Through the #begov ehealth portal!
by Dries De Roeck on April 30, 2016
Last Friday I had a regular health checkup, nothing too spectacular. It was the first time my doctor mentioned that I had to decide whether I was ok with giving other health related entities access to my medical file. I asked him whether I could access this information myself, my doctor replied : “yeah, probably if you google it you will find something”.
Indeed, there seemed to be a Belgian governmental e-health site. This all seemed very regular and boring, but once I started to look for my actual medical file I was totally blown away that they put something like this online. The most excellent example of making something that is not accessible by anyone, but is supposed to serve many. Since the whole ‘experience’ was rather shocking, I want to take the time to go through (part) of the process using screenshots, in a mere 18 easy steps (not).
tl;dr
In order to access my shared medical file, I had to install java, a middleware application, a cardreader driver, a firefox extension, go through three websites, one pdf document, install an application from an unregistered developer and enter the pincode of my e-id card. If you are not a computer person, you’ll never get to see your medical file.
During the process I would expect a constant feeling of security, yet the design of this ‘flow’ could be optimised in so many ways. I’m very much an advocate of ‘don’t complain, suggest what’s better’ – but this time … I honestly wouldn’t know where to start.
Prerequisites
Before logging in, I needed to make sure I could log in to governmental services. In Belgium this is done using an e-id. In order to do so, you need some middleware software, a cardreader and the correct drivers for that cardreader. Ow yes, you also need a recent version of java, and preferably you’d be using Firefox with the e-id firefox extension installed. Suppose that you’d get through all that, you’re good to go!
Step 1: My eHealth
After logging in on the ehealth portal, this is where you end up. A rather unstructured site, with seemingly unrelated content.
Step 2: My eHealth – my details
When looking for my medical file, I’d figure I could find some pointers via my personal information. Turns out the personal info section links to a site with a totally different design where I can only update my email address. Weird.
Step 3: Online services
Going back to the homepage, I end up here. An overview of ‘services’, described in a very cryptic way. I’m still not sure what the difference between eHealthConsent and patientConsent is.
Step 4: Vitalink
After more cryptic text, this Vitalink thing seemed to be hinting towards what I was looking for : my shared online medical file. Yay! Almost there .. I figured.
Step 5: Vitalink?
Hello Vitalink. Ow, looks like there is no link between the ehealth portal and this site. I thought I said before that I was a citizen, not a caretaker (?)
Step 6: Vitalink, perhaps.
Okay, the vitalink homepage. This seems to be a place to figure out where to get info on my vaccinations and such – that sounds like my medical file!
Step 7: Let’s do this!
After spotting the ‘aan de slag’ (to work) button – I thought I was really getting close. There was even a ‘consult your data’ button (the one with the magnifying glass), exactly what I needed.
Step 8: Software
Aha, looks like I need to get some software to access my medical file. Okay, and I can’t download it from this site – but I need to get it from my health insurer. Okay…
Step 9: hello health insurer
At this point, I’m very confused. This is the third organisation I have to go through in order to access my governmentally owned health record. Or, is it not owned by the government after all? Nevertheless, I’m pushing on – I find a link to install the software on my the website of my health insurer.
Step 10: What!? A .pdf?
I get presented with a PDF. A manual in a way, or perhaps a procedure … I’m not sure. I start reading through it. It is an instructional manual of the ‘HealthViewer’ application, which is the thing I need to access my medical file. I scroll down to the installation instructions.
Step 11: Back to yet another website
Another link, to an organisation called intermut. Whatever. I laugh at the comment ‘this URL is case sensitive’.
Step 12: Sure this isn’t spam?
After clicking the link in the .pdf document, I end up here. This looks very dodgy, almost like one of those odd illegal filesharing popups. Nevertheless, I click the big green button. A .dmg file starts downloading.
Step 13: .dmg mounted!
Okay, nearing completion of this quest! Yes, I want to install the software – don’t really like installers on OSX, but not giving up now!
Step 14: Unidentified developer
My-o-my, unidentified developer. Seriously, if I’d be a less savvy OSX user – this would have been the end. In this case, I right click the installer and manage to get past this screen.
Step 15: An installer! (the 90’s called)
Yes, we’re finally good to go. Although that I haven’t seen this installer screen in a very long time – did I just timetravel to 1999?
Step 16: HealthViewer
Despite all previous steps, the software opens. It is very lowres on this retina screen. But at least I can finally log in. I make sure my eID middleware software is running and that my eID card is inserted in the cardreader … because you never know.
Step 17: Pincode
I get promted with a textbox asking my for a pincode. What pincode? The pincode of this software? Or that of my medical file? Does that even have a pincode? … I figured it might just be asking the pincode of my eID card.
Step 18 : Done!
Behold my medical file. Nice and empty. I know there should be 2 entries there somewhere, but somewhere else I found out that as a patient I can’t access my Sumehr (Summarized Electronic Health Record). Strange, again.
Why do I blog this?
I totally see the advantage of an online ehealth system. I can imagine the Belgian government worked hard to get this online, and integrate various governmental agencies, databases and other entities. But experience wise, there’s so much wrong in this flow. Nothing is clear, nor are there attempts other than long pieces of text to explain what is needed at what time. A seriously missed opportunity, but on the other hand … a very interesting evolution. I’m sure we’ll get there, some day, in a galaxy far far away.
2 comments
Hi Dries,
It’s nice to see you dedicated your time to write this blog and share your opinion and experience with ehealth in Belgium. I would like to add some much needed information and hopefully fill in the empty spaces to complete the puzzle many readers and you yourself might still have.
The patient consent and informed consent are the same things. The inconsistent use of these two words only adds to the general confusion regarding the consent.
More information about the informed consent can be found on the official website which does a better attempt at explaining this important matter. It even has a nice video that should make it clear for everyone. https://www.ehealth.fgov.be/sites/default/files/assets/patientconsent/index.html
A lot of people share the same misconception about the informed consent. Mainly the fact that any caregiver in Belgium can access all your files once you register your consent. Of course this is nowhere near the truth. Besides the informed consent a doctor has to register a therapeutic link to prove they are your caregiver. They can register this by simply asking for your eID/ISI+ or SIS card and reading your card with a card reader. Only the SIS and eID-card can be read by a card reader. The numbers on an ISI+ card must be entered manually since the card lacks a chip. They doctor requires your social security number and the number of your card to register a therapeutic link and an informed consent. Depending on the role of the caregiver the therapeutic link has a duration. For a GP for example it has a duration of 15 months, for a pharmacist it is 6 months. A doctor that you would visit on night duty can register a therapeutic link of 24 hours to access your Sumehr if shared by your GP.
The informed consent can be registered at home by yourself, by your GP, at the hospital and even at your local pharmacist or at any other caregiver that is connected with eHealth. The role of the caregiver determines the type of information they have access to and can share with others. In most cases no information is available if the caregiver doesn’t share the information they have. Which is exactly what you experienced with the Patient Health Viewer.
Vitalink is only a part of the eHealth story and only covers a part of your medical record as a patient for the Flemish community. Vitalink is a platform that enables your GP, pharmacist etc. to share the information they have gathered/shared from your health record. I can’t make it any clearer than they do themselves with read/write access matrix:
http://www.vitalink.be/Vitalink/Burgers/Gegevens/Toegang-en-rechten-op-gegevens/
With the Patient Health Viewer you will only have access to your vaccine and medication scheme as a patient at this moment.
For Brussels and Walloon you have Inter-Med/RSW that shares the same type of information as the Flemish Vitalink and the hospitals (hubs).
Your best chance at accessing medical data is by asking your GP to open up certain types of documents that are made available to the doctor by the hospitals, which are called hubs. The easiest way for you to view this would be via CoZo (http://www.cozo.be), one of the five hubs in Belgium which can access the information from the other hubs thanks to the connection called meta-hub.. Your doctor can view this information within their own medical software or access it by logging in to the website with their eID.
So there are two flows of information:
1. Information shared by the hospitals. The hospitals decide which information they share to doctors outside of the hospitable. Depending on the hub either all your information is accessible as a patient or only after your GP has made them available for you.
2. Information shared by individual caregivers, mainly by GP’s, pharmacists.
Both flows of information require your informed consent and an active therapeutic link.
I think I’ll just stop here for now. There is so much more to explain, but as you see it can be a maze if you don’t know how this system works.
I do share the same opinion that this is all very confusing and it obviously will improve over time. The patient will be able to easily access more of their information in the nearby future thanks to the current evolution of mHealth. If this all has intrigued you to learn more about eHealth and what the future has to offer for us as patients or as caregiver, I would highly recommend visiting http://www.plan-egezondheid.be/.
Kind regards,
An anonymous ehealth consultant
by NoName on May 2, 2016 at 9:28 pm. #
@anonymous ehealth consultant: thanks so much for taking the time to reply here!
I was very confident that I was for sure missing part of the story. When I was starting this journey through the maze, I had no intention to document it at all – but since the haziness of the whole journey it made sense to share my experiences (perhaps in a ‘cutting corners’ way – but I figured that would be the best way to get my point across).
Yesterday I was talking to someone in my family who is a bit more up to speed about these things too – during that conversation VaccinNet was mentioned. Which, if I got it right, is being integrated in Vitalink.
Additionally, we were talking about why patients have no access to their Sumehr – I’m not up to speed with that reasoning yet – but I can imagine there is a good reason for limiting access.
To close this comment-rant, I’ve been figuring out if I can access the vaccination data of my children – which doesn’t seem to be easy since I don’t have PIN codes of their kids-ID cards.
Nevertheless, I’m very interested in how this will all unfold – clearly a lot of parties are still figuring their roles out – which is an interesting process to follow!
by Dries on May 2, 2016 at 10:33 pm. #