1. AORTA National IT-infra for healthcare applications Karel de Smet IT architect NICTIZ Noordwijkerhout, The Netherlands 2005 May 5th

2. Agenda Current IT in health care NICTIZ purpose National IT infrastructure –HC information broker –National citizen register –National HC provider register –HC provider directory

3. HC Chain Management PatientGPSpecialistPharmacistOther HC provider

4. Current IT-facilities PatientGPSpecialistPharmacistOther HC provider GPISHISPhISxIS

5. Problems due to shortcoming IT Wrong medication prescriptions Redundant examinations Double registrations Insurance fraud Administrative burden etc.

6. Current IT developments GPSpecialistPharmacistOther HC provider GPISHISAISxIS AIS PhIS RIS LIS Regional network SMTP/POP3 VPN HL7 MLP TCP/IP OZIS: Edifact SMTP xDSL HC Insurer IS Insurance infra: Edifact/XML Web GPpost IS ASP

7. NICTIZ purpose PatientGPSpecialistPharmacistOther HC provider National Health Care Record

8. Where to store HC data? Chipcard with patient –however law says: HC provider responsible National database –however privacy law does not allow With HC providers –possibly regional/categoric central database

9. HC Information Broker GPSpecialistPharmacistOthet HC provider GPISHISPhISxIS HC Information Broker -> pull HC data (query) -> push HC data (orders, notifications)

10. How to find HC data? HC provider wants: –correctness –up-to-date –completeness

11. Pull: whom to send a query? GPSpecialistPharmacistOther HC provider GPISHISPhISxIS HcIB RI Reference index Citizen register National citizen number Query

12. Citizen register National citizen number Given name Birth surname Birth date Birth place Sex Address

13. Law concerning HC data HC provider: –professional secrecy –needs patient permission –only in emergency cases Patiënt: –obligation to provide information –right to read, copy, append, destroy HC data

14. Authorisation mechanism when HC provider queries HC data: –is there a treatment relation? –is he directly involved? –does he need the data? –did patiënt give permission? –is privacy of a third involved? –is it an emergency case?

15. Pull: how to protect HC data? GPSpecialistPharmacistOther HC provider GPISHISPhISxIS HcIB RI Citizen register LOG Access log Provider register National HC provider number APT Authorisation protocol APF Authorisation profile

16. HC provider register National HC provider number Name Profession Specialism, if any HC organisation PKI certificates

17. Push: where to send an order? GPSpecialistPharmacistOther HC provider GPISHISPhISxIS HcIB Citizen register Provider directory HC provider Contact data ACT Application Conformance Table Provider register Order

18. HC provider directory National HC provider number Name, Profession, Specialism, … Availability of services Contact data: –Visiting address, mail address –Telephone numbers –E-mail adress –URL organisation –HL7 application ID

19. National IT infrastructure GPSpecialistPharmacistOther HC provider GPISHISPhISxIS HcIB RI LOG APT APF interoperability: HL7v3 SOAP HTTP security: PKI SSL scalabilitymanagement by SSC response timesup to date Citizen register Provider directory Provider register

20. Well Managed HC system GPSpecialistPharmacistOther HC provider GPISHISPhISxIS HcIB RI LOG APT APF availability up-to-date security interoperability Citizen register Provider directory Provider register

21. The End