A vision on electronic cooperation in the Belgian health care sector, based on the experience in the

1
A vision on electronic cooperation in the Belgian
health care sector, based on the experience in
the social sector, and the role of the Be-Health
platform
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

• existing electronic cooperation in the social
  sector
• the problem
• the solution
• basic principles
• advantages
• towards an electronic cooperation in the health
  care sector, based on the experience of the
  social sector
• objectives
• useful building blocks
• Be-Health platform

3
Actors in the Belgian social sector

• about 2,000 public and private institutions 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
• re-imbursement of health care costs
• holiday pay
• old age pensions
• guaranteed minimum income
• delivery of supplementary social benefits
• delivery of supplementary benefits based on the
  social security status of a person

4
The problem

• a lack of well coordinated service delivery
  processes and of a lack of well coordinated
  information management led to
• a huge avoidable administrative burden and
  related costs for
• the companies
• the citizens
• the actors in the social sector
• service delivery that didnt meet the
  expectations of the companies and the citizens
• suboptimal effectiveness of the social protection
• higher possibilities of fraud
• suboptimal support of the social policy

5
Expectations of citizens and companies

• integrated services
• attuned to their concrete situation, 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,
  decease, starting up a company, )
• across government levels, public services and
  private bodies
• attuned to their own processes
• with minimal costs and minimal administrative
  burden
• if possible, granted automatically
• well performing and user-friendly
• reliable, secure and permanently available
• accessible via a channel chosen by the user
  (direct contact, phone, electronic devices, )
• sufficient privacy protection

6
The solution

• a network between all 2,000 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
• 190 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 2006 511 million electronic messages were
  exchanged amongst actors in the social sector,
  which saved as many paper exchanges

7
Social security card
name Christian name date of birth sex social
security number period of validity of the
card card number
sickness fund sickness fund registration
number insurance period insurance status social
exemption status
key 1
other data to be added in the future, if useful
8
Electronic identity card
9
Contribution certificate health care sector
present situation
Employees
Employer
Sickness funds
Control
RIZIV
RSZ
10
Contribution certificate health care sector
present situation
11
Derived rights in tax affairs

• a number of people are entitled to an increased
  refund of the costs for medical care
• moreover, a number of municipalities and
  provinces grant these persons reductions or even
  exemptions of the taxes

12
Derived rights in tax affairs - past situation
Sickness fund
13
Derived rights in tax affairs - present situation
CBSS
sickness funds network
14
The solution

• 41 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 3 events
• immediate declaration of recruitment and
  discharge (only electronically)
• quarterly declaration of salary and working time
  (only electronically)
• occurence of a social risk (electronically or on
  paper)
• in 2006 17.9 million electronic declarations were
  made by all 220,000 employers, 98 of which from
  application to application
• according to a study of the Belgian Planning
  Bureau, rationalization of the information
  exchange processes between the employers and the
  social sector implies an annual saving of
  administrative costs of more than 1 billion a
  year for the companies

15
Start/end of an employment relationship
Simplification
Employment contract
Work force register
Special work force register
Individual document
Students contract
NOSS
On line consultation
Inspection
Work force register
Data- base
16
Quarterly declaration salary working time
Simplification
Employer
one electronic declaration
NOSS
INAMI
FAT
old age pension
ONP
ONEM
FMP
CBSS
holiday pay
ONVA
ONAFTS
17
Declaration of social risks

• types of social risks
• child allowances
• incapacity for work ((labour) accident,
  (occupational) disease, )
• unemployment
• old age pension
• 3 possible moments of declaration
• start of the social risk
• recurrence or continuation of the social risk
• end of the social risk
• structure of the declaration
• identification data
• if necessary, salary and working time data not
  yet declared via a quarterly declaration
  (mini-declaration)
• specific data concerning the social risk

18
The solution

• electronic services for citizens
• maximal automatic granting of services based on
  electronic information exchange between actors in
  the social sector
• 4 electronic services via an integrated portal
• 2 services to apply for social benefits
• 2 services for consultation of social benefits
• about 30 new electronic services are foreseen
• an integrated portal site containing
• electronic transactions for citizens and
  employers
• information about the entire social security
  system
• harmonized instructions and information model
  relating to all electronic transactions
• a personal page for each citizen and each company
• an integrated multimodal contact centre supported
  by a customer relationship management tool

19
The solution

• coordination by the Crossroads Bank for Social
  Security
• board of directors consists of representatives of
  the companies, the citizens and the actors in the
  social sector
• mission
• definition of the vision and the strategy on
  E-government in the social sector and of the
  common principles related to information
  management
• definition, implementation and management of an
  interoperability framework
• secure messaging of several types of information
  (structured data, documents, images, metadata, )
  with business logic and orchestration support
• coordination of business process reengineering
• stimulation of service oriented applications
• management of a reference directory for
• preventive control on the legitimacy of the
  information exchange
• organisation of the routing of information
• automatic communication of changes of information

20
The solution

• reference directory
• directory of available services/information
• which information/services are available at any
  institution depending on the capacity in which a
  person/company is registered at each institution
• directory of authorized users and applications
• list of users and applications
• definition of authentication means and rules
• definition of authorization profiles 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 actor that accesses the
  information/service
• directory of data subjects
• which persons/companies have personal files in
  which institutions for which periods of time, and
  in which capacity they are registered
• subscription table
• which users/applications want to automatically
  receive what services in which situations for
  which persons/companies in which capacity

21
Towards a network of service integrators
Service integrator (Corve, Easi-Wal, )
RPS
RPS
Services repository
Extranet region or commmunity
Service integrator (CBSS)
Services repository
ASS
Extranet social sector
ASS
Internet
Municipality
FPS
ASS
VPN, Publi-link, VERA,
FPS
FEDMAN
Services repository
Service integrator (FEDICT)
City
Province
FPS
Services repository
22
Basic principles

• information modelling
• unique collection of re-use of information
• management of information
• electronic exchange of information
• protection of information

23
Information modelling

• information is being modelled in such a way that
  the model fits in as closely as possible with the
  real world
• information modelling takes as much account as
  possible of anticipated use of information
• the information model can be flexibly extended or
  adapted when the real world or the use of the
  information changes

24
Unique collection and re-use of information

• information is only collected for well-defined
  purposes and is targeted to meet the requirements
  of these purposes
• all information is collected once, from as near
  to the authentic source as possible
• information is collected according to the
  information model and following uniform
  guidelines
• with the possibility of quality control by the
  supplier before the transmission of the
  information
• the collected information is validated once
  according to established task sharing criteria,
  by the institution that is most entitled to it or
  by the institution which has the greatest
  interest in correctly validating it
• it is then shared and re-used by authorized users

25
Management of information

• a task sharing model is established indicating
  which institution stores which information as an
  authentic source, manages the information and
  maintains it at the disposal of the authorized
  users
• information is stored according to the
  information model
• information can be flexibly assembled according
  to ever changing legal concepts
• every institution has to report probable errors
  of information to the institution that is
  designated to validate the information

26
Management of information

• every institution that has to validate
  information according to the agreed task sharing
  model, has to examine the reported probable
  errors, to correct them when necessary and to
  communicate the correct information to every
  known interested institution
• information is only retained and managed as long
  as there exists a business need, a legislative or
  policy requirement, or, preferably anonimized or
  encoded, when it has historical or archival
  importance

27
Electronic exchange of information

• once collected and validated, information is
  stored, managed and exchanged electronically to
  avoid transcribing and re-entering it manually
• electronic information exchange can be initiated
  by
• the institution that disposes of information
• the institution that needs information
• the institution that manages the interoperability
  framework (CBSS as service integrator)
• electronic information exchanges take place on
  the base of a functional and technical
  interoperability framework that evolves
  permanently but gradually according to open
  market standards, and is independent from the
  methods of information exchange

28
Electronic exchange of information

• available information is used for
• the automatic granting of benefits
• prefilling when collecting information
• information delivery to the interested parties

29
Protection of information

• security, integrity and confidentiality of
  government information is ensured by integrating
  ICT measures with structural, organizational,
  physical, personnel screening and other security
  measures according to agreed policies
• personal information is only used for purposes
  compatible with the purposes of the collection of
  the information
• personal information is only accessible to
  authorized institutions and users according to
  business needs, legislative or policy
  requirements
• the access authorization to personal information
  is granted by an independent institution,
  designated by Parliament, after having checked
  whether the access conditions are met
• the access authorizations are public

30
Protection of information

• every actual electronic exchange of personal
  information is preventively checked on compliance
  with the existing access authorizations by an
  independent institution managing the
  interoperability framework
• every actual electronic exchange of personal
  information is logged, to be able to trace
  possible abuse afterwards
• every time information is used to take a
  decision, the information used is communicated to
  the person concerned together with the decision
• every person has right to access and correct
  his/her own personal data

31
Advantages

• gains in efficiency
• in terms of cost services are delivered at a
  lower total cost due to
• a unique information collection using a common
  information model and administrative instructions
• a lesser need to re-encoding of information by
  stimulating electronic information exchange
• a drastic reduction of the number of contacts
  between actors in the social sector on the one
  hand and companies or citizens on the other
• functional task sharing concerning information
  management, information validation and
  application development
• in terms of quantity more services are delivered
• services are available at any time, from anywhere
  and from several devices
• services are delivered in an integrated way
  according to the logic of the customer
• in terms of speed the services are delivered in
  less time
• benefits can be allocated quicker because
  information is available faster
• waiting and travel time is reduced
• companies and citizens can directly interact with
  the competent actors in the social sector with
  real time feedback

32
Advantages

• gains in effectiveness better social protection
• in terms of quality same services at same total
  cost in same time, but to a higher quality
  standard
• in terms of type of services new types of
  services, e.g.
• push system automated granting of benefits
• active search of non-take-up using
  datawarehousing techniques
• controlled management of own personal information
• personalized simulation environments
• better support of social policy
• more efficient combating of fraud

33
Critical success factors

• common vision on electronic service delivery
  amongst all actors
• support of and access to policymakers at the
  highest level
• trust of all stakeholders
• electronic service delivery as a structural
  reform process
• process re-engineering within and across actors
• back-office integration for unique information
  collection, re-use of information and automatic
  granting of services
• integrated and personalized front-office service
  delivery
• focus on more efficient and effective service
  delivery, and on cost control

34
Critical success factors

• appropriate balance between efficiency on the one
  hand and privacy and security on the other
• respect for legal allocation of competences
  between actors
• co-operation between all actors concerned based
  on distribution of tasks rather than
  centralization of tasks
• quick wins combined with long term vision
• technical and semantic interoperability
• legal framework
• adaptability to an ever changing societal and
  legal environment
• creation of an institution that stimulates and
  co-ordinates

35
Critical success factors

• need for radical cultural change within
  government, e.g.
• from hierarchy to participation and team work
• meeting the needs of the customer, not the
  government
• empowering rather than serving
• rewarding entrepreneurship within government
• ex post evaluation on output, not ex ante control
  of every input

36
United Nations Public Service Award
37
Structure of the presentation

• existing electronic cooperation in the social
  sector
• the problem
• the solution
• basic principles
• advantages
• towards an electronic cooperation in the health
  care sector, based on the experience of the
  social sector
• objectives
• useful building blocks
• Be-Health platform

38
Objectives

• to optimize the quality and the continuity of the
  health care delivery system and the patients
  safety
• to avoid unnecessary bureaucracy for the health
  care providers
• quality support of the health care policy
• through a well organized electronic information
  exchange between all parties associated with the
  health care delivery system
• with the necessary guarantees for the information
  security and the protection of the privacy

39
Useful building blocks

• general use of a patient identification number
• minimal content of health care files that can be
  communicated electronically
• permanent availability and accessibility of the
  minimal electronically communicable content of
  health care files
• standardized content, format and methods for the
  exchange of electronic care prescriptions
• sectoral committee of the Commission for the
  protection of privacy (CPP)
• user and access management

40
Useful building blocks

• secured platform for the 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 parties associated with the health care
  delivery system
• network
• basic services
• exchange standards
• access channels for the users
• independent organization for the management of
  the exchange platform
• appropriate legal framework

41
Patient identification number

• either social security identification number
  (SSIN)
• or identification number irreversibly derived
  from the social security identification number by
  means of an algorithm available with each health
  care provider, that will be specified for
  instance by the Security study group of the
  Commission for Telematics Standards in relation
  to the Health Sector
• either unique for each patient and used by all
  health care providers and institutions
• or unique for each patient and used by one health
  care provider / institution with a possibility of
  conversion between patient identification numbers
  of the different health care providers /
  institutions by the independent organization that
  manages the exchange platform (see hereafter)

42
Patient identification number

• encoding or anonymization of information when the
  identification of the patient through the patient
  identification number is no longer necessary
• on the occasion of the Royal Decree on the Cancer
  register, the CPP has already given a positive
  advice with regard to the method for the
  irreversible derivation of a patient
  identification number from the social security
  identification number

43
Minimal communicable content health care file

• agreements on the minimal content of a health
  care file that can be communicated electronically
• information about the patient
• information on the provided care
• information on the results of the provided care
• no monopoly or recognition of software products
• but incentives for health care providers /
  institutions to keep electronic health care files
  with minimal communicable content and to make
  them permanently electronically available for
  authorized persons

44
Accessibility health care file

• minimal communicable content of health care files
  must be electronically available and accessible
  at all times for the authorized persons
• either with the health care provider himself
• or with a subcontractor chosen by the health care
  provider
• health care institution
• cooperation between health care providers
• independent institution that manages the exchange
  platform
• with the necessary back-up services

45
Electronic care prescriptions

• standardized content and electronic format of the
  different types of care prescriptions
• methods for the creation of electronic care
  prescriptions with a minimum of bureaucracy
• methods for the electronic exchange of care
  prescriptions
• guaranteed free choice of the care provider by
  the patient
• incentives for care providers / institutions to
  create and exchange electronic care prescriptions

46
Sectoral committee

• composed of
• representatives of the CPP
• independent experts in social security and health
  care appointed by the Chamber of Deputies
• tasks
• to give authorizations for the (electronic)
  exchange of personal social data and personal
  health data in cases not regulated by the law
• to determine the organization and policies with
  regard to information security for the processing
  of personal social data and personal health data
• to give advices and recommendations with regard
  to information security for the processing of
  personal social data and personal health data
• to investigate complaints on violation of the
  information security during the processing of
  personal social data and personal health data

47
User and access management

• guarantee that only authorized health care
  providers / institutions get access
• to the personal information they are authorized
  to according to the law or to the authorizations
  granted by the Sectoral committee
• concerning patients whose personal information
  they need for the health care providing process

48
User and access management

• authentication of the identity of the health care
  provider, for instance through his electronic
  identity card
• on-line verification of the status of the health
  care provider through an electronic consultation
  of the authentic data base(s) of the health care
  providers
• on-line verification of the mandates of the user
  to act on behalf of a health care provider /
  institution through the electronic consultation
  of the authentic data base(s) containing the
  mandates

49
User and access management

• authentication of the patients identity through
  his electronic identity card or his SIS card,
  except
• if a fixed care relation between the health care
  provider / institution and the patient has been
  registered (see hereafter, reference directory)
• in cases of emergency
• management of access authorizations with
  following specifications
• which health care provider / institution /
  application
• with which status
• can have access in which situation
• to which type of data
• concerning which patients
• and regarding which period

50
Reference directory

• content
• mentions for each patient, identified through his
  patient identification number, the places where a
  specific type of electronic information is
  available about the patient, the provided care
  and the results of the provided care
• on the one hand, table with fixed care relations
  between health care providers and their patients,
  the nature of the relation, the begin date and
  end date of the relation
• on the other hand, a table with the places where
  without a fixed care relation there is electronic
  information available about the different
  patients, possibly through a stepped system
  (general reference directory refers to specific
  reference directories for each group of health
  care providers or each health care institution)
• no personal information !!!

51
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 an automatic communication of
  information to certain care providers

52
User and access management

• access authorizations are provided by the
  Sectoral committee, unless they result from a law
• conformity of a concrete access request with the
  access authorizations is preventively validated
  by the independent institution that manages the
  exchange platform
• all accesses are subject to an electronic logging
  on the user level so that the legitimacy of the
  access can be verified afterwards (only
  who-what-when, no content)
• access to the loggings is strictly protected

53
Network and exchange standards

• use of the existing network infrastructure
  (internet, social security extranet, FedMAN, ...)
  with end-to-end encryption of the information
  (concept of virtual private networks (VPN))
• exchange based as much as possible on structured
  electronic messages from application to
  application
• exchange based as much as possible on open
  standards or at least open specifications
• orchestration of the data exchange by the
  independent organization that manages the
  exchange platform

54
Access channels for the users

• several devices
• PC and laptop
• PDA
• cell phone
• maximal integrated access to the information
  regardless of the information source
• with at least one free and generally accessible
  application for the integrated access to the
  information

55
Independent management organization

• preferably one management organization,
  administered by
• various types of health care providers /
  institutions
• health insurance funds as representatives of the
  patients
• public institutions responsible for the
  organization of the health care (insurance)
• tasks
• to develop and manage the secure exchange
  platform choice of the infrastructure,
  definition of standards and specifications, ...
• to offer access channels for the users
• to organize an operational system of user and
  access management
• to manage the reference directory

56
Independent management organization

• tasks
• to coordinate the development of processes for
  the electronic data exchange between the users of
  the exchange platform
• to orchestrate the electronic information
  exchange between the users of the exchange
  platform
• possibly, to convert the patient identification
  numbers between health care providers /
  institutions
• proactive policy to avoid illegitimate access to
  personal information, e.g. through
• preventive control of the legitimacy of the
  access to personal information
• keeping and analyzing loggings of the exchange of
  personal information (only who-what-when)
• helpdesk

57
Appropriate legal framework

• possibility or obligation to use patient
  identification number
• method for determining the minimal electronically
  communicable content of health care files
• incentives and gradual obligation of permanent
  electronic availability of the minimal
  electronically communicable content of the health
  care file and the electronic exchange of care
  prescriptions
• obligation to update the reference directory
• probative value of electronic prescriptions and
  electronic data exchanges

58
Appropriate legal framework

• creation of the organization for the management
  of the secure exchange platform and decision on
  the composition and the missions of the
  management organization
• creation of Sectoral committee within the CPP and
  decision on the composition and competences

59
Critical success factors

• cooperation between all parties concerned by the
  health care delivery system, based on a division
  of tasks rather than 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
  (management organization for exchange platform,
  Sectoral committee, ...) and then further
  elaboration of processes between these
  institutions
• quick wins in combination with a long term vision
• legal framework

60
Be-Health platform
Patients and care providers
Portal SS
SVA
SVA
SVA
AVS
Portal RIZIV
PortalBeHealth
MyCareNet
SVA
SVA
SVA
AVS
SVA
SVA
SVA
AVS
Users
Platform with basic services
VAS
VAS
VAS
VAS
VAS
VAS
Suppliers
61
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

62
Available basic services

• network, based on existing infrastructure
  (internet, carenet, social security extranet,
  FedMAN, ...)
• portal environment (https//www.behealth.be),
  including
• a content management system
• a search engine
• personal electronic mailbox for each care
  provider
• integrated user and access management
• logging management

63
Portal
64
Portal
65
User and access management

• authentication of the identity according to the
  required security level
• electronic identity card
• user number, password and citizen token
• user number and password
• verification of statuses 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

66
Policy Enforcement Model
67
Policy Enforcement Point (PEP)

• intercepts the request for authorization with all
  available information about the user, the
  requested action, the resources and the
  environment
• passes on the request for authorization to the
  Policy Decision Point (PDP) and extracts a
  decision regarding authorization
• grants access to the application and provides
  relevant credentials

Action
on
Action
application
Policy
on
DENIED
application
User
Enforcement
Application
PERMITTED
(
PEP
)
Action
on
application
Decision
Decision
request
reply
Policy
Decision
(
PDP
)
68
Policy Decision Point (PDP)

• based on the request for authorization received,
  retrieves the appropriate authorization policy
  from the Policy Administration Point(s) (PAP)
• evaluates the policy and, if necessary, retrieves
  the relevant information from the Policy
  Information Point(s) (PIP)
• takes the authorization decision (permit/deny/not
  applicable) and sends it to the PEP

Policy
Enforcement
(
PEP
)
Decision
Decision
request
reply
Information
Request
/
Policy
Policy
Reply
retrieval
Decision
(
PDP
)
Informatie
Vraag /
Antwoord
Policy Information
Policy Administration
Policy Information
(
PAP
)
(
PIP
)
(
PIP
)
69
Policy Administration Point (PAP)

• environment to store and manage authorization
  policies by authorised person(s) appointed by the
  application managers
• puts authorization policies at the disposal of
  the PDP

Authorization
Policy
management
retrieval
PDP
PAP
Manager
Policy
repository
70
Policy Information Point (PIP)

• puts information at the disposal of the PDP in
  order to evaluate authorization policies
  (authentic sources with characteristics,
  mandates, etc.)

Information
Request /
Reply
PDP
Information
Request /
Reply
PIP
1
PIP
2
Authentic source
Authentic source
71
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
72
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 (division 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

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Principle of circles of trust"

• aim
• to avoid unnecessary centralization
• to avoid unnecessary threats to the protection of
  the privacy
• to avoid multiple similar controls and
  registration of loggings
• method division of tasks between the entities
  associated with the electronic service, including
  clear agreements on
• who is in charge of which authentications,
  verifications and controls by which means and who
  is responsible for this
• how the results of the authentications,
  verifications and controls can be safely
  exchanged electronically between the entities
  concerned
• who keeps which loggings
• how to ensure that in case of an investigation,
  on ones own initiative or in response to a
  complaint, a complete tracing can be realized in
  order to know which natural person has used which
  service or transaction concerning which citizen
  or company, when, through which channel and for
  which purposes

74
Examples of added value services

• third party billing
• Medic-e
• input in cancer register
• Medattest
• support of electronic care prescription in
  hospitals
• electronic registration of birth

75
Third party billing

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

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Medic-e

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

77
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

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Medattest

• supplier RIZIV
• users medical doctors, dentists,
  kinesthesiologists, nurses, speech therapists,
  orthopedists, health care institutions and their
  mandataries
• functionality on-line order of care prescription
  formulars
• 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
• logging

79
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 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 places without
  overhead
• local validation that the prescription has not
  been modified after applying the methods to
  guarantee the integrity and the electronic time
  stamping

80
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

81
Electronic care prescription in health care
institutions

• possible solution
• the authentication of the identity and the
  verification of the status are performed on 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 that stipulates 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 in
  implementation of article 21 of the royal decree
  n 78
• a regulation is being elaborated that indicates
  under which conditions postscriptions are possible

82
Legal framework for the creation of Be-Health

• article 4 of the Law of 27 December 2006
  including several provisions
• Within the Federal Public Service Public
  Health, Food Safety and Environment, a public
  service in charge of the management of the
  electronic service platform for the exchange of
  health care data is created, named Be-Health,
  with a separate management as referred to in
  article 140 of the Government Account Acts,
  coordinated on 17 July 1991.
• The King determines, after a decree deliberated
  in the Council of Ministers, the missions and
  further rules for the management and the working
  of this public service with a separate
  management.

83
Proposition of mission

• the elaboration of and the supervision of the
  compliance with a vision and a strategy for the
  supply of electronic services in the health care
  sector, in close consultation with the various
  public and private actors of this sector
• the elaboration of and the supervision of the
  compliance with the necessary norms, standards
  and basic architecture for an efficient use of
  ICT to support this strategy
• the elaboration, as part as a common strategy, of
  basic services for the potential support of the
  actors in the public health sector, e.g.
• an interoperability framework for secure
  electronic data exchange
• the necessary basic services to support this
  electronic data exchange, like a system of user
  and access management, a system for the
  organization and logging of electronic data
  exchanges or a system for the electronic access
  to data
• the management of the cooperation with other
  public entities in charge of the coordination of
  electronic services

84
Composition of the Management Committee

• representatives of health care providers and
  health care institutions
• representatives of sickness funds
• representatives of the public institutions
  concerned
• National Institute for Health and Invalidity
  Insurance
• FPS Public Health, Food Safety and Environment
• Federal Knowledge Centre for Public Health and
  the Federal Agency for Medicine
• Crossroads Bank for Social Security and FPS ICT

85
More information

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

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Th_at_nk you !Any questions ?