{"id":37773,"date":"2018-04-01T10:28:02","date_gmt":"2018-04-01T08:28:02","guid":{"rendered":"https:\/\/gestions-hospitalieres.fr\/?p=37773"},"modified":"2018-05-29T05:41:55","modified_gmt":"2018-05-29T03:41:55","slug":"certification-hebergement-donnees-de-sante","status":"publish","type":"post","link":"https:\/\/www.ricom-web8.com\/gestions\/certification-hebergement-donnees-de-sante\/","title":{"rendered":"Certification h\u00e9bergement donn\u00e9es de sant\u00e9"},"content":{"rendered":"<span class=\"span-reading-time rt-reading-time\" style=\"display: block;\"><span class=\"rt-label rt-prefix\">Temps de lecture\u00a0: <\/span> <span class=\"rt-time\"> 3<\/span> <span class=\"rt-label rt-postfix\">minutes<\/span><\/span><h1>Une certification et un audit pour r\u00e9pondre aux limites de l\u2019agr\u00e9ment<\/h1>\n<p>Le mod\u00e8le actuel d\u2019agr\u00e9ment est en fin de vie. Pour encore quelques mois, sur les bases d\u2019une d\u00e9claration, l\u2019h\u00e9bergeur candidat exprime toute sa bonne foi dans un \u00e9norme dossier remis \u00e0 l\u2019Agence des syst\u00e8mes d\u2019information partag\u00e9s (Asip) de sant\u00e9. Le candidat ne fait l\u2019objet d\u2019aucun audit de la part des autorit\u00e9s.<\/p>\n<p>L\u2019exercice consiste donc \u00e0 \u00eatre coh\u00e9rent et cr\u00e9dible face aux r\u00e8gles \u00e9nonc\u00e9es par le minist\u00e8re de la Sant\u00e9. Et, pour certains, parfois ne pas r\u00e9aliser compl\u00e8tement ce qui a \u00e9t\u00e9 \u00e9crit\u2026 Nous comprenons tr\u00e8s vite les limites d\u2019un tel syst\u00e8me, notamment en termes de s\u00e9curit\u00e9 num\u00e9rique.<\/p>\n<p>Le mod\u00e8le de certification d\u00e9sormais propos\u00e9 par la D\u00e9l\u00e9gation \u00e0 la strat\u00e9gie des syst\u00e8mes d\u2019information de sant\u00e9 (DSSIS) et l\u2019Asip Sant\u00e9 cherche \u00e0 accro\u00eetre la confiance envers les h\u00e9bergeurs, en instaurant un audit sur site r\u00e9alis\u00e9 par un tiers ind\u00e9pendant. Et ce aux frais de l\u2019h\u00e9bergeur.<\/p>\n<p>De ce fait, le ticket d\u2019entr\u00e9e de la certification sera bien plus \u00e9lev\u00e9 que ne l\u2019\u00e9tait celui de l\u2019agr\u00e9ment, avec pour cons\u00e9quence une redistribution des cartes chez les actuels h\u00e9bergeurs d\u00e9j\u00e0 agr\u00e9\u00e9s.<\/p>\n<h1>Le paradigme du contr\u00f4le de l\u2019application<\/h1>\n<p>La r\u00e9alisation d\u2019un audit n\u2019est pas le seul changement notable. Un autre paradigme change avec la certification\u2009: le contr\u00f4le de l\u2019application.<\/p>\n<p>Dans le mod\u00e8le actuel, les h\u00e9bergeurs se sont attribu\u00e9s le contr\u00f4le de l\u2019applicatif de leur client, remplissant un vide juridique laiss\u00e9 par le d\u00e9cret instaurant l\u2019agr\u00e9ment en 2010. Cette philosophie, port\u00e9e par les h\u00e9bergeurs historiques, a permis de prot\u00e9ger ces derniers des grands <i>cloud providers<\/i>, en construisant un mod\u00e8le franco-fran\u00e7ais d\u2019h\u00e9bergement de donn\u00e9es de sant\u00e9. L\u2019intention \u00e9tait louable \u2013 prot\u00e9ger la donn\u00e9e de sant\u00e9 du citoyen fran\u00e7ais \u2013 mais elle a eu d\u2019autres cons\u00e9quences.<\/p>\n<p>Ce mod\u00e8le n\u2019a pas d\u00e9montr\u00e9 sa capacit\u00e9 \u00e0 porter l\u2019investissement massif permettant l\u2019\u00e9closion de plateformes d\u2019IoT, de <i>deep learning<\/i> ou encore de <i>big data<\/i>. En ralentissant l\u2019acc\u00e8s \u00e0 l\u2019agr\u00e9ment aux tr\u00e8s grands fournisseurs IaaSetCloud, le mod\u00e8le a peut-\u00eatre frein\u00e9 l\u2019innovation n\u00e9cessaire dans la sant\u00e9.<\/p>\n<h1>La certification change-t-elle la donne\u2009?<\/h1>\n<p>En analysant la derni\u00e8re version de travail, nous pouvons penser que oui. En retirant le contr\u00f4le de l\u2019applicatif aux h\u00e9bergeurs et en proposant un syst\u00e8me \u00e0 deux \u00e9tages, un certificat h\u00e9bergeur d\u2019infrastructure physique et un certificat d\u2019infog\u00e9reur, les autorit\u00e9s publiques obligent ou autorisent, selon les points de vue, les h\u00e9bergeurs \u00e0 une transformation de leur m\u00e9tier (<i>figure\u00a01<\/i>).<\/p>\n<button data-toggle=\"collapse\" data-target=\"#enc_2018_274_01\">FIGURE 1<\/button><div id=\"enc_2018_274_01\" class=\"encadre collapse\"><p><span class=\"surtitre_enc\">figure 1<\/span><\/p>\n<h2>H\u00e9bergeurs de donn\u00e9es de sant\u00e9<\/h2>\n<p><img decoding=\"async\" class=\"alignnone size-full wp-image-37776\" src=\"https:\/\/gestions-hospitalieres.fr\/wp-content\/uploads\/2018\/05\/Capture-d\u2019\u00e9cran-2018-05-18-\u00e0-10.34.05.png\" alt=\"\" width=\"600\" height=\"512\" srcset=\"https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2018\/05\/Capture-d\u2019\u00e9cran-2018-05-18-\u00e0-10.34.05.png 600w, https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2018\/05\/Capture-d\u2019\u00e9cran-2018-05-18-\u00e0-10.34.05-300x256.png 300w\" sizes=\"(max-width: 600px) 100vw, 600px\" \/><\/p>\n<\/div>\n<p>Rien n\u2019emp\u00eache l\u2019infog\u00e9reur d\u2019op\u00e9rer ses propres infrastructures. Dans ce cas de figure, il est titulaire des deux certificats. Cela peut \u00eatre un bon mod\u00e8le pour l\u2019univers hospitalier par exemple. Mais la certification l\u2019autorise aussi \u00e0 op\u00e9rer des plateformes fournies par les grands fournisseurs de <i>cloud<\/i> et de IaaS. \u00c0 sa charge dans ce cas-l\u00e0\u2009:<\/p>\n<ul>\n<li>d\u2019assurer le maintien en condition op\u00e9rationnelle, la s\u00e9curit\u00e9 et la conformit\u00e9\u2009;<\/li>\n<li>de proposer une couche de service innovante et compl\u00e9mentaire en ad\u00e9quation avec le besoin terrain\u2009;<span class=\"Apple-converted-space\">\u00a0<\/span><\/li>\n<li>de trouver le ou les bons partenaires respectueux de la l\u00e9gislation en vigueur mais capables d\u2019apporter cette force de frappe qui manque cruellement \u00e0 la sant\u00e9 fran\u00e7aise.<\/li>\n<\/ul>\n<p>L\u2019innovation cumul\u00e9e entre les infog\u00e9reurs et les fournisseurs IaaS et <i>cloud<\/i> publics pourrait permettre le d\u00e9veloppement de grands projets de sant\u00e9 et de recherche.<\/p>\n<h1>Des incertitudes demeurent<\/h1>\n<p>Toutefois, si les autorit\u00e9s publiques fran\u00e7aises ont retir\u00e9 aux h\u00e9bergeurs ce r\u00f4le de radar automatique de l\u2019applicatif de leur client (ce qui r\u00e8gle quelques douloureux probl\u00e8mes d\u2019\u00e9thique, avouons-le), il est \u00e0 regretter que rien n\u2019a \u00e9t\u00e9 pens\u00e9 pour le remplacer. Et pourtant, la r\u00e8gle qui veut que 80\u2009% des attaques aient lieu sur l\u2019applicatif (et non sur l\u2019infrastructure) est toujours une r\u00e9alit\u00e9.<\/p>\n<p>Il est donc important que les autorit\u00e9s publiques montent le troisi\u00e8me \u00e9tage du dispositif, qui voudrait qu\u2019un organisme tiers de confiance et ind\u00e9pendant contr\u00f4le l\u2019application traitant de la donn\u00e9e de sant\u00e9.<\/p>\n<p>De m\u00eame, le positionnement des autorit\u00e9s publiques sur l\u2019obligation des GHT \u00e0 se certifier HDS doit \u00eatre confirm\u00e9. En effet, le d\u00e9cloisonnement ville\/h\u00f4pital devient une strat\u00e9gie nationale avec, pour cons\u00e9quence, une ouverture croissante des syst\u00e8mes d\u2019information hospitaliers. Des \u00e9tablissements support sont d\u00e9sign\u00e9s pour porter le projet informatique pour tous leurs voisins. Il est donc plus que temps de se questionner sur l\u2019encadrement des donn\u00e9es de sant\u00e9 des GHT, dans le m\u00eame format et avec les m\u00eames r\u00e8gles que chez un h\u00e9bergeur de donn\u00e9es certifi\u00e9.<\/p>\n<h1>Infog\u00e9reur sant\u00e9\u2009: un m\u00e9tier d\u2019avenir<\/h1>\n<p>Pour conclure, l\u2019infog\u00e9reur en sant\u00e9 n\u2019exerce plus de contr\u00f4le sur l\u2019application de ses clients. Il garde un devoir d\u2019information et d\u2019alerte et, s\u2019il en est capable, les accompagne dans une d\u00e9marche vertueuse de s\u00e9curisation. Et, d\u00e9sormais, il autorise, facilite et contr\u00f4le l\u2019acc\u00e8s \u00e0 des services de IaaS et de <i>cloud<\/i> innovants, en phase avec le besoin de la sant\u00e9 en France.<\/p>\n<script>function PlayerjsAsync(){} if(window[\"Playerjs\"]){PlayerjsAsync();}<\/script>","protected":false},"excerpt":{"rendered":"<p>Une certification et un audit pour r\u00e9pondre aux limites de l\u2019agr\u00e9ment Le mod\u00e8le actuel d\u2019agr\u00e9ment est en fin de vie. Pour encore quelques mois, sur les bases d\u2019une d\u00e9claration, l\u2019h\u00e9bergeur candidat exprime toute sa bonne foi dans un \u00e9norme dossier remis \u00e0 l\u2019Agence des syst\u00e8mes d\u2019information partag\u00e9s (Asip) de sant\u00e9. Le candidat ne fait l\u2019objet d\u2019aucun audit de la part des autorit\u00e9s. L\u2019exercice consiste donc \u00e0 \u00eatre coh\u00e9rent et cr\u00e9dible&hellip; <\/p>\n","protected":false},"author":23133,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[26,2],"tags":[6714,6717,1809,6716,6712,6718,6715,6713],"class_list":["post-37773","post","type-post","status-publish","format-standard","hentry","category-dossier","category-gestions-hospitalieres","tag-agrement","tag-cloud","tag-ght","tag-hads","tag-hebergeur-de-donnees","tag-iaas","tag-infogereur","tag-securite-numerique"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.8.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Certification h\u00e9bergement donn\u00e9es de sant\u00e9 - Gestions hospitali\u00e8res<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ricom-web8.com\/gestions\/certification-hebergement-donnees-de-sante\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Certification h\u00e9bergement donn\u00e9es de sant\u00e9 - Gestions hospitali\u00e8res\" \/>\n<meta property=\"og:description\" content=\"Une certification et un audit pour r\u00e9pondre aux limites de l\u2019agr\u00e9ment Le mod\u00e8le actuel d\u2019agr\u00e9ment est en fin de vie. Pour encore quelques mois, sur les bases d\u2019une d\u00e9claration, l\u2019h\u00e9bergeur candidat exprime toute sa bonne foi dans un \u00e9norme dossier remis \u00e0 l\u2019Agence des syst\u00e8mes d\u2019information partag\u00e9s (Asip) de sant\u00e9. Le candidat ne fait l\u2019objet d\u2019aucun audit de la part des autorit\u00e9s. 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