• Providers Bull-Orga, Gemplus, Oberthur,
  Schlumberger (Solaic)
• Average of 4M cards per month (up to 7M in March)
• ITSEC Certificate

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Roll Out

• Health Professional Card CPS
• Family of cards (CPS, CPE, CPF, CPA, CSA)
  50,000 cards (mainly Physicians) by May 99
• Target more than 1 Million cards
• Smart card (CPS OS, crytpo-chip, 4 KB EEPROM)
• Chips from Thomson
• Provider Schlumberger
• ITSEC Certificate

16
Perspectives
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Perspectives

• Vitale 2 Card an individual card (60 M)
• Smart card (16 KB EEPROM)
• Medical data set
• Mandatory Private HI
• Security tool (card cardholder authentication,
  digital signature, encryption key, etc.)
• HP Card a fully standard compliant card
• Authentication and signature RSA
• Encryption RSA and DH
• X509 certificates storage

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Feed back on French situation
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Feed back on French situation

• Political problems
• Many actors involved
• Reluctancy of HP for HIS (threat of control, of
  new technologies)
• Long term process

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Feed back on French situation

• Organisational problems
• Certification of all the identifiers for the
  whole population (60 M in France)
• HP certification process (credentials)
• Card Distribution a chicken and egg problem
• First Vitale cards
• Synchronisation with CPS distribution and RSS
  availability
• Do not wait for HP to be ready to accept cards

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Feed back on French situation

• Technical problems
• System Integration is complex (large scale,
  number of actors, etc.)
• Smart cards have to be integrated with open
  systems
• Smart card life cycle vs. de facto standard
• Lack of solution from the industry (e.g. PC/SC is
  compatible with transparent mono-slot terminals
  and MS-Windows only)
• Integration of SC / Terminals / Workstations by
  card issuers (GIE SESAM-VITALE, GIP CPS)

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Conclusion (1)

• Smart card is ONE component of a whole
  Information System
• Smart cards are needed to reach a high level of
  security and for portability
• Smart cards need to be secured (ITSEC, Common
  Criteria), reliable and cost effective
• Objective Trust by users

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Conclusion (2)

• Issuing Cards is an industrial process not so
  difficult to control (mass distribution must be
  planned in advance)
• Cards represent approx. 10 of the cost of the
  Security of an Information System (RA, PKI, etc.)
• Issues are neither on technical points nore on
  card technology, but on information systems
  (PKI), organisational and financial topics

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Conclusion (3)

• Need for national and international cooperation
  with other sectors
• Services, Technical topics (cards technology,
  card management, terminals, TTP, etc.),
  Organisational topics
• Need for international cooperation in the Health
  Care sector use of technology
• Simplification of procedures for citizens
• Facilitate the secure exchange of information
  between HP

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Thanks for your attention

• For more information http//www.sesam-vitale.fr
  http//www.sante.gouv.fr/sis