36th International Conference (Mauritius)
16th October 2014
Panel 7: E-Health and Data Protection
The electronic health records in
Luxembourg
Gérard Lommel (President)
The electronic health records in Luxembourg
Healthcare systems in Europe
 Largely publicly funded and build on compulsory
“social security” insurances (universal health care)
 Challenges:
– The demand for health care is rapidly growing as a
result of ageing populations and of rising public
expectations
– How to keep Healthcare systems able of delivering
equal, efficient and high quality services at affordable
cost without:
• avoiding redundancy of medical acts and
unnecessary care
• encouraging a closer interdisciplinary cooperation of
professionals and a coordinated follow up of
treatments and care
– Make it ready for integration of advanced eMedecine and
mobile technologies
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The electronic health records in Luxembourg
Healthcare systems in Europe
 Can the introduction of “electronic health records”
and a new coordination role of a referred doctor be
the answer to these challenges?
– Make existing data and a comprehensive information
about the patient available helps to ensure best quality of
treatment and follow up
– guidance by a dedicated referring doctor should help to
avoid inefficient consumption of health services
– Enhanced cost efficiency helps control & reduce the
rapid growth of health care costs (avoiding duplication
and unnecessary examination and treatments)
– But the new gatekeeper function raises critics, as it
might limit free access to medical consultation and care
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The electronic health records in Luxembourg
Enhanced sharing of patient information:
a key element of eHealth policy
 Since 10 years, the EU Commission promotes national
eHealth strategies
 Stimulating the set up of:
– Health Portals on the Internet for a comprehensive patient information
– Nationwide directories of health professions by region and
specialization
– Collaborative platform facilitating a personalized interaction
among physicians
– Regional and nationwide EHR systems for :
• the sharing of individual patient information by all health
professionals enrolled in care
• chronological record of examinations & medication delivery and
registration of diagnostics/intervention reports
• ePrescription, prepare for smart new technologies …
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The electronic health records in Luxembourg
Other elements of eHealth policy
 In parallel:
– More focus on preventive health policy
– Boosting of statistical data gathering on entire health
population and development of multiple monitoring tools
– Enhanced secondary use of medical data for analytics
and scientific research
 Prepare for integration of new electronic medical devices
and mobile solutions in existing IT systems
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The electronic health records in Luxembourg
Exchange of medical data via a cloud platform
 Compatible with the Medical secrecy obligation?
(the Duty of confidence)
 Threats for privacy and data security:
– The whole consultation and care history of each patient
will be laid down in a central register
– More and more patient data are gathered and accessed
from anywhere by a great number of praticioners
– Data confidentiality and security risks (data hosted
centrally and accessed through a cloud system)
– Secondary use of anonymized data is made possible for
statistical purposes and scientific research
 Importance of trust to win the adherence of the
public to such a large-scale and sensitive project
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The electronic health records in Luxembourg
Introduction of EHR in Luxembourg
 Method chosen by the Data Protection Authority for
assessing privacy risks and data protection = PIA
Privacy Impact Assessment
– Constructive dialogue between CNPD and “eSanté”agency (in charge of the developpment of the system
and running of the EHR platform)
– “Privacy by design” methodology best fitting to the
scope and sensitivity of the project
 Important to build trust through transparency and
a high level of implemented safeguards
 Public acceptance of our intervention is crucial for
the credibility of Luxembourg’s DPA’ action
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The electronic health records in Luxembourg
Privacy Impact Assessment (PIA)
 Evaluation of the model (central indexation, partly
decentral storage) and its technical & operational
properties
 Detailed analysis of all potential privacy risks and of
the validity of implemented safeguards which are to
be examined with their long-term consequences
 The PIA grid will continue to be a part of our
monitoring of the further evolution of the “eSanté”management
 Close look on ways of expression of patient
consent/opt-out and tools for giving him own control
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The electronic health records in Luxembourg
Main focus of the PIA
 The technical security measures
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–
–
–
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architectural design of the system,
security of data communication (transmission ways),
security of data storage,
encryption policy
advanced anonymisation techniques, ...
 The organisational data governance
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code of conduct for all implicated actors,
implementation of a data security policy,
business continuity plans,
audit policy, ...
 The data accountability
– respect of a patient’s self determination and a proper privacy policy,
– limitation of data exchange to the needs of treatment, care, follow-up, etc.
– granular definition and control of limited access rights (e.g. EHR matrix
habilitation),
– prevention of abuse, tracing of all accesses,
– facilitation of data subjects rights,
– Transparency and appropriate information policy.
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The electronic health records in Luxembourg
Informational self-determination
 Opt-out: Each person covered by social security will
automatically get an EHR. He can however decide to
deactivate it at any time
 Patients get own control over what information may be
shared: they can hide certain data/documents (of
sensitive nature) from a particular practitioner or
completely ban them from sharing across the system
 The patient can add personal comments or particular
information about his well-being to the EHR (personal
expression space)
 The patient can verify any time who accessed his EHR
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The electronic health records in Luxembourg
Public criticism
 A patient right organization claimed for:
– leaving a full “opt-in”-choice to the patient : explicit consent
asked before his EHR is activated and for each including of
data and documents
– a more detailed and comprehensive code of conduct
applicable to the medical and administrative staff with severe
sanctions established for cases of misuse and data
confidentiality breach
– stronger technical security measures
– stricter conditions for one-time access allowed to medical
staff by-passing the normal justification in urgent situations
– User friendly controls for the patients over their health data
– the creation of a specific supervisisory body
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36th International Conference (Mauritius)
16th October 2014
Panel 7: E-Health and Data Protection
The electronic health records in
Luxembourg
Questions?
Commission nationale pour la protection des données
1, avenue du Rock’n’Roll
L-4361 Esch-sur-Alzette (Belval)
261060-1
www.cnpd.lu
info@cnpd.lu