1. Information management in the Belgian social and health care sector
Frank Robben
General Manager CBSS and eHealth platform
CEO Smals
Sint-Pieterssteenweg 375
B-1040 Brussels
Website CBSS:
eHealth platform portal:
Personal website:

2. Structure of the presentation
about me
stakeholders of the Belgian social and health care sector
divisions of tasks with regard to eGovernment/eHealth in the social and health care sector
implementation order used by the CBSS in the social sector (start up 1991)
achievements in the social sector
advantages in the social sector and international recognition
creation of the eHealth platform (start up 2008)
principles implemented in the health care sector
achievements in the health care sector
advantages in the health care sector
critical success factors
Smals, an organisation specialised in information technology and related competencies
June 20th, 2011

3. About me
°1961
studied law, ICT, ICT audit, business administration and personal coaching in Leuven, Antwerp, Tübingen, Munich and Boston
: advisor to the Belgian Minister of Social Affairs
: advisor to the Belgian Prime Minister
1990-now: co-founder Interdisciplinary Center for Law and ICT at KULeuven
1991-now: member of the Belgian Privacy Commission
1991-now: founder and general manager Crossroads Bank for Social Security
: founder and president of Fedict and co-developer of the Belgian electronic identity card
2004-now: general manager Smals
2008-now: founder and general manager eHealth-platform
see
June 20th, 2011

4. Stakeholders stakeholders of the Belgian social sector
> 11,000,000 citizens
> 220,000 employers
about 3,000 public and private institutions (actors) at several levels (federal, regional, local)
stakeholders of the Belgian health care sector
> care providers (medical practitioners, dentists, clinical laboratories, pharmacists, physiotherapists, home nurses, …)
> 300 care institutions (hospitals, residential care homes, …)
health insurance funds
government institutions
June 20th, 2011

5. Division of tasks same division of tasks in both sectors
no central data storage but secured exchange of data
Crossroads Bank for Social Security (CBSS) in the social sector and eHealth platform in the health sector act as service integrators
common vision
driving force for change and change management
solid ICT architecture and performant basic ICT services
in charge of a highly protected ICT-cooperation platform, with a reference directory for
access control
routing
in some situations, automatic communication of alterations
process optimization, lateral way of thinking
standards
quality
information security
technical and semantic interoperability
cross-actor program and project management
training and coaching
June 20th, 2011

6. Division of tasks actors (or their ICT service providers)
development of value-added services for internal purposes (for themselves and their co-workers) and external purposes (for the citizens, companies, …)
information management according to agreed division of tasks
Smals, an association specialised in information technology and related competencies, owned by the public actors in the social and health sector
hires ICT-specialists at normal market conditions and puts them at the disposal of its members
elaborates shared ICT-services for its members (e.g. data centers, monitoring and supervision of applications, portal environments, …)
executes (common) projects for its members
has a research and development center for its members (recent European patent application for electronic (health) vault)
June 20th, 2011 6

7. Implementation order used in the social sector
common vision on information management and information security
demonstration of feasibility
political and public support, support of the social partners, support of the social security institutions
basic legislation
creating an institution as a driving force (CBSS has been created in 1991) and a control committee on information security and privacy protection
translating the common vision on information management and information security
integration of unique identification key in all information systems
June 20th, 2011

8. Common vision on information management
information is being modelled in such a way that the model fits in as closely as possible with the real world, in order to allow multifunctional use of information
information is collected from citizens and companies only once by the social sector as a whole, via a channel chosen by the citizens and the companies, preferably from application to application, and with the possibility of quality control by the supplier before the transmission of the information
the collected information is validated once according to established task sharing criteria, by the actor that is most entitled to it or by the actor which has the greatest interest in correctly validating it
a task sharing model is established indicating which actor stores which information as an authentic source, manages the information and maintains it at the disposal of the authorized users
June 20th, 2011

9. Common vision on information management
information can be flexibly assembled according to ever changing legal concepts
every actor has to report probable errors of information to the actor that is designated to validate the information
every actor that has to validate information according to the agreed task sharing model, has to examine the reported probable errors, to correct them when necessary and to communicate the correct information to every known interested actor
once collected and validated, information is stored, managed and exchanged electronically to avoid transcribing and re-entering it manually
electronic information exchange can be initiated by
the actor that disposes of information
the actor that needs information
the CBSS that manages the interoperability framework
June 20th, 2011

10. Common vision on information management
electronic information exchanges take place on the base of a functional and technical interoperability framework that evolves permanently but gradually according to open market standards, and is independent from the methods of information exchange
available information is used for
the automatic granting of benefits
prefilling when collecting information
June 20th, 2011

11. Common vision on information security
security, availability, integrity and confidentiality of information is ensured by integrated structural, institutional, organizational, HR, technical and other security measures according to agreed policies
personal information is only used for purposes compatible with the purposes of the collection of the information
personal information is only accessible to authorized actors and users according to business needs, legislative or policy requirements
the access authorization to personal information is granted by an independent Sectoral Committee of the Privacy Commission, designated by Parliament, after having checked whether the access conditions are met
the access authorizations are public
June 20th, 2011

12. Common vision on information security
every actual electronic exchange of personal information has to pass an independent trusted third party (basically the CBSS) and is preventively checked on compliance with the existing access authorizations by that trusted third party
every actual electronic exchange of personal information is logged, to be able to trace possible abuse afterwards
every time information is used to take a decision, the information used is communicated to the person concerned together with the decision
every person has right to access and correct his/her own personal data
every actor in the social sector disposes of an information security officer with an advisory, stimulating, documentary and control task
June 20th, 2011

13. Implementation order used in the social sector
implementation of the ICT architecture and the basic ICT services
controlled access to databases with authentic data
re-engineering of processes between actors in the social sector at all government levels
re-engineering of processes between actors in the social sector and companies
re-engineering of processes between actors in the social sector and citizens
always combined with the necessary legislative changes
June 20th, 2011

14. Achievements in the social sector
a network between all 3,000 social sector actors with a secure connection to the internet, the federal MAN, regional extranets, extranets between local authorities and the Belgian interbanking network
a unique identification key
for every citizen, electronically readable from an electronic social security card and an electronic identity card
for every company
for every establishment of a company
an agreed division of tasks between the actors within and outside the social sector with regard to collection, validation and management of information and with regard to electronic storage of information in authentic sources
June 20th, 2011

15. Achievements in the social sector
NOSS
FPS SS
NOSS-PLPS
NISSE
citizen and
company
ASI
HVZ
FPS
ELSD
RKW
NEO
Crossroads Bank
for
Social Security
PDOS
interPI
network
RIZIV
FAO
NIC:
sickness fund
network
FOD
SIGEDIS
RVP
RJV
OSSO
other social sector actors
June 20th, 2011

16. Achievements in the social sector
225 electronic services for mutual information exchange amongst actors in the social sector, defined after process optimization
nearly all direct or indirect (via citizens or companies) paper-based information exchange between actors in the social sector has been abolished
in 2010, 700 million electronic messages were exchanged amongst actors in the social sector, which saved as many paper exchanges
electronic services for citizens
maximal automatic granting of benefits based on electronic information exchange between actors in the social sector
13 electronic services via an integrated portal
about 30 new electronic services are foreseen
June 20th, 2011

17. Achievements in the social sector
42 electronic services for employers, either based on the electronic exchange of structured messages or via an integrated portal site
50 social security declaration forms for employers have been abolished
in the remaining 30 (electronic) declaration forms the number of headings has on average been reduced to a third of the previous number
declarations are limited to 4 events
immediate declaration of recruitment (only electronically)
immediate declaration of discharge (only electronically)
quarterly declaration of salary and working time (only electronically)
occurrence of a social risk (electronically or on paper)
in 2010, 25 million electronic declarations were made by all 220,000 employers, 98 % of which from application to application
June 20th, 2011

18. Achievements in the social sector
an integrated portal site containing
electronic transactions for citizens, employers and professionals
simulation environments
information about the entire social security system
harmonized instructions and information model relating to all electronic transactions
a personal page for each citizen, each company and each professional
an integrated multimodal contact centre supported by a customer relationship management tool
a data warehouse containing statistical information with regard to the labour market and all branches of social security
June 20th, 2011

19. Useful tool: the reference directory
directory of available services/information
which information/services are available at any actor depending on the capacity in which a person/company is registered at each actor
directory of authorized users and applications
list of users and applications
definition of authentication means and rules
definition of authorization profiles: which kind of information/service can be accessed, in what situation and for what period of time depending on in which capacity the person/company is registered with the actor that accesses the information/service
directory of data subjects
which persons/companies have personal files at which actors for which periods of time, and in which capacity they are registered
subscription table
which users/applications want to automatically receive what information/services in which situations for which persons/companies in which capacity
June 20th, 2011

20. Useful tool: the social security card
name
Christian name
date of birth
sex
social security number
period of validity of the card
card number
sickness fund
sickness fund registration number
insurance period
insurance status
social exemption status
key 1
key 2
other data to be added in the future,
if useful
June 20th, 2011

21. Useful tool: the electronic identity card
June 20th, 2011

22. Uselful tool: the electronic identity card
identification of the holder
name
Christian names
nationality
date and place of birth
sex
identification number of the National Register
main residence
manual signature
electronic authentication of the identity of the holder (private key and certificate)
possibility for the holder to sign electronically (private key and certificate)
no encryption certificate
no electronic purse
no biometric data
June 20th, 2011

23. Advantages gains in efficiency
in terms of cost: services are delivered at a lower total cost
due to
a unique information collection using a common information model and administrative instructions
a lesser need to re-encoding of information by stimulating electronic information exchange
a drastic reduction of the number of contacts between actors in the social sector on the one hand and companies or citizens on the other
a functional task sharing concerning information management, information validation and application development
a minimal administrative burden
according to a study of the Belgian Planning Bureau, rationalization of the information exchange processes between the employers and the social sector implies an annual saving of administrative costs of about 1.7 billion € a year for the companies
June 20th, 2011

24. Advantages gains in efficiency
in terms of quantity: more services are delivered
services are available at any time, from anywhere and from several devices
services are delivered in an integrated way according to the logic of the customer
in terms of speed: the services are delivered in less time
benefits can be allocated quicker because information is available faster
waiting and travel time is reduced
companies and citizens can directly interact with the competent actors in the social sector with real time feedback
June 20th, 2011

25. Advantages gains in effectiveness: better social protection
in terms of quality: same services at same total cost in same time, but to a higher quality standard
in terms of type of services: new types of services, e.g.
push system: automated granting of benefits
active search of non-take-up using data warehousing techniques
controlled management of own personal information
personalized simulation environments
better support of social policy
more efficient combating of fraud
June 20th, 2011

26. United Nations Public Service Award 2006
June 20th, 2011

27. European Public Service Award 2007
June 20th, 2011

28. Creation of the eHealth platform in 2008
in 2008, based on the experience in the social sector, a new parapublic institution, the eHealth-platform, has been created by law having as an overall objective
what ?
to optimize healthcare quality and continuity
to optimize patient safety
to simplify administrative formalities for all healthcare actors
to reliably support healthcare policy and research
how ?
trough a well-organised, mutual electronic service and information exchange between all healthcare actors
with the necessary guarantees in the area of information security, privacy protection and professional secrecy
the eHealth-platform is governed by representatives of the stakeholders (health care providers, health care institutions, patients, sickness funds, relevant government institutions, …)
June 20th, 2011

29. Some evolutions in healthcare
more chronic care on top of merely acute care
remote care (monitoring, assistance, consultation, diagnosis, operation, ...)
mobile care
multidisciplinary, transmural and integrated care
patient-oriented care and patient empowerment
rapidly evolving knowledge => need for reliable, coordinated knowledge management and accessibility
threat of excessively time-consuming administrative processes
reliable support for healthcare policy and research requires reliable, integrated and anonymous information
cross-border mobility
June 20th, 2011

30. Those evolutions require ...
collaboration between all actors in healthcare, not necessarily based on centralized data storage
efficient and safe electronic communication between all actors in healthcare
high quality electronic patient records, across specialties
technical and semantic interoperability
optimized processes
guarantees for
information security
privacy protection
respect for the professional secrecy of healthcare providers
trust of all stakeholders in the preservation of the necessary autonomy and the security of the system
June 20th, 2011

31. Electronic communication also stimulates …
quality of care and patient safety
prevention of erroneous care and drugs
negative drug interaction
drug contraindications (e.g. allergies, diseases, …)
prevention of errors in administering care and drugs
availability of trustworthy databases containing information about best care practices and decision support tools
qualitative support of health care policy and health care research based on reliable, integrated and anonymized information
June 20th, 2011

32. Principles implemented in the health care sector
at first creation of an adequate governance and consultative structure about eHealth and then further implementation under control of the governance and consultative structure
stimulation of multidisciplinary and high quality electronic patient records
if the patient wishes so, gradual referencing to places where his/her personal health data are available
common patient identifier
well elaborated legal and ethical framework
patient rights
privacy protection
professional secrecy
respect for local, regional or national health care organisation structures and initiatives
never use ICT to impose change to organisational structures !
June 20th, 2011

33. Principles implemented in the health care sector
interoperable technical platform for safe and reliable electronic information exchange
based on a service oriented architecture
with common basic services provided for free such as
process orchestration
integrated portal
user and access management (ao proof of consent of patient and of therapeutic relationship between user and patient)
logging
reference directory
encryption
eHealth-box
time stamping
coding and anomyzation
eHealth vault
using technical and semantic interoperability standards
June 20th, 2011

34. Principles implemented in the health care sector
hospital
other
care
institution
other
care
provider
citizen
hospital
medical
practitioner
hub
hospital
health
insurance
fund
pharmacist
hospital
eHealth platform
basic services
hub
health
insurance
fund
NIC
hospital
health
insurance
fund
prescription server
hospital
FAMHP
RIZIV
Communities
FPS PH
June 20th, 2011

35. Principles implemented in the health care sector
special attention to information security and privacy protection
end-to-end encryption of exchanged personal health data
very thorough preventive access control
personal health data can only be exchanged with permission provided legally, by the Privacy Commission or by the patient
logging of electronic services performed (who, what, about whom, when – not exchanged personal health data !)
information safety policies and advisors in health care institutions
long-term vision combined with quick wins
concrete collaboration programs and projects with added value, e.g.
multidisciplinary electronic summary patient record
electronic exchange of (structured) information between health care providers
electronic health care prescription
simplification of administrative processes
electronic consultation of health care insurance status …
June 20th, 2011

36. Achievements in the health care sector
9 basic services are in production
27 value-added electronic services for health care actors have been implemented within 2 years by several partners, always using the basic services of the eHealth-platform
choice for a unique patient identifier and the use of an electronic identity card were very useful
initial fear of health care providers and patients has turned into enthusiasm to collaborate
June 20th, 2011

37. Achievements / Projects
numerous projects
communication system of electronic patient records between care providers
hospitals: hubs & metahub
extra muros care providers: extra-muros vault
electronic prescription
in-hospital: legal value through time-stamping and identification/authentication
ambulatory: recip-e project
handling of reimbursement requests (chapter 4)
disease en therapy registries
cancer registry, other diseases
implant registries: orthopride (hip- and knee replacements), Qermid (cardiac devices)
Evidence Based Medicine
distribution of guidelines and advice, inclusion in software packages
verification and registration of medical record software packages
semantic interoperability …
June 20th, 2011

38. Hospitals A Meta- Hub C B Hub June 20th, 2011 3: Fetch data from hub A
1: Where can we find data?
Meta- Hub
2: In hub A and C
3: Fetch data from hub C C B
June 20th, 2011

39. >110 general hospitals will join a hub in 2010-2011

40. Therapeutic relationships
Patient
Informed
consent
by the
patient
Therapeutic relationships GP
Pharmacist …
Homecare
Specialist
Software
As A
service
Own
Software
Software
As A
service
MetaHUB
Own
software
Software
As A
service
eHealth basic services
Hospital
HUB
encryption
granular access
eHealth
kadaster
NISS
eHealth
box
Extra mural vault
Cloud computing

42. Without keys X!ilqshnf2@0à Key 1 Key 2 In DB : Result :
June 20th, 2011

43. With key 1 In DB : X!ilqshnf2@0à Key 1 Key 2 Result : B8i!(mà}z1&ajt
June 20th, 2011

44. With key 2 In DB : X!ilqshnf2@0à Key 1 Key 2 Result : K9l#'ç9gnh3lk
June 20th, 2011

45. With both keys In DB : X!ilqshnf2@0à Key 1 Key 2 Result : Clear data
June 20th, 2011

46. Towards a network of service integrators
(Corve, Easi-
Wal, CIRB, …)
RPS
RPS
Extranet
region or community
Services
repository
Service
integrator
(CBSS)
Services
repository
ASS
Extranet
social
sector
Doctor
ASS
Service
integrator
(eHealth)
Internet
FPS
ASS
VPN, …
Services
respository
FPS
FEDMAN
Service
integrator
(FEDICT)
Pharmacist
Hospital
FPS
Services
repository
June 20th, 2011

47. Advantages gains in efficiency
in terms of cost: health care services are delivered at a lower total cost
due to
avoiding unnecessary multiple medical examinations
avoiding errors causing health care
a minimal administrative burden for health care providers and patients, enabling health care providers to spend the maximum available time on healthcare
in terms of quantity: more services are delivered
relevant information is available at any time, from anywhere and from several devices
services are delivered in a more integrated way: one connection to an electronic platform suffices for the use of several applications
June 20th, 2011

48. Advantages gains in efficiency
in terms of speed: the services are delivered in less time
health care can be allocated quicker because relevant information is available faster
waiting and travel time is reduced
health care providers (and patients) can interact directly with real time feedback
June 20th, 2011

49. Advantages
gains in effectiveness: better health care provision and patient safety
in terms of quality: same services at same total cost in same time, but to a higher quality standard
support of multidisciplinary and transmural cooperation
easier referrals between healthcare providers / institutions
customized valorization of knowledge
improved support in the practice of the health care provider
more transparancy to and empowerment of the patient
in terms of type of services: new types of services, e.g.
remote care
mobile care
better support of health policy and research
more efficient combating of fraud
June 20th, 2011

50. Critical success factors
common vision oriented towards gain of efficiency and effectiveness and added value for all users (citizens, companies, care providers and care institutions, actors in the social sector, …)
starting from health care and social protection objectives irrespective of government levels and actors
translated into objectives for each government level and each group of actors, according to the division of tasks and responsabilities
with derived objectives with regard to information management and information security for all actors involved
basic principles for everyone, preferably fixed within enforceable legal framework
objectives per group of actors and per actor
translated into operational programs and projects
balanced mix of long-term and quick wins
multidisciplinary approach (BPR, change management, legal aspect, technical aspect, …)
June 20th, 2011 50

51. Critical success factors
cooperative governance
directed by organs (management organs, consultative organs) in which all relevant actors are represented
oriented towards
clients
willingness to cooperate and division of tasks
trust based on transparency and respect
buy in and commitment
use of expertise and knowledge
coordinated program and project management
June 20th, 2011 51

52. Critical success factors
solid architecture
information architecture
data modelling
semantic interoperability
authentic sources complying with quality, availability and performance requirements
process architecture
chains of values developed under the coordination of service integrators
various aspects
information gathering
validation of information
information management
information supply
communication of supposed errors
June 20th, 2011 52

53. Critical success factors
solid architecture
technical architecture (SOA - service oriented architecture)
modular => flexible
reusable services => cheaper and faster time to market
scalable
oriented towards cooperation between actors
June 20th, 2011 53

54. What is Smals?
it is a non commercial organisation, owned and governed by public social security/eHealth agencies
specialised in information technology and related competencies
very focused: provides services exclusively to these agencies
exists as long as the actual social security system
1800 ICT professionals
June 20th, 2011

55. Services provided by Smals
ICT consultancy – long term missions
need for government agencies to be accountable for the Information Technology function and hence need for skilled ICT staff
legal system for recruitment of public agents less suitable for recruitment of IT specialists
public sector system lacks the flexibility to handle fast pace evolutions in ICT salaries
public sector salaries are experience based, not competence based, competencies acquired in private sector are not enough valued in public sector system
shared services
3 data centers
portals, inter organizational secured network …
projects + Research and Development
June 20th, 2011

56. Smals: an enabling organisation
modernization programs with a high degree of information technology involved are prone to failure
Smals has been able throughout the years to drastically reduce this risk
as a matter of fact though there have been issues and problems to be managed, no high profile failures were registered during several decennia
cooperation between government agencies and Smals form a specific model
June 20th, 2011

57. Smals reduces contract management
in traditional contract management for ICT projects
red tape in (government) contract procedures requires carefull, specialized and labor intensive management
it is difficult, expensive and time consuming to make a complete "description of work" (DOW)
client and contractor rarely have the same understanding of the DOW, often leading to conflictual situations
the DOW in many cases is already outdated at the moment of delivery; for the above mentioned reasons there is little or no room for flexibility
in the Smals model the client and the contractor are, by their structure, both accountable for the financial health of the project. There is less need for an elaborate DOW, little incentive for conflict and there is more flexibility should the need arise
June 20th, 2011

58. A "business also" competence pool
modernization programs are (almost) never "technology only" programs. The technicians need to know the business and its environment
a complex information system can easily be compared with a big factory, a large ship or plane or other big facilities: without a crew that understands the system as a whole as well as the details, the system cannot be kept running
Smals people are focused on the business of social security and e-Health and know the details of the system. This leads to less "starter errors", less coordination and control and getting faster up speed in projects
June 20th, 2011

59. Multi-agency projects
social security agencies also have their own internal ICT department, most of who's technicians are also provided by Smals
modernization and technology can be leveraged by cooperation between agencies. Smals facilitates common projects, due to their knowledge of the different environments, the experience of multi-agency projects and the possibility to concentrate project management and budget allocation
June 20th, 2011

60. Risk management data stay local (guaranteed)
no risk of your vendor being acquired by another company
independent management but possibility to take measures if the need should occur
Smals cannot phase out services for purely commercial reasons
no risk of bankruptcy due to shared financial responsabilities
June 20th, 2011

61. Technology watch and innovation
scale allows for investment in state of the art infrastructures
commitment of government agencies to technology watch and innovation
R&D activities shared with the technicians of all members
innovative solutions: requirements for data protection in E Health could not be met by market solutions, a novel and performing (patented) approach has been developed
June 20th, 2011

62. Interdependent engineering
an architecture is interdependent if one part cannot be created independently of the other part
interdependent architectures optimize performance in terms of functionality and reliability
new programs with new functionalities require the performance delivered by interdependent engineering
organizations in these situations must be integrated, they must control the design and the delivery of every critical component
government agencies need to control these critical resources in order to optimize chances for program success
June 20th, 2011

63. There remain challenges though …
there is no fixed price but project budgets should be predictable, how to achieve commitment and ownership from the organization and the people?
lack of market correction mechanisms threatens cost competitiveness, need for cost benchmarking against the (ICT) market in general
complement internal Smals skills with skills drawn from the general ICT market, obtain a good mix of skills
idiosyncratic financial structure requires specific precautions e.g.
risk margin on projects
risk provisions
advance payment as a rule (in public procurement advance payments are an exception)
June 20th, 2011

64. Governance aims to meet these challenges
elaborate end-to-end project management practices (chain management)
describe (SLA), follow up (monitoring), report, discuss with user organization and continuously improve EVERY service
human resources management is critical: elaborate job descriptions, introduce competence management, recruit and retain, offer career development
score cards and Key Performance Indicators
continuous communication with the member organizations, tools developed to support this communication (e.g. overall budget and progress status)
June 20th, 2011

65. More information social security portal
website Crossroads Bank for Social Security
Belgian eHealth platform portal
personal website Frank Robben
June 20th, 2011

66. Th@nk you ! Any questions ?66
11/12/2018
20 juni 2011