Building safety-critical medical device platforms and Meaningful Use EHR gate...
Technical network loeber
1. First US-German Summit on Primary Care
Current Implementation and Technologies
of a Secure Network für 50,000 Physicians
in Germany
Frank Löber
CIO/ CTO HÄVG Rechenzentrum
Washington, 9th April 2010
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2. Agenda
Initial Situation in Germany – Facts & Figures
Overview current solution in Germany for 50,000 Physicians
Current Situation & Next Steps
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4. Initial Situation in Germany
Fact & Figures
New reimbursement system (payment system) since June 2008
50,000 familiy physicians & 70,000,000 sick fund covered people
160 sick funds, recently substantial decrease in number due to
mergers
60 different software-solutions (doctor´s IT-system) for familiy
physicians with different operating systems
Different ways of communication (paper, CD-Rom, online)
High requirements for data protection for transmission and
storage
Main medical data to transfer: reimbursement items, diagnoses,
drugs, referrals, form-data
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5. Initial Situation in Germany
Billing Process in new reimbursement system
Documenting Send
Receive
medical data medical
Physician billing &
(diagnoses, data by
Payment
drugs ..) software
Check &
Hausaerzte- clearing Create
verband data & billing &
create and send it & do
(Clearing) send billing payment
file
Check
Sick Fund billing file &
Payment
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6. Initial Situation in Germany
Different business needs for different parties
Physicians:
No additional costs for hard- & software, software must be easy to
use
Software-Developers / Manufacturers:
Easy integration, installation & configuration of new software
Hausaerzteverband:
scalable solutions, authenfication of physicians, exchange
medical data between family and special physicians, increase
quality of primary care
Sick Funds:
Reduce costs of drugs and remedies, increase quality of primary
care
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7. Initial Situation in Germany
Legal Requirements for protection & authentification
High requirements for data protection & authentification:
Files with medical and personal data must be encrypted
Transmission must be encrypted
Files with medical data must be signed by a physician
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8. Initial Situation in Germany
Conclusion
Regarding all business needs of all parties means:
Development of a specific software-module („Core“)
without GUI for integration in existing software-solutions
Development of requirements and technical specifications
for existing software-manufacturers
Develop own software with GUI for physicians with basic
functions to manage our contracts (stand alone solution)
Usage of this software is part of our contracts
Develop own data-center
Develop own infrastructure to connect doctors for data
exchange
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11. Current Solution – Encryption & Transmission
Medical Data from doctor´s practice to data center
2 ways of online transmission:
Hardware-Router
with certicate of
doctor´s practice
Software-VPN with
certicate of doctor´s
practice
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12. Current Solution – Encryption & Transmission
Transmission Encryption
Secure Communication between doctors practice and our
data-center based on legal requirements using:
IPSec-Tunnels
Secure TLS-Connections
Key-Exchange-Protocol: Diffie-Hellman
Digital Certificates: X.509 (v3) Certificates with 2048 Bit key-length
Software VPN is based on OpenVPN (open source)
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13. Current Solution – Encryption & Transmission
File Encryption
Medical data (reimbursement items, drugs, …) will be
compressed and encrypted with a hybrid method before
transmission
Payload (Content of the file) will be symmetric encrypted
with AES (Advanced Encryption Standard) with 256 Bit key-
length
Encryption Key will be asymmetric encrypted with the public
certificate of the receiver with 2048 Bit key-length by SHA1-
RSA
Data will only decrypted in our data-center
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15. Current Solution – Core-Module
Overview Technical Solution
Doctor`s Practice
Usable on
clients,
Doctor´s servers and
IT-System as ASP- Core Online-Updates Data-
Solution Center
Core-Functions
HTTPS
VPN
XML Konnektor
SOAP
Contract Contract Contract
1 2 3
Open
VPN
Modular specific Contract-Data using open
source database SQLite
Database Modules Software Run Time Environment Interface
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16. Current Solution – Core-Module
Functions
Validate medical data in doctor´s practice
Provide steering algorithms i.e. substitutions
for low priced drugs
Provide specific data i.e. special Core
catalogues of ICD10-diagnoses
Provide Online-Services i.e.
„check enrolled patients“
Encrypt medical data before transmission
Receive daily-updates Existing
No graphical user interface Software Core
with GUI
Easy to integrate in existing software solutions
Defined data structure for medical data
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22. Current Solution – Authentification
Doctor & Practice
Authentification is used for following purposes
Identification
Signing medical data
Current Solution: Rollout of software-based certificates
Planned: Rollout of hardware-based certificates
(health professional card)
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24. Current Solution – Data-Center
Overview of Services
Provide Online-Services i.e. „check enrolled patients“
Receive data from the physicians
Approval & Decryption & Clearing & Storage
Billing & Accounting-Services
Provide Online-Updates
Interfaces to several Sick Funds for data exchange
Exchange Data in XML
Multiple & Mass Data Processing
Provide Trust Center to manage certificates
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26. Current Situation & Next Steps
Using our system since June 2008
2,000 physicians using Hardware-Router, 8,000 physicians using
Software-VPN for transmission encryption
10,000 integrated Cores in existing 35 software-solutions
6,000,000 insured persons are enrolled in the new system
500,000,000 medical data, diagnoses, drugs, remedies, referrals
every 3 months to validate
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27. Current Situation & Next Steps
Provide Core-Module in Java
Provide Core-Module as ASP-Solution
Provide billings for doctors online as PDF to download
30,000 physicians and 30,000,000 insured persons in the new
system
And…. It will work!!!
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