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Importance: développer des niveaux adéquats de protection des données des patients
As of 1 June 2004 the eye-readable EHIC has become a proof of entitlement to healthcare abroad within EU/EEA countries. The idea underpinning this EU co-funded project under the e-TEN programme, is to build upon this achievement facilitating the ‘electronification’ of EHIC and ease cross-border administrative transactions.Thus, any “mobile” European citizen with his/her card and in need of non-planned medical treatment abroad can benefit from the NETC@RDS service. Netc@rds enable health practitioners to check foreign patients’ entitlement to healthcare and it is based on a General Agreement between Health Insurance Organisations (HIO) Participating actors – about 30 partnering organisations in total: … Technical/research institutes or standardisation bodies acting on behalf of health insurance organisations
Key Steps: 1. The patient presents his/her EHIC or national/regional health insurance card to the Healthcare provider (HCP). 2. HCP will read administrative data from the EHIC or national health insurance card using an Optical Card Reader or a Smart Card Reader 3. Eligibility is then verified within a few seconds by checking the administrative data via two NETC@RDS portals against the database of the relevant health insurance authority. National service portals and databases : accessed from authorised and identified health professionals and certificates are stored in different devices depending on national schemes (e.g. workstation hard disks, health professional cards, USB keys). The electronic data set is processed and used as a proof of entitlement and guarantee of cross-border reimbursement.
There are benefits measurable on several levels, linked to each of the various impacted stakeholders’ operational domain: Healthcare professionals: Able to focus on their job (delivery of care) and reduction of administrative duties Patients: Can receive the needed treatment timely; are granted entitlement like at home; are not being bored by forms, dedicated cards, cash payment, etc. Health Insurance: Can have a satisfied customer; can accrue more cost effective procedures: e.g. no calls for E111 and no paper based reimbursement; no errors in data. The Netc@rds project was officially terminated in 2011. However, about 7 countries are defining how to continue the project beyond EU funding / for greater sustainability.
Using their national electronic identities (e.g. smart card), citizens can easily access basic public services (social insurance, taxation, certificates, etc.) from abroad. STORK works towards the establishment of an interoperable platform to assist mutual recognition of eIDs across national borders . It includes 32 partners and about 12 business organisations as subcontractors. The project tests some of the most useful services for EU citizens, such as working or studying in other EU countries (e.g. requesting official certificates); The project interacts with other key EU initiatives in order to maximise the usefulness of eID services. Specifically in the domain of eHealth, STORK has conducted as part of its working programme an evaluation of links and coordination opportunities with: [email_address] : electronic EHIC, in fact, is a logical candidate to be used as ELECTRONIC PATIENT IDENTIFICATION in eHealth. epSOS : for the evaluation of which a liaison called “STORK meets epSOS (STepS)” was established. The important link between STORK and epSOS is clear given that secure identification and authentication plays a crucial role in the eHealth domain. The goal is to identify GAPS and how these can be addressed.
Today, there are around 30 million eIDs used in the EU (e.g. smart/chip cards, mobile phones, e-readers). They are used for multiple purposes, in different sectors for both public and private services. The challenge is that all MS have their own eID infrastructure . This means that there is a very varied scenario: Different MS use different ways for citizen identification; The identifier for a service may often not be used outside of the issuing country; Different identifiers are used in different sectors and/or by different service providers. The idea underlying STORK is to keep these existing national systems or infrastructures and only enhance (without changing) national solutions. Interoperability is added on top of the existing infrastructure (exactly like epSOS). STORK is to be intended as an ENABLER for different service domains (eGovernment, eHealth, etc.) and thus sector-independent or sector-neutral. The citizen accesses the services using his national eID and the STORK platform obtains the required guarantee and authentication from the national government. In this instance, data is only exchanged between MS and not shared. Privacy guarantee: USER always controls data to be sent and is required to give explicit consent before information is sent out to the service provider; Platform does not STORE any personal data , so no data can be lost either.
Clearly, in eHealth secure access and authentication of the user is the key building block to provide any eHealth service . Electronic identification and authentication is already in use in several MS for both access of patients to online healthcare services and exchange of data with healthcare providers which are part of the National Health Service. However there’s a need to enable use also abroad not just at home, to realise cross-border care. However, differently than what happens with most eGovernment services, in the case of healthcare, the user does not JUST need to identify himself for WHO HE IS , but also in terms of ‘attribute’, e.g. the ROLE he/she plays (e.g. nurse, health practitioner, patient). This is needed in addition to the basic eID data. The potential link between the three projects envisions: Use of national eIDs as a Healthcare sector entry point Facilitate interoperability of national solutions , developing interfaces and proxy solutions to enable communication between systems; Use of ‘additional attributes’ linked to the role of the person (e.g. health professional) in order to ensure authorised access to transferred data; Access to the different eHealth services (e.g. e-prescriptions) and thus to patient-related health information. We see, in particular, the high potential for synergies between the LSPs STORK and epSOS , how? - STORK has established a cross-border framework which enables the authentication of foreign eIDs; - epSOS wishes to enable both secure access to patient health information and transfer of data to healthcare providers. For both functionalities epSOS needs identification and authentication of the id of the person + authentication of the ROLE of the person to verify rights of access to data. First field tests undertaken by STORK and epSOS demonstrate that these functionalities are achievable between the two networks BUT More work is needed to tackle gaps and fine-tune potential solutions.