Building Consensus around EPrescription: the Belgian Roadmap. Dercq JP. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

1. e-Prescription in Belgium
Based on Trust and Free Basic IT Services
JP Dercq, MD

2. Some basic IT functions can be developped and used
for a lot of e-health services, including e-prescription;
This allows:
• To limit the costs (you never pay the same thing twice)
• enhancing performance (one single investment better
investment)
• by always using the same basic services, the professionnals
becomes more familiar with these;
• Basic services are developped by authority, and are free of
charge for developpers of services with added value: creativity

3. E-health services
• E-prescription: drugs, labs, medical images,
physiotherapy, care
• Messages ( reports, patient events..)
• Administrative Processes (authorization, recognition)
• Billing fee
• Patient record, specific registers ( cancer, arthritis,
orthopaedic, medical devices,….)
• Decision support, EBM, journals,
• E-monitoring
• Data Storage

4. Typical example is the
authenticated database of
professionnals
• One single permanent update; no copies
• Always available (24/24 7/7)
• Can be used to prove identity and quality
• All e-health application need this basic services

5. Ehealth.fgov.be the Belgian technical
platform wich ensures basic services

6. Ehealth.fgov.be
• Authority: availability, scalability, safety,
financial ( >1€/hab/year)
• Insurers
• Professionnals
• Services, but no personnal health data
• Personnal health data are handled under
control of Professionnals

7. Basic services
• Portail www.ehealth.fgov.be
• User management
• Physician( e-id+ dbase of professionnals, single sign on) restricted access/proven
Id
• Patient (e-id+dbase of patients),
• Systems Certificates, PC
• Loggings (track): who, what ,when
• Message: encryption, structure and vocabulary (HL7, Kmehr), codification
( ICPC, ICD, ICF, ….)
• Business processes coordination, especially for multi-business processes.
• On line Storage ( safety, availability, scalability)
• Authenticated dbases: Drugs, Professionnals, Patient, relationship P-P
• Software homologation (local software or Software as a Service)
• Data stamping (hashing as a proof of content at a time)
• Tools for Anonymity (ex.longitudinal studies)
• Free eBox for professionnals

8. Global architecture
eHealth Access
System :
identification
authentification Logging and Prescription Temporary Encrypted
Encryption Public Key Time Autorisation Monitoring
autorisation Audit Trail Data Storage
End to End Infrastructure Stamping Policy Engine See 8
See 1 System See 7
See 2 See 3 See 4
See 6
See5
ESB
Base de données des
Prescribed Care
services mis à Prescription Prescribers
Web Portal for
Providers Intermediary
disposition par les
... Process Intermediary systems
Patients
systems
mutualités Management See 15
Assurability check See 10
See 11 See 13
Other services
See 9
INTERNET
INTERNET
Prescribed Care
Prescribers Providers
Integration Integration
Archiving system Module Module
See 16 See 12 See 14
Web Services
Web Services
Prescribed Care
Prescribers Providers
Software package Workstation Software package
Other Doctor Doctor Patient Pharmacist Other Pharmacist Other

9. Insurer On line
authorization
Access
Prescription Controlled by
the profession
E-Id Professionals ( physician/pharmacist)
Patient
-Properties
Drugs - Price
-authorization
GP

10. Drugs database
Software
homologation
Market Reimbursement
Medical
Independent
Information

11. Conclusion
• Pilote Project end of 2010
• After, progressive enlargement to the whole
Country
• Incentive: authorization
• Incentive for the doctor
• Incentive for the pharmacist
• Incentive for the patient
• Trust is created by bringing the prescription
database/project under the control of
Professionnals