The table below will present a summary for each country of any reported eHealth application, showing specifically the name of the application, an URL, a summary of its use/functionality, and its operational status (fully operational – pilot – implementation stage – design phase – planning stage). Specific eSignature aspects will be dealt with in the following section.
Country Application name and URL Use/functionality Status Austria eHealth Directory Service
http://www.ehvd.at
Directory of health care professionals (HCP) and their respective roles. HCPs can apply for being registered to the directory Order) will certify the role. In addition a HCP-token (“GDA-Token”, a signed statement of the HCP’s role) can be stored on the citizen card
Operational
Belgium On-line Cancer Registry
https://www.kankerregistratie.be/wbc r/
On-line registration of cancer occurrences, thus facilitating epidemiological research
Operational
Croatia Primary Health Care Information System – PZZ
http://www.hzzo-net.hr/
General platform for eHealth communication, building on the CIHI card and local clients in the doctors’ praxes
Operational
e-zdravstveno (e-health) Application that allows businesses that are registered in the register of the Croatian Institute for Health Insurance (CIHI) to register employees and their family members.
Operational
On-line supplementary insurance
(on-line dopunsko osiguranje) Submission of proposals for supplementary health insurance
Operational
Denmark Sundhed.dk www.sundhed.dk
General platform for eHealth support, including signature functionality through OCES
Operational
National Health Telematic General platform for eHealth Pilot
Country Application name and URL Use/functionality Status Ireland HealthLinkOnline Secure transfer of patient
information over the internet between GPs and acute hospitals
Operational
Italy Sistema Informativo dei Servizi Transfusionali, SISTRA
Norway MyGP/MyDoctor (MinFastlege), an application within the MyPage (MinSide) portal
www.minside.no
Allows natural persons to change their offial GP
Operational
Slovenia e-Health Portal General platform for eHealth communication (exchange of the signature used, reported signature type, and cross border accessibility (if any).
Country Application name Signatures used Reported signature type
Qualified signatures Foreigners can obtain citizen cards. Several
federal token Qualified signatures
and simple signatures None (unless the foreign user has a Belgian eID card or token).
Croatia Primary Health Care CIHI card Advanced signatures CIHI card holders
Country Application name Signatures used Reported
(e-health) FINA card, CIHI card,
and Zagrebačka
FINA card Qualified signatures Persons holding a FINA card and
Ireland HealthLinkOnline Username, password
and PIN Simple signatures Restricted to the
health care
UZI-Register UZI-card, a smart card issued to health care professionals113
Qualified signatures UZI-card holders only (i.e. health care professionals registered in the Dutch UZI-Register) Norway MinFastlege MyID authentication
solutions Authentication based
Country Application name Signatures used Reported signature type
Cross border accessibility Slovenia e-Health Portal The professional
health card will be supported
Qualified signature Holders of the professional health presently operational, and two where applications were in pilot/design stage. eHealth applications using eSignature solutions are thus significantly fewer in number than eProcurement applications.
It should be noted that again Estonia did not provide a specific profile for eHealth applications, noting that the same signature infrastructure is universally usable (irrespective of application field).
Looking at the scope of the applications, seven of the ten descriptions relate to general eHealth platforms that could be used to securely exchange information in the eHealth sector (Austria, Croatia, Denmark, Germany, Ireland, Slovenia and the Netherlands). The three other applications related to cancer research (Belgium), blood transfusions (Italy), and changing GP (Norway).
With regard to signature solutions, and looking exclusively at the 8 operational applications, there is some diversity to be found:
• Five solutions presently rely on qualified signatures (Austria, Belgium, Germany, Italy and the Netherlands)
• Two require advanced signatures: Croatia and Denmark;
• Three applications have components that can operate on the basis of a simple signature: the Irish example relies exclusively on a simple signature, whereas the Belgian and Norwegian application support it to some extent.
When breaking down the signature types per use case in the 8 operational applications:
• For the six operational general eHealth platforms (Austria, Croatia, Denmark, Germany, Ireland, and the Netherlands), three rely on qualified signatures, two on advanced signatures, and one on a simple signature.
• For the two operational specific applications (in Italy and Norway), one uses qualified signatures and the other a simple signature.
The sample size is too small to attach significant conclusions to this distribution.
Given the sensitive nature, the need to be able to verify the professional status of a health care professional, and the link to a specific sector, it could reasonably be anticipated that interoperability initiatives would be at a less advanced stage in eHealth applications than in the eProcurement applications described above. This is indeed confirmed by the overview above: all countries restrict accessibility of the solution to the holder of national credentials.
In a number of cases, this is due to the exclusive reliance on a sector specific national card, as is e.g.
the case for Croatia (CIHI card), Germany (EGK and HBA card), Italy (EIC and NSC card), and the Netherlands (card). These cards serve to determine the capacity of the signatory (e.g. the UZI-card is only available to health care professionals registered in the Dutch UZI-Register), meaning that interoperability is much harder to achieve in this field.
It should be also noted however that for a number of applications the actual need for interoperability is also much smaller than for applications with a potentially unlimited user group. E.g. the Belgian application is targeted towards charting cancer occurrences in Belgium; the Norwegian application allows Norwegian residents to officially change their GPs; and the Italian one aims to facilitate the coordination of blood transfusions in Italy. In each of these examples, the application’s scope is delineated at the national level, which means that all users should have access to appropriate national credentials. In those specific cases, the need for interoperability is thus much smaller.
4.3.2.3 eJustice