Contribution to:
Interoperability of health professionals’
       authentication in Europe


                             ...
General overview

     Phase 0           Phase 1                 Phase 2                   Phase 3                    Phas...
HPRO Card workpackages

 • WP1 : Identification of the competent authorities for
   health professionals in EU
 • WP2 : Id...
Interoperability levels

              Jurisdiction # 1                                          Jurisdiction # 2


      ...
Interoperability levels in ID
management

                     Legislation,
 Political / Legal   nomination of responsible...
Electronic certificates’ production

    Registration        Certification          Publication
    authorities          a...
Competent Authorities
Directive 2005/36 (5 health professions)




                                             Identifica...
Results

How many competent authorities in EU ?
          about 893 competent authorities identified

 They can be classif...
For example: Workflow for Estonia
                                                                                        ...
For example: Workflow for Spain
                                                                                          ...
For ex: Workflow Czech Republic
                                                                         Conclusion for Cz...
Results
How many professionals in EU ?
     WHO’s database
     •   Physicians: 1 543 500
     •   Dental practitioners: 3...
Health professionals’ identity
documents
• Some countries have no card. For example, Poland issues
  a professional passpo...
Existing health professionals’
smart cards
•   Austria
     •   Pharmacists (Apothekerausweis)
     •   Doctors in contrac...
Projects of health
professionals’ cards
 •   Belgium (2010)
      •   Pharmacists
 •   Finland (2011)
      •   All profes...
e-Identity cards for health
      professionals
• eID card used by the doctors, for instance in
  Estonia

• Belgium eID c...
Proposed architecture

        HPRO-Card.es        HPRO-Card.fr

                         3. Verification of access rights...
Technical materials on 23
    different systems
Health professionals’ databases

 • Some online examples :
     Austria: doctors
     Czech republic : doctors, dentists a...
Health professionals’ databases
Health professionals’ databases


                        •Evidenční číslo: Evidence
                        number
      ...
Use Case 1


•   A health professional wants to practice in
    another EU State Member for a temporary
    providing of s...
German demonstrator



  Country A                       Country B




         Authentication   Authentication
          ...
Middlewares

                                                        Applications
                                        ...
Use Case 2

• A health professional has to access medical data
  of a foreign patient in the patient’s country of
  origin...
Spanish                                                        French medical

demonstrator                               ...
Access for foreign doctors
to Xarxa Sanitària i Social de Santa Tecla
e-signature of the patient
to give access to a foreign doctor
e-Signature of the foreign doctor
Verification of the foreign doctor




   HPRO.es




       French doctor


                             HPRO.fr
Belgium demonstrator


                  2                    2
                1 1                    1   1

            ...
Use Case 3


• A health professional wants to be recognized as
  a health professional in another country

• Studied issue...
Belgium
demonstrator   Website




                         Result
Perspectives and orientations

   Cartography of health professionals ID
            tools and databases



    How to pro...
More information



        www.hprocard.eu
  mariane.cimino@sante.gouv.fr
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HPRO Card: An Overview of Health Professionals’ Identity Management within Europe

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HPRO Card: An Overview of Health Professionals’ Identity Management within Europe. Cimino M. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

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HPRO Card: An Overview of Health Professionals’ Identity Management within Europe

  1. 1. Contribution to: Interoperability of health professionals’ authentication in Europe Barcelona March 16, 2010 Mariane Cimino, HPRO Card, ASIP-santé, France
  2. 2. General overview Phase 0 Phase 1 Phase 2 Phase 3 Phase 4 Work on professional Presentation HPRO Pilots and HPRO Card qualifications to EP implementation Oct. 2007 Directive HPRO Card with a Access management 2005/36/CE harmonized to applications European face •Competent authorities • Governance (ex. Electronic Health •Existing H Pro systems • HCP identity federation Record, •Possible architectures framework e-prescription) •Interoperability issues • Pilot epSOS, STORK… Past situation Present Future situation
  3. 3. HPRO 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
  4. 4. Interoperability levels Jurisdiction # 1 Jurisdiction # 2 Function A Function A Top- Down Political / Legal Political / Legal IOp Agreement Interface; Mapping; Translation ... Organisational Organisational Semantic Semantic Bottom -up Technical Technical Education & Awareness raising
  5. 5. Interoperability levels in ID management Legislation, Political / Legal nomination of responsible authorities, definition of covered entities Organisational Registration procedures, verification procedures Data models, Semantic identifiers, numbering systems Certificates, Technical ID-tokens (e.g. cards), directory databases, networking infrastructure
  6. 6. Electronic certificates’ production Registration Certification Publication authorities authorities authorities 5 professions PKI Databases or 27 state-members Validation authorities Repositories 893 Competent authorities Access profiles
  7. 7. Competent Authorities Directive 2005/36 (5 health professions) Identification of the competent authorities Process of registration
  8. 8. Results 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 organization of each country, they can be organized at the: - National level (Sweden …) - Regional level (Germany …) - Local level (Italy …)
  9. 9. For example: Workflow for Estonia Conclusion for Estonia : Competent Authorities = Health Care Board HP Diploma’s Right to practise Id’s Sanction’s HP card’s provider provider provider provider provider University (Initial procedure or training 2 Health care colleges**** changes in the professional situation) diploma Health Care Board* Professional associations** registration documents State sanction / no sanction Agency right to practice / or not National Health Care Board* Automatic calculation of the level Code in the registry (Kood) registration documents identifier Id Card (for all citizens***) with : Name, Surname, Id Code, Date of birth, Date of validity… registration documents * governmental agency, which started operations on 1st of January 2002 under the jurisdiction of HP card 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
  10. 10. For example: Workflow for Spain Conclusion for Spain : Competent Authorities for Doctors = OMC HP Diploma’s Right to practise Id’s Sanction’s HP card’s provider provider provider provider provider training Universities CGCOM** : (Initial procedure or • Central Registration Database changes in the professional situation) 52 …/… • Central Ethics Commission diploma Regional Medical Councils* Regional Medical Councils* registration documents CGCOM** 52 …/… Professi onal sanction / no sanction organiza right to practice / or not tions Regional Medical Councils Regional registration documents in coordination with CGCOM** 52 …/… level identifier Regional Medical Councils 3*** in coordination with CGCOM** registration documents : smart cards * 52 Regional Medical Councils in the 17 autonomous regions HP card dental 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
  11. 11. For ex: Workflow Czech Republic Conclusion for Czech Republic - Pharmacists, dentists and physicians : national chambers -Nurses and midwives : Ministry of Health HP Diploma’s Right to practise Id’s Sanction’s HP card’s provider provider provider provider provider (Initial procedure or Universities changes in the professional situation) training diploma Ministry of health ** Ministry of health ** registration documents Chamber * Chamber * Mixed sanction / no sanction Nature right to practice / or not Ministry of health ** Chamber * National registration documents Health insurance level identifier registration documents No document HP card * : for pharmacists, dentists and physicians ** : for nurses and midwives
  12. 12. Results 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…)
  13. 13. Health 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
  14. 14. Existing 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)
  15. 15. Projects 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 • …
  16. 16. e-Identity cards for health professionals • 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
  17. 17. Proposed architecture HPRO-Card.es HPRO-Card.fr 3. Verification of access rights PKI Validation CR demand/response L 4. Secured access on 2. Validation of the certificate the right application 1. Authentication Application
  18. 18. Technical materials on 23 different systems
  19. 19. 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
  20. 20. Health professionals’ databases
  21. 21. Health professionals’ databases •Evidenční číslo: Evidence number •Jméno a příjmení: 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
  22. 22. Use Case 1 • 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 ?
  23. 23. German demonstrator Country A Country B Authentication Authentication signature signature
  24. 24. Middlewares Applications ? Citizen card Own software PKCS#11 Konnektor PKCS#11 With the UZI- Classic Client G&D Common CSP middleware spezifikation card the 5.1.7 - 004 SafeSign 2.2 (Cryptographic MS CAPI that origins standard for ZZZS Software from CDSA SafeSign Provider) who eGovernment Identity Client understands programmes middleware is PKCS#15 file provided from + coop with A.E.T. CSP provider Europe B.V (SecMaker and for Windows, their application MacOS X – NetID) : both and Linux. client and server additional functions, such as “Single-sign- on” Austria Austria France Germany Italy Netherlands Slovenia Spain Sweden Workstation + reader
  25. 25. 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 ?
  26. 26. Spanish French medical demonstrator consultation Spanish patient Form and signature (PDF) Spanish hospital Reply Verification request Spanish Medical Chamber Reply Verification request French Order of doctors Phase 1 Phase 2 Phase 3
  27. 27. Access for foreign doctors to Xarxa Sanitària i Social de Santa Tecla
  28. 28. e-signature of the patient to give access to a foreign doctor
  29. 29. e-Signature of the foreign doctor
  30. 30. Verification of the foreign doctor HPRO.es French doctor HPRO.fr
  31. 31. Belgium demonstrator 2 2 1 1 1 1 1 Belgium pharmacist card French pharmacist card French health French pharmaceutical assurance card record (4 months-history of delivered medicines in every French pharmacies)
  32. 32. 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 ?
  33. 33. Belgium demonstrator Website Result
  34. 34. Perspectives and orientations Cartography of health professionals ID tools and databases How to provide an infrastructure to interoperate at the EU level ?
  35. 35. More information www.hprocard.eu mariane.cimino@sante.gouv.fr

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