[Members] Push for XMPP as mandatory standard for message exchange in Dutch Healthcare

Peter Waher peterwaher at hotmail.com
Sun Jun 9 21:13:26 UTC 2019

Hello Winfried (et al)

Thanks for an taking your time to describe your efforts. It sounds both interesting and important. Following is some input from my part:

  *   Government agencies like standards. Solutions based on standards are seen more favorable compared to proprietary solutions.
  *   IEEE 1451.99 is based on XMPP and provide much of what you describe, including missing points, such as management of legal identities, signatures and a strong protection of privacy (links below). IEEE is the world's largest technical professional organization for the advancement of technology, which can help convince decision-makers.
  *   I don’t think special certificate authorities is a good way to go: It will create problems with interoperability and cooperation across domains at some point. (Consider for example other countries trying to go the same way, but choosing other CAs.) As an alternative, consider consent-based authorization (which XMPP is designed for) and End-to-end encryption with strong ciphers to protect the privacy and integrity of data. (Storage of sensitive information on brokers creates many privacy-problems.) (We can also provide social networking software for information management, including messaging, that is based on E2E encryption, and not broker or centralized storage of information, suitable for e-Health solutions.)
  *   IEEE 1451.99 provides mechanisms to include things (and distributed processing, discovery, decision support, smart contracts, monetization, etc.), which is useful in e-Health. (We can for instance provide bridges between BlueTooth and IEEE 1451.99 (XMPP), which makes it easy to integrate health-related devices in health services – useful when caring for people in their homes, for instance.)
  *   First draft is scheduled to be completed this summer (northern)
  *   Libraries and software is available, making it relatively easy to create PoCs.

More information:
Overview & test integration broker:

Let me know if this sounds interesting to your effort. If so, I’m happy to connect and discuss further. There are a lot of other areas within 1451.99 to explore. There are also many other synergies with similar efforts being made in other fields.

Best regards,
Peter Waher

Från: Winfried Tilanus<mailto:winfried at tilanus.com>
Skickat: den 6 juni 2019 23:50
Till: XSF Members<mailto:members at xmpp.org>
Ämne: [Members] Push for XMPP as mandatory standard for message exchange in Dutch Healthcare


As announced in the XSF muc, some more details on my attempt to push
XMPP as mandatory standard for messaging in Dutch healthcare. I would
appreciate it my strategy will not become public yet, so I post it here
@members. Use it to XMPP's advantage, but don't spread it or cite from
it without my consent. Any feedback, suggestions or questions are welcome.

I believe XMPP, with its focus on security, federated structure,
extensibility and patterns like push, pull & pubsub and possibility to
send both structured as unstructured data has a big potential in
(health)care. I suggest the use of XMPP where appropriate. Technologists
willing to investigate in it, feel it is a strong technology. Others
rather don't learn a new technology. That had been a bit of a blocker
until now. Right now there are several vendors in Dutch healthcare that
are using a XMPP server as messaging back-end.

The Dutch ministry of health announced last year they are taking more
control over data exchange in healthcare. As showcase for their new
role, they ordered one of the standardisation institutions to create a
norm for securing messaging/e-mail and to come up with an
interoperability standard for messaging between different vendors and
healthcare institutions. (Note the confusion between messaging and
e-mail here.) The norm commission consisted mainly of vendors of 'secure
e-mail' solutions. They came a month ago up with a norm that is wrong in
every aspect you can imagine and their interoperability standard
consisted out of the intent to cooperate between those vendors (!).

My push:
I couldn't resist attacking this norm publicly. My attack also caught
the attention of the head of information of the ministry of health,
making the members of the norm commission quite nervous. In those
discussions (on LinkedIn, in Dutch, they are on my timeline) I sketched
a solution for the interoperability standard based on XMPP.

At the same time a group of vendors of patient record systems and
similar systems that is more care then cure focused (but where also a
huge vendor for software for general practitioners participates) had a
meetup to discuss how to support digital multidisciplinary meetings.
They feel the need for a federated communication standard, an
authentication standard and a standard / infrastructure for maintaining
an address book. I knew on forehand that one of the vendors present was
already considering using XMPP as interoperability standard for exactly
this use. At the end of the meeting, all vendors present had already
articulated the intent to continue creating such standard, I proposed to
team up with the vendor already interested in XMPP and to prepare with
that vendor a hackaton with all interested vendors to make a proof of
concept of using XMPP here. And that is where we are now.

My strategy:
Provide a way for the Dutch ministry of health to prove that their new
strategy is still working, despite the failure of their commission. At
the same time bypassing all the e-mail vendors and confront them with a
world that suddenly speaks XMPP. Technical I want to focus on messaging
and only the communication protocol. The other issues still need to be
discussed among the vendors.

The technical plan:
Each system for electronic patient records, health communication or each
personal health environment vendor runs an own federating XMPP server.
The XMPP servers prove each other they are trusted by presenting a
certificate that is signed by an auditor. These systems themselves
function as XMPP clients, but when sufficiently authenticated, the
servers should allow other client connections too (opening the
possibility for push messages on any device). If one user has accounts
on multiple of these systems, then it translates in multiple XMPP
addresses for that user. Once connected, users can open chats, create
groups or do whatever they want.

Still open issues:
- Translating known identifiers (SSN, name, medical registration) to
XMPP addresses. This part needs some serious privacy by design (but this
is an issue anyway, with or without XMPP). There is a parallel project
that should supply this. (https://eur04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fnuts.nl%2F&data=02%7C01%7C%7C831aa76008724613fb0c08d6eac907c8%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636954546472144491&sdata=AYg11vyLxmi2Ckb9fPC0X71sjR%2F0ExZKlb%2BUpEjTlLo%3D&reserved=0)
- Proving identities or attributes (over 18, insurance) over XMPP. We
consider using IRMA here. (https://eur04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fprivacybydesign.foundation%2F&data=02%7C01%7C%7C831aa76008724613fb0c08d6eac907c8%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636954546472154500&sdata=LpXcFJLEriJQ9pLrkWkEPl4Ft8d7kVcIohfj%2BY7Y%2Ffw%3D&reserved=0)
- Allowing & signing of self-hosted servers (I would love that)

Proof of concept:
I plan to do more or less the following. Showing messages across systems
is the main point I want to make, but showing the possibility to
federate between trusted servers would make the POC stronger.
1 all participating vendors set up an XMPP server
2 an mock-auditor signs the server certificates with his root certificate
3 all servers only accept s2s connections from servers with a
certificate signed by the root certificate of the mock-auditor
4 all participating vendors integrate some way (separate logins,
component, server integration) with their existing messaging interface.
5 setting up a mock address book, that can be as little as a list of
test-accounts handed out to all participating vendors, but can also
reside in the network somewhere / somehow.
6 the users send messages by name (to be implemented on systems)
7 systems accept messages by people 'not in list'
8 happy messaging ;-)
9 bonus: show that a independent messenger can work too.
10 screencast & document everything, carefully present to the ministry
of health and/or publish & make lots of noise

If you want to help:
- anybody who wants to think along is welcome
- help with planning/preparing the POC is welcome
- help at or being standby during the POC would be welcome
- if you are aware of or involved with 'sister initiatives' in other
countries, please let me know, that would strengthen my argument towards
the Dutch ministry of health.
- it may be interesting to investigate if this can become an EU(-funded)
project, if you are in the position to help investigate that, please let
me know

So far for now,



privacy strategist & privacy architect

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