# Presentation: 922434

## NETLINK : Interoperability of Smart Card - Based  Information Systems

**Philippe Bédère****GIE SESAM-VITALE****CTST’99 - Chicago, May 14****th****, 1999**

## Project Presentation

**Abstract**
**Consortium**
**Background**
**Rationale**
**Overall Description**
**Progress of Works**
**Conclusion**

## Abstract

**What is NETLINK ?**
**An Project of the IV****th**** R&D Framework****(TAP / ref. HC 4016)**
**Partially funded by the European Commission**
**Bringing together participants of France, Germany, Italy, and the Province of Quebec (Canada)**

## Consortium (1/4)

**Main partners**
**GIE SESAM VITALE (FR)**
**Z.I. (DE) : Central Research Institute of Ambulatory Health Care in Germany**
**FINSIEL (IT)**
**MOTUS Technologies (Quebec, CA)**

## Consortium (2/4)

**Associated partners**
**Caisse Nationale de l’Assurance Maladie  des Travailleurs Salariés (FR)**
**Conseil National de l’Ordre des Médecins (FR)**
**Centre National des Professions de Santé (FR)**
**GIP Carte de Professionnel de Santé (FR)**
**Istituto Nazionale della Previdenza Sociale (IT)**

## Sponsors
Ministère de l’Emploi et de la Solidarité (FR)
Ministère de la Santé et des Services sociaux du Québec (CA)
Ministère des Relations Internationales du Québec (CA)
Régie de l’Assurance Maladie du Québec (CA)
Industry Canada (CA)

**Ministère de l’Emploi et de la Solidarité (FR)**
**Ministère de la Santé et des Services sociaux du Québec (CA)**
**Ministère des Relations Internationales du Québec (CA)**
**Régie de l’Assurance Maladie du Québec (CA)**
**Industry Canada (CA)**

**Consortium (3/4)**

## Sponsors
Ministero della Sanita (IT)
Regione Piemonte (IT)
Regione Liguria (IT)
Provincia Autonoma Trento (IT)
Provincia Autonoma Bolzano - Alto Adige (IT)
Federazione Nazionale degli Ordini dei Medici (IT)

**Ministero della Sanita (IT)**
**Regione Piemonte (IT)**
**Regione Liguria (IT)**
**Provincia Autonoma Trento (IT)**
**Provincia Autonoma Bolzano - Alto Adige (IT)**
**Federazione Nazionale degli Ordini dei Medici (IT)**

**Consortium (4/4)**

## Proposal
Proposal to EC		April, 1997
Retained by EC		July, 1997
Negotiation			
Contract Signature	June, 1998
Project
Starts on 			July 1st,1998
Ends on 			June 30th, 2000

**Proposal to EC****	****	****April, 1997**
**Retained by EC****	****	****July, 1997**
**Negotiation****	****	****	**
**Contract Signature****	****June, 1998**
**Project**
**Starts on ****	****	****	****July 1st,1998**
**Ends on ****	****	****	****June 30th, 2000**

**Background**

## Strategy
Continuity of care
Communication facilitation
Simplification of administrative procedures
Security (data exchanges, administrative procedures)
For the benefit of Citizens, Governments, Health Professionals, Health Insurance Funds

**Continuity of care**
**Communication facilitation**
**Simplification of administrative procedures**
**Security (data exchanges, administrative procedures)**
**For the benefit of Citizens, Governments, Health Professionals, Health Insurance Funds**

**Rationale**

**Notes:**
Countries involved in the NETLINK consortium (France, Germany, Italy and the Province of Québec) have set up or are in the process of setting up new nation-wide Information Systems in the Health Care sector based on the use of modern technologies : smart cards (used by Health Professionals and Patients), computers (used by Health Professionals, Hospitals, Health Insurance Funds), large networks, trusted third parties (for security purpose).
Their objective is to make these new nation-wide Information Systems interoperable for the benefit of :
patients (including continuity of care, enhancement of quality of care, simplification of administrative procedures),
health practitioners (including communication facilitation, continuity of care, simplification of administrative procedures),
health insurance funds (including communication facilitation, simplification of administrative procedures).
The common process undertaken by the country members of the NETLINK consortium constitutes a first step towards the establishment of standards or recommendations for the healthcare sector at the European and international levels.

## Interoperability
Smart Card - based Nation-wide Health Information Systems
Infrastructures
In line with existing national
Systems or projects
Regulations

**Smart Card - based Nation-wide Health Information Systems**
**Infrastructures**
**In line with existing national**
**Systems or projects**
**Regulations**

**Rationale**

**Notes:**
Countries involved in the NETLINK consortium (France, Germany, Italy and the Province of Québec) have set up or are in the process of setting up new nation-wide Information Systems in the Health Care sector based on the use of modern technologies : smart cards (used by Health Professionals and Patients), computers (used by Health Professionals, Hospitals, Health Insurance Funds), large networks, trusted third parties (for security purpose).
Their objective is to make these new nation-wide Information Systems interoperable for the benefit of :
patients (including continuity of care, enhancement of quality of care, simplification of administrative procedures),
health practitioners (including communication facilitation, continuity of care, simplification of administrative procedures),
health insurance funds (including communication facilitation, simplification of administrative procedures).
The common process undertaken by the country members of the NETLINK consortium constitutes a first step towards the establishment of standards or recommendations for the healthcare sector at the European and international levels.

## Establish recommendations and technical specifications for :
Access to Patient Data Cards (free or controlled)
Asynchronous exchange of secured documents (including non-repudiation and confidentiality services)
On-line access to secured data bases
Simplification of administrative procedures by using new technology

**Access to Patient Data Cards (free or controlled)**
**Asynchronous exchange of secured documents (including non-repudiation and confidentiality services)**
**On-line access to secured data bases**
**Simplification of administrative procedures by using new technology**

**Overall Description (1/3)**

## Technical Goals
Smart Cards (Patients, Health Professionals)
Workstations (Health Professionals)
Networks, Directory services
Servers
Security architectures (frameworks, smart cards, trusted third parties)

**Smart Cards (Patients, Health Professionals)**
**Workstations (Health Professionals)**
**Networks, Directory services**
**Servers**
**Security architectures (frameworks, smart cards, trusted third parties)**

**Overall Description (2/3)**

## Project objectives
Recommendations and technical specifications
Cross-border pilot sites
Cooperation with other countries (Europe, North America, Japan) or EU projects
Secretariat of the G8 SP6 group (Health Cards)

**Recommendations and technical specifications**
**Cross-border pilot sites**
**Cooperation with other countries (Europe, North America, Japan) or EU projects**
**Secretariat of the G8 SP6 group (Health Cards)**

**Overall Description (3/3)**

## Access to PDC
Country A : Citizens have PDC
Country B : HPC have computers
Citizens from Country A go to Country B
In case of emergency, Health Professionals from Country B can read data in the PDC of citizens from Country A

**Country A : Citizens have PDC**
**Country B : HPC have computers**
**Citizens from Country A go to Country B**
**In case of emergency, Health Professionals from Country B can read data in the PDC of citizens from Country A**

**Recommendations (1/8)**

## Access to PDC
Emergency Data Set (identification, administrative, medical)
Proposed changes to G7 Emergency Data Set (as defined in 1996)
Data Storage in PDC (and display to HP)
Technical requirements on PDC / Terminal / HP Workstation

**Emergency Data Set (identification, administrative, medical)**
**Proposed changes to G7 Emergency Data Set (as defined in 1996)**
**Data Storage in PDC (and display to HP)**
**Technical requirements on PDC / Terminal / HP Workstation**

**Recommendations (2/8)**

## Secure Messaging
Country A & B :
HP have HPC, Workstations and Network connection
TTP (CA, Directory, etc.) connected to the Network
Secure exchange of e-mails between HP from Country A or B
Authentication of origin, Integrity, Non-Repudiation
Confidentiality

**Country A & B :**
**HP have HPC, Workstations and Network connection**
**TTP (CA, Directory, etc.) connected to the Network**
**Secure exchange of e-mails between HP from Country A or B**
**Authentication of origin, Integrity, Non-Repudiation**
**Confidentiality**

**Recommendations (3/8)**

## Secure Messaging
E-mail protocols and formats
Connections between Workstations, Directory, TTP, etc.
Security mechanisms (Certificates, Digital signature, Encryption)
Role of HPC, Workstation, TTP

**E-mail protocols and formats**
**Connections between Workstations, Directory, TTP, etc.**
**Security mechanisms (Certificates, Digital signature, Encryption)**
**Role of HPC, Workstation, TTP**

**Recommendations (4/8)**

## Data Base Access
Country A & B :
Patients have PDC
HP have HPC, Workstation, Network connection
PDC storage capability are extended to data bases with the concept of Index
HP securely access to anonymous data bases using smart cards (HPC + PDC)
HP can update index in PDC

**Country A & B :**
**Patients have PDC**
**HP have HPC, Workstation, Network connection**
**PDC storage capability are extended to data bases with the concept of Index**
**HP securely access to anonymous data bases using smart cards (HPC + PDC)**
**HP can update index in PDC**

**Recommendations (5/8)**

## Data Base Access
Formats of requests to data base
Data structure in PDC
See PDC Access
Telecommunication protocols and formats
See Secure Messaging

**Formats of requests to data base**
**Data structure in PDC**
**See PDC Access**
**Telecommunication protocols and formats**
**See Secure Messaging**

**Recommendations (6/8)**

## Simplification of administrative procedures
Country A & B :
Patients have PDC
HP have HPC, Workstation, Network connection
Use of technology to simplify administrative procedures
E1xx forms and medical information in PDC
Reimbursement process

**Country A & B :**
**Patients have PDC**
**HP have HPC, Workstation, Network connection**
**Use of technology to simplify administrative procedures**
**E1xx forms and medical information in PDC**
**Reimbursement process**

**Recommendations (7/8)**

## Simplification of administrative procedures
Data to be stored in PDC
Access to PDC
See PDC Access
Telecommunication protocols and formats
See Secure Messaging

**Data to be stored in PDC**
**Access to PDC**
**See PDC Access**
**Telecommunication protocols and formats**
**See Secure Messaging**

**Recommendations (8/8)**

## Cross-border pilot sites
France - Italy
France - Germany
EU - Quebec
Demonstrate accuracy of recommendations
Technical
Organizational

**France - Italy**
**France - Germany**
**EU - Quebec**
**Demonstrate accuracy of recommendations**
**Technical**
**Organizational**

**Pilot Sites**

## Evaluation Process

**Evaluation strategy and methodology for the pilot sites**
**Ongoing process, input to system design**
**Technology acceptance on pilot sites**
**Input to national projects**
**Based on Quebec experience**

## Liaisons

**Support to national strategies definition & projects roll out**
**Liaison with **
**European Projects**
**R&D**
**Dissemination activities**
**Countries that plan national projects**
**G8 SP6 Group (Heath Cards)**

## Conclusion

**Some Key Ideas**
**Interoperability**
**Existing national systems and projects**
**National regulations**
**Support to national projects**
**Basis for broader discussion (other countries & sectors)**

## Conclusion

**Thanks for your attention**** **
**For more information :****	****	****http://www.sesam-vitale.fr/**** **
**Questions ?**