# Presentation: 307253

## The Netlink Project and the French Health Card Interoperability in Actionby Noël Nader, GIE SESAM-Vitale, France.

**The Netlink Project and the French Health Card *****Interoperability in Action*****by Noël Nader, GIE SESAM-Vitale, France.**

**CardTech/SecurTech 2000***** ***
**Health Care Applications Conference, Miami Beach, Florida, May 3****rd****, 2000**

## Project overview and status
The pilots in the context of the general implementation of cards in France
Canadian (Quebec) pilot status
Italian situation and work status
Q&A

**Project overview and status**
**The pilots in the context of the general implementation of cards in France**
**Canadian (Quebec) pilot status**
**Italian situation and work status**
**Q&A**

**Agenda**

## Project Overview and Status

## What is NetLink ?
A IVth Framework R&D Project of the EC (HC 4016)
Partially funded by the European Commission:
Overall budget : 3,345 M Euros,
EC Funding : 1,14 M Euros.
Bringing together participants of France, Germany, Italy, and the Province of Quebec (Canada).

_**What is NetLink**_** ?**
**A IV****th**** Framework R&D Project of the EC (HC 4016)**
**Partially funded by the European Commission:**
**Overall budget : 3,345 M Euros,**
**EC Funding : 1,14 M Euros.**
**Bringing together participants of France, Germany, Italy, and the Province of Quebec (Canada).**

**Abstract**

## Consortium:
Main partners (France, Italy, Germany),
Associated partners (France, Italy),
Cooperation partners (Canada/Québec),
Sponsors (France, Italy, Germany).

_**Consortium:**_
**Main partners (France, Italy, Germany),**
**Associated partners (France, Italy),**
**Cooperation partners (Canada/Québec),**
**Sponsors (France, Italy, Germany).**

**Netlink Actors **

## Interoperability between nation-wide Health Information Systems.
For the benefit of Patients, Health Professionals, Governments and Health Insurance Funds :
Continuity of care,
Communication facilitation,
Simplification of administrative procedures.

_**Interoperability**_** between nation-wide Health Information Systems.**
_**For the benefit**_** of Patients, Health Professionals, Governments and Health Insurance Funds :**
**Continuity of care,**
**Communication facilitation,**
**Simplification of administrative procedures.**

**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.

## Overall Description

_**Project objectives**_
**To establish technical and functional recommendations for interoperable network and smartcard based health system solutions:**
**Free or controlled access to Patient Data Cards,**
** ****Asynchronous exchange of secured documents,**
**On-line access to secured servers,**
**Administrative procedure simplification.**
**To demonstrate the viability of the selected solutions through cross-border pilot sites.**

**Overall Description**

## Requirements for interoperability

_**To specify the complete infrastructure**_**: card terminals, HPCs, Trusted Third Parties.**
_**To develop secure communication procedures:**_
**to be used in connection with networks and/or patient card systems,**
**to be used inside a country or across borders of the countries represented in the consortium.**
_**To propose to the standardisation bodies these procedures or parts of them as an input for their standardisation work**_**.**

## Work/Standards with  relevance for the Health Care sector

**Work/Standards with  relevance for the Health Care sector**

_**ISO-Standards:**_**	****ISO 215 „Health Informatics“ WG 4 „Security“,****	****ISO 215 „Health Informatics“ WG 5 „Health Cards“.**
_**CEN-Standards:**_**	****CEN TC 251 „Health Informatics“, ****	****WG III „Security, Safety and Quality“,****	****PT 37 „Strong authentication using microprocessor cards“.**
_**Cooperation with other projects:**_** G8 SP6 HC, NETLINK-CEE, RETRANSPLANT, TESS, TRUSTHEALTH II, ...**

## Components & Services:
Smart Cards for Health Professionals,
Smart Cards for Patients,
Workstations for Health Professionals,
Wide IP-based Networks,
Health Telematics Applications,
Directory services,
Security architectures (authentication, digital signature, data encryption, TTP).

_**Components & Services:**_
**Smart Cards for Health Professionals,**
**Smart Cards for Patients,**
**Workstations for Health Professionals,**
**Wide IP-based Networks,**
**Health Telematics Applications,**
**Directory services,**
**Security architectures (authentication, digital signature, data encryption, TTP).**

**Technical Features**

## Achievements & products

**Achievements & products**

_**Issued Documents:**_
**Netlink Requirements for interoperability (D2),**
**Evaluation Framework and Methodology (D3.1),**
**Evaluation Guide (D3.2).**
_**Pilot sites**_** in France, Italy, Germany, Quebec/CA**
**A laboratory for interoperability between nation wide Health Card systems,**
**Health Smart Cards under interoperability test to be distributed in May and June 2000.**

## Netlink scenarios

**1.****	****PDC emergency medical dataset (free access).**
**2.****	****PDC access (protected).**
**3.****	****DB access.**
**4.****	****Secure messaging.**
**5.****	****Procedure simplification.**

## Interoperability global scenario

## Interoperability in emergency situation scenario 

## Netlink Pilots in the French context of cards implementation

## Institutions

**GIE-SV**

- GIP-CPS

- DSS, DH, DAEI, DGS
- Health Info. Mission

- Ministry of
- Agriculture

- Budget
- Management

- Min. of
- Employment
- and  Solidarity

- Ministry of
- Finances

**Manufacturers and users**

**SESAM-VITALE Actors**

## SESAM-VITALE objectives

**To improve Health Care service quality with no cost increase by using secure digital equipment (Smartcards, programmable e.devices, Networks). **
**Main benefits for:**
_**Citizens**_** (Simplified Insurance Reimbursement),**
_**Patients**_** (Medical Prescription under preparation),**
_**Health Professionals**_** (Health Practioners Facilities).**

## SESAM-VITALE Approach

_**Simplifying**_**:**
**The reimbursement process with secure electronic transactions (E. Reimbursement Claim, Prescription**).
_**Providing**_**:**
**The necessary information for a medical control of the evolution of health care expenses as well as the infrastructure to allow new services to emerge.**

## SESAM-VITALE System

_**Secure Intranet**_** (RSS):**
**For Electronical Reimbursement Form Exchange. Connection may be supplied either directly or through Health private networks and/or the Internet. **
_** **__**Smartcard**_** based system (PDC, HPC):**
**For secure data transactions under HPC control as well as administrative data storage on PDC (VITALE).**
_**Multi-applications**_** secure programmable readers**

##  The French CPS Health Practitioners  Smart Card

_**Functions:**_
**Identification of the HCP,**
**Authentication & Digital signature & Encryption as well as keys management.**
_**50 000 cards issued.**_

## The French Vitale Health  Smart Card

_**Functions:**_
**Identification of the insured person,**
**Health insurance information.**
_**40 Millions cards issued !**_

## VITALE Health Cards Suppliers

_**Founders**_**: ****	**
**Thomson micro-electronics, Motorola.**
_**Card Production**_**:**
**Oberthur, Gemplus, Schlumberger and Bull / Orga.**
_**Customization**_**:**

**OBERTHUR SC**

**GEMPLUS**

**BULL**

**SCHLUMBERGER**

**ORGA**

## Creation of electronical reimbursement claims

**HCP****SOFTWARE**

**SESAM-VITALE****SOFTWARE**

**SESAM-Vitale****READER**

**WORKSTATION**

## Transfert of electronical reimbursement claims

**PROCESSING OF****THE REIMBURSEMENT****CLAIM**

**SESAM-Vitale****READER**

**WORKSTATION**

**HFI**

## The French Vitale Health Care System benefits

_**Medical fees e.reimbursement form (FSE):**_
**reducing dramatically the costs,**
** ****no more time wasted due to lost forms,**
**neither letters to send nor stamps to pay (3 FF),**
**no more paper forms to copy,**
**patient faster refunding !**

## The situation in France today

_**SESAM-VITALE statistics end March 2000**_**:**
**200 000 everyday Vitale Card users **_**joined every week by 500  more of them**_**!**
**19 200 000 Electronical forms have been issued by network since the system kick-off in 1998.**
**20 500 Health Practitioners using their HPC, among them 16 700 Physicians (i.e 30 % of the Physicians).**
_**Forecast end 2000:**_** **
**40 000 HPC everyday users.**

## The French Health Care System Evolution

**Major Regulation changes in 1999.**
**Medical prescription and digital signature.**
**Medical Dataset in card.**
**VITALE new card implementation delayed 2001/2002.**
**Private Insurances Companies members of GIE SESAM-Vitale in 2000.**

## French Legal Framework for Cryptography: status update

## Netlink Pilots Overall objectives

**To demonstrate the availability of Interoperable solutions between nation-wide Health Care systems:**
**by preparing bilateral agreements between the cooperating countries (France, Italy, Germany) for Procedure Simplification,**
**by applying technical specifications outcoming from the Netlink Interoperability Document (v2.0) to update Patients Cards with Emergency Medical Data.**

## Netlink Pilots sites location

**France**
**Italy**
**Germany**
**Canada (Quebec)**

## French-German pilot site

_**Main Objectives:**_** **
**Simplification of administrative procedures for French dialysis patients treated in Germany,**
**Secure Remote German Database Access for French Health Professionals,**
**Pilot site between Strasbourg (University Hospital and CPAM) and German Dialysis Centers (Achern & Offenburg Areas).**
_**Bilateral agreements**_** under preparation.**

## French-Italian pilot site

_**Main objectives:**_
**Administrative procedure simplification,**
**Emergency data usage.**
_**2 areas involved:**_
**Nice in France (CHRU NICE),**
**Imperia, Pinerolo, Bolzano, Trento in Italy.**
**Patient and Health Professional Smart Cards.**
_**Bilateral agreements**_** under preparation.**

## Netlink French pilot functions

_**NICE Hospital cluster**_** (CHRU):**
**To host Italian Card holders in Emergency Situation,**
**To update Netlink French Health Cards with EDS.**
_**STRASBOURG Hospital**_** (CHU):**
**To send French Card holders to German Dialysis Centers (Hospitals), **
**To let French Health Practitioners to have Secure Access to Remote German Nephrology Databases.**

## Netlink French pilots set-up

_**Bilateral agreements under preparation:**_
**Netlink compliant French Health Cards to be updated  with **_**Emergency Medical Dataset**_** for patient going abroad (Italy),**
_**Procedure Simplification**_** when patient abroad (Italy, Germany) in an Emergency situation (E111/E125 forms for medical fees reimbursement),**
_**Procedure Simplification**_** for patient having dialysis health care in a German Hospital (E112 form). **

## Canadian (Quebec) pilot status

**CHARL Project, since September 1999**
_**Health Information system based**_** on:**
**2 Smartcards (Patient and Health Professional),**
**2 usages for the SmartCards:**
**Patient data storage,**
**Security for access and update,**
**Patient folder hold in the SmartCard additionally to other clinical information.**
**10 000 cards issued (9000 PDC, 1000 HPC).**

## Planning Year 2000

**May****	****	****Netlink compliant cards in Quebec**
**June ****	****	****French-Italian Pilot Kick-Off**
**July****	****	****French-German Kick-Off**
**October****	****	****Evaluation and Exploitation Plan**
**December****	****Closing the Project**

## Italian situation & work status

**Italian situation & work status**

## Conclusion

**Netlink is actually beyond implementation of nation-wide Social and Health Care solutions based on Smart Cards and Telematics Applications.**

## Questions & Answers

**Noël Nader**
**Netlink Project Coordinator**
**GIE SESAM-Vitale**
**2, Alexandre Oyon blvd, 72019 Le Mans (France)**
**Wired:****	****+33 2 43 57 44 59**
**Mobile:****	****+33 6 20 44 01 55**
**E.mail:****	****Noel.Nader@sesam-vitale.fr**
**http://www.sesam-vitale.fr/Projects/Netlink-G7-En/**

## Thank you !