1 With the support of the European Commission HPRO Card The European professional card Chisinau, June 2013

2 With the support of the European Commission  Project history  Towards interoperability of smart cards to ensure patient safety  Project philosophy  Project details and results  The situation today

3 With the support of the European Commission  Project history  Towards interoperability of smart cards to ensure patient safety  Project philosophy  Project details and results  The situation today

4 With the support of the European Commission Objectives:  Ensure patient safety throughout Europe  Facilitate the mobility of health professionals in all Member States

5 With the support of the European Commission European Directive on the recognition of professional qualifications  Directive published in the Official Journal in September 2005  Facilitate the recognition of qualifications  New : temporary provision of services. A professional legally established in a Member State may provide services in another Member State on a temporary basis more easily.

6 With the support of the European Commission « The introduction, at European level, of professional cards by professional associations or organisations could facilitate the mobility of professionals, in particular by speeding up the exchange of information between the host Member State and the Member State of origin. This professional card should make it possible to monitor the career of professionals who establish themselves in various Member States. … ». (Whereas 32) European Directive on the recognition of professional qualifications

7 With the support of the European Commission « … Such cards could contain information, in full respect of data protection provisions, on the professional's qualifications (university or institution attended, qualifications obtained, professional experience), his legal establishment, penalties received relating to his profession and the details of the relevant competent authority. » (Whereas 32) European Directive on the recognition of professional qualifications

8 With the support of the European Commission Report of the EP: « Impacts and consequences of the exclusion of health services from the Directive on services in the internal market » (2006/2275-INI Rapporteur Bernadette Vergnaud, adoption on May 2007) Report of Bernadette Vergnaud, MEP

9 With the support of the European Commission « The Commission was asked to set up a system for collecting data and exchanging information between the various national authorities on health care providers, and to set up a European card to provide access to information on the skills of health care professionals. That information should be available to patient. In the context of increased professional mobility in Europe, the Commission was asked to establish a legal duty for national authorities to exchange registration and disciplinary information about health care professionals in order to ensure patient safety. » Report of Bernadette Vergnaud, MEP

10 With the support of the European Commission  Project history  Towards interoperability of smart cards to ensure patient safety  Project philosophy  Project details and results  The situation today

11 With the support of the European Commission Creation of the HPRO card group  2007 Creation of a European and interprofessional working group (doctors, dentists, midwives, pharmacists, nurses)  Meetings in different European countries  October 2007 Presentation and adoption of the visual face of the European Parliament  July 2007 presentation of the project to the European Commission (DG Empl)  February 2008 allocating a grant from the European Commission project (interoperability)

12 With the support of the European Commission Specifications of the card Credit Card Size 2 sides : -a national side (specific to each profession and each Member State) -An harmonised European side

13 With the support of the European Commission  Specific to each profession and each Member State.  Including the necessary information for the recognition of the holder with his signature and photo  The registration number  The expiration date  (A chip) and security hologram The Brussels agreement – The nationale side

14 With the support of the European Commission  A harmonized presentation  The profession  The details of the competent registration authority The Brussels agreement – The European side All information should be written in two languages ​​ (the national language and a language of international understanding)

15 With the support of the European Commission Sharing of health data and protection of medical confidentiality The development of communicating healthcare applications (EHR, health data collection, …) is a chance for the health system, and the future of Europe But it raises... the problem of the protection of patient privacy, basis of professional ethics (Oath of Hippocrates, Oath of Galen, Code of Ethics) In this new context, the use of reliable means to ensure the electronic recognition of the identity and qualifications of the applicants to access to patient records is essential

16 With the support of the European Commission  Project history  Towards interoperability of smart cards to ensure patient safety  Project philosophy  Project details and results  The situation today

17 With the support of the European Commission Who will use the card? All health professionals listed in Directive 2005/36/EC and which benefit from automatic recognition of their qualifications: doctors, dentists, midwives, nurses and pharmacists.

18 With the support of the European Commission Who will issue the card?  The competent authorities (CAs) as listed in EU Directive 2005/36/EC.  « ‘competent authority’: any authority or body empowered by a Member State specifically to issue or receive training diplomas and other documents or information and to receive the applications, and take the decisions, referred to in this Directive «

19 With the support of the European Commission How the system will work?  Direct request in the database of the competent authority of the country of origin, via the chip …/…  Updated constantly with chip  No need to create a new database at European level

20 With the support of the European Commission Database of the country of origin Database of the host country Health professional Card Card Request on the right to exercise Competent authority Employer or government Border Respons e Information 1 Example of architecture Information 2 Country of origin Host country

21 With the support of the European Commission How the system will work?  Direct request in the database of the competent authority of the country of origin, via the chip …/…  Updated constantly with chip  No need to create a new database at European level

22 With the support of the European Commission  Project history  Towards interoperability of smart cards to ensure patient safety  Project philosophy  Project details and results  The situation today

With the support of the European Commission 23 7 partners + 20 support partners = 13 States Members (AT, BE, BG, CZ, ES, FR, HU, IT, LU, PL, SK, SE, UK) + other countries in working groups (CH, DE, EE, GR, MT, NO, RO, SI) Partners

With the support of the European Commission 24 Work packages list WP1 : Identification of the competent authorities for health professionals in EU WP2 : Identification of health professionals cards in Europe WP3 : Conditions for implementation of strong authentication of health professionals WP4 : Interoperability between different health professionals authentication systems WP5 : Project management WP6 : Dissemination

25 With the support of the European Commission WP1 - Results How many competent authorities in EU ? about 893 competent authorities identified  They can be classified in two main categories : - Professional organizations: Orders, Chambers, Associations … -State organizations: Ministry of Health, Agencies, -Health insurance…  Depending on the administrational and political organization of each country, they can be organized at the: - National level (Sweden, Estonia …) - Regional level (Germany …) - Local level (Italy …) Health professionals’ competent authorities

With the support of the European Commission 26 WP1 and 2 Madrid Brussels Stockholm Luxembourg Oslo Krakow Tallinn Budapest London Athens Professions or countries partners

27 With the support of the European Commission For example : Workflow for Estonia HP Diploma’s provider Right to practise provider Sanction’s provider Id’s provider HP card’s provider training diploma registration documents right to practice / or not registration documents identifier sanction / no sanction registration documents HP card (Initial procedure or changes in the professional situation) University 2 Health care colleges**** Health Care Board* * governmental agency, which started operations on 1st of January 2002 under the jurisdiction of the Ministry of Social Affairs, according to the Health Services Organization Act ** one association by profession, the sanctions are not registered (due to regulation on privacy) *** there is no plan to issue professional cards **** for nurses and midwives Conclusion for Estonia : Competent Authorities = Health Care Board Professional associations** Health Care Board* Automatic calculation of the Code in the registry (Kood) Id Card (for all citizens***) with : Name, Surname, Id Code, Date of birth, Date of validity… State Agency National level

28 With the support of the European Commission For example : Workflow for Spain HP Diploma’s provider Right to practise provider Sanction’s provider Id’s provider HP card’s provider training diploma registration documents right to practice / or not registration documents identifier sanction / no sanction registration documents HP card (Initial procedure or changes in the professional situation) Universities Regional Medical Councils* * 52 Regional Medical Councils in the 17 autonomous regions dental surgeons ?? pharmacists ??, nurses ??, midwives ?? ** CGCOM : El Consejo General de Colegios Oficiales de Médicos : The Spanish Medical Association groups together all Autonomous and Regional Medical Councils, and is the responsible of the relations with State Government and at the international level. *** Barcelona, Girona and national level Regional Medical Councils in coordination with CGCOM** : smart cards Regional Medical Councils* CGCOM** CGCOM** : Central Registration Database Central Ethics Commission Regional Medical Councils in coordination with CGCOM** Conclusion for Spain : Competent Authorities for Doctors = OMC 52 …/… 3*** Professio nal agency Regional level

29 With the support of the European Commission WP1 - Results How many professionals in EU ?  WHO’s database Physicians: Dental practitioners: Pharmacists: Nurses: Midwives: healthcare professionals in Europe  HPRO Card’s database 10 to 35% of discrepancies between WHO and HPRO databases e.g. this represents a difference of HCP in Belgium, HCP in Poland 52% of discrepancies for Spanish nurses (= nurses) 87 % of discrepancies for Swedish pharmacists (= 2500 pharmacists) Different dates, different definitions (active/non active persons…)

30 With the support of the European Commission graduated as health professionals Exercising in healthcare In contact with patients (care) WHO’s focus on:

31 With the support of the European Commission Health professionals’ identity documents Some countries have no card. For example, Poland issues a professional passport and Luxembourg has a paper certificate Some have plastic or paper cards. For example, France or Ireland WP2 - Results

32 With the support of the European Commission Exemples of Existing health professionals’ smart cards Austria  Pharmacists (Apothekerausweis)  Doctors in contract with social insurance (Ordinationskarte or o-card) France  All professions (Carte de Professionnel de Santé CPS) Germany  Doctors (Arztausweis) Hungary  Doctors Italy (Lombardy)  All professions (Carta SISS) Netherlands  All professions (UZI-pas) Portugal  Dentists Slovenia  All professions (Profesionalna kartica) Spain (3 regions)  Doctors (Carné de médico colegiado) Sweden  All professions (SIS card and SITHS card) UK  All professions (NHS CRS smartcard)

33 With the support of the European Commission eID card used by the doctors, for instance in Estonia Potential eID card used by doctors in Norway ? e-Identity cards for health professionals

34 With the support of the European Commission Databases/Repositories Some examples :  Austria: doctors  Czech republic : doctors, dentists and pharmacists  Denmark : doctors, dentists, nurses and midwives  Estonia: doctors and pharmacists  France: all regulated professions  Lithuania : all regulated professions  Ireland: nurses and midwives  Norway : all regulated professions  Poland: doctors and dentists  Portugal : dentists  Spain: doctors  UK: doctors and pharmacists WP4 - Results

35 With the support of the European Commission Evidenční číslo: Evidence number Jméno a příjmení: Name and surname Místo výkonu povolání: Instead profession Odbornost: Expertise Licence: License In the register there are additional information (non public ones) : date of birth address Databases/Repositories WP4 - Results

36 With the support of the European Commission Databases/Repositories WP4 - Results

37 With the support of the European Commission Demonstrators: German cooperation  A health professional wants to practice in another EU State Member for a temporary providing of services.  Studied issue : at which conditions he can use the workstation + card reader + application of the foreign country ?

38 With the support of the European Commission Upload file Download file Country A Country B Authentication signature Demonstrators: German cooperation

39 With the support of the European Commission  A doctor has to access medical data of a foreign patient in the patient’s country of origin  Studied issue : at which conditions he can authenticate himself and receive the access rights ? Demonstrators: Spanish cooperation

40 With the support of the European Commission Demonstrators: Spanish cooperation Reply French medical consultation Spanish hospital Form and signature (PDF) Phase 1 Phase 2 Phase 3 Verification request Reply Verification request Spanish Medical Chamber French Order of doctors Spanish patient

41 With the support of the European Commission  A pharmacist has to access medical data of a foreign patient in the patient’s country of origin  Studied issue : at which conditions he can authenticate himself and receive the access rights ? Demonstrators: Belgian cooperation

42 With the support of the European Commission French health assurance card Belgium pharmacist card French pharmacist card French pharmaceutical record (4 months-history of delivered medicines in every French pharmacies) Demonstrators: Belgian cooperation

43 With the support of the European Commission  A health professional wants to be recognized as a health professional in another country  Studied issue : how can we verify the authenticity of his card ? Demonstrators: Belgian cooperation

44 With the support of the European Commission Card number Result Website Demonstrators: Belgian cooperation

45 With the support of the European Commission  Project history  Towards interoperability of smart cards to ensure patient safety  Project philosophy  Project details and results  The situation today

46 With the support of the European Commission Work on the Directive 2005/36 a debate between MEPs and national Members of Parliament (MPs) " The internal market for professionals: how to make it work? Improving the Recognition of Professional Qualifications”. October 26, 2010 Internal Market and Consumer Protection Committee (IMCO) of the European Parliament Bernadette Vergnaud, MEP Michel Barnier, Commissioner for the internal Market

47 With the support of the European Commission Work on the Directive 2005/36  Steering Group on the European Professional Card  President : Michel Barnier, Commissioner for the internal Market  Several meetings from January 2011 to September 2011  Green paper “Modernising the Professional Qualifications Directive “  Single Market Act, Krakow, 2-4 October 2011  “A card to:  simplify mobility in Europe  replace the requirement to provide numerous documents  optional  useful to the competent authorities  inked to a database available to the competent authorities  (consumers or employers) would be reassured that the professional is fully qualified”

48 With the support of the European Commission Revision of the Directive 2005/36  19 December 2011 : European Commission proposal  October 2013 : Approval expected in the European Parliament  One of the main new issues : THE EUROPEAN PROFESSIONAL CARD  In the main body of the text (before, in a whereas)  Conceived as an alternative (not mandatory for professionals) to the current recognition procedure, with the objective to ease the process

49 With the support of the European Commission Revision of the Directive 2005/36 The “card” will be issued to migrating professionals by the competent authority of the home Member States Conditions set by Member States for implementation : - professions with significant mobility (or potential), - education regulated in a significant number of States - sufficient interest by the stakeholders

50 With the support of the European Commission Revision of the Directive 2005/36 The “card” is now conceived as an electronic certificate linked to the IMI system The current concept: an electronic certificates embedded in different media (card, smartphone…)

51 With the support of the European Commission THANK YOU Patrick FORTUIT Ordre national des Pharmaciens Tel: 0033/ Mariane CIMINO