# Presentation: 026029

## Conseil National de l’Ordre des MédecinsHEALTH CARDS ’97

- Olivier DUBOIS, MD, Délégué Général, CNOM
- Jean-Pierre THIERRY, MD, consultant CNOM

## CNOM	 French National Medical Council	 	

- Role :
- Represents the medical profession
- Produces the code of ethics, part of the French Law (Public Health Policy)
- Determines the rules of good practice for all physicians (public and private sectors)

## CNOM	 French National Medical Council

- Role (cont.)
- organizes the disciplinary measures (malpractice, litigation, etc.)
- Defends professional independence
- Promotes quality of care

## CNOM  challenges to basic principles

**Freedom of access for the patient (the right to choose a physician)**
**but evolution towards “managed care” environment**
**Freedom of prescription**
**but cost-containment and recent input of new constraints (e.g. generics, Disease Management) **
**Confidentiality and privacy**
**increased risks of breaches with IT, internet, etc.**

## CNOM Legal aspects of confidentiality

- Healthcare professional rules
- (code of prof. ethics, revised 1995)
- Computer Information and Liberty Law  (1978)
- Criminal Law (1994) Encryption Law (1996)
- European directives (1995) Resolutions from the Council of Europe

## CNOM Legal aspects of confidentiality

- Professional rules (deontology
- and medical ethics) written by the CNOM and part of the Law on Public Health.
-  6 articles dealing with “secrecy” for the MD and allied
- healthcare professionals including relationship with Social services regarding transmission of medical information
- Strong adhesion from the medical community.

## CNOM’s approach in HCT     

- Our main concern is Security, confidentiality, and privacy...
- Integrity of data
- Availability
- Confidentiality
- accountability
- accessibility			...a prerequisite to a 					real Interoperability.

## CNOM’s approach in HCT

- Matching IT solutions and rules of Ethics
- Integrity, availability, accessibility = quality and continuity of care
- Confidentiality and security = privacy and medical « secret »
- Accountability = responsibility, disciplinary measures,
- _Electronic Health Care Record is the major issue_

## CNOM’s involvement in HCT

- National programs
- Participation to the AFNOR group (mirror national WG of CEN TC 251)
- WG with CNIL (Computer Information and Liberties National Commission, established 1978 with Law)

## CNOM’s involvement in HCT

- National programs (cont.)
- WG with CLUSIF (Industry Association for the Promotion of Security in IT)
- _Chair of the GIP CPS “Deontologic board” for the diffusion of  HPCards._

## CNOM and the GIP CPS 

- CNOM

- GIP CPS

- GIP CPS
- Deontology
- Board

- The GIP CPS is Responsible for
- issuing, managing and promoting the CPS

- CNOM

- CNOM

- CNOM

## CNOM and the security issue

- The role of the CPS (HPC)
- Will be distributed, by law, to all practicing physicians within 2 years ( approx. 200,000) and later to   others HC professionals (approx. 300,000)
- Features :
- identification, authentication, electronic signature
- NEW : encryption (choice of  national TTP to be announced)

## CNOM and the security issue

- The CPS will be used to secure :
- electronic  EDI Billing of services coupled with the patient ’s personal smart card VITALE and VITALE 2 (incl. Medical minimal data set). Patients smart cards to be distributed to +57 millions persons before 2002
- electronic medical messages based on EDI between Healthcare professionals

## CNOM and the security issue

- The CPS will be used to secure (cont.) :
- access to medical Databases (local, HIS, Web sites, ...)
- access to a patient’s own medical file (with VITALE) and, in France only through a referring physician.

## CNOM’s involvement in HCT

- Associated Contractor in  EU projects (DGXIII)
- Starting 98
**RUBIS** (Integration of Applications on Digital Sites in Finland, Germany and France)
**NETLINK** (definition of medical content of patient ’s smartcard used between French and German regions)

## CNOM’s involvement in HCT

- Participation to International Projects
- EAMF (European Academy for Medical Continuing Education)
- Conference Strasbourg Oct 97 : Impact of IT on CME, with US Alliance for Medical Education
- G7 Enabling Mechanisms
- G7 Teleplans (Telemedicine)
- Assistance to other countries in establishing Medical Councils.

## CNOM Recommendations 3/12 Oct. 97

- Communication of nominative medical data and HC records should remain under the authority and control of the patient’s physician
- non secured use of Internet to be discouraged or forbidden for nominative medical data transmission
- Use of the CPS HPC - with cryptography +TTP - to be mandatory to secure nominative data communication.

## Conclusions

- Security, confidentiality and privacy issues  may well represent a major threat with risks of professional and consumerist reactions if improperly addressed and managed, notably through appropriate technology such as smart cards.
- Involvement of  Medical Councils and similar organizations is more thoroughly needed in order to gain professional and public awareness and acceptance of IT solutions applied to health