# Interoperability of teleconsultation platforms in Europe

> What the platform should exchange around video: ANS repository v1.5.1, INS, CDA, DMP, MSSanté, FHIR Appointment/Encounter, and why WebRTC is not EHDS.

Author: Ala Ben Aicha

Canonical page: https://alabenaicha.me/insights/telehealth-interoperability-europe

Updated: 2026-09-17

## Direct answer

Video is not file exchange. In France, the ANS v1.5.1 standard (decree of October 18, 2024) imposes INS, DMP, CDA, MSSanté and digital prescription. A WebRTC stream is not EEHRxF.

## The Next.js stack is not the exchange contract

The English page [telehealth with Next.js and Node.js](https://alabenaicha.me/insights/building-telehealth-platforms-nextjs-nodejs) described **application architecture** (WebRTC, Node services, FHIR server). **This is the interoperability contract** around the session: identity, report, order, messaging, appointment. Associated service: [telehealth solutions](https://alabenaicha.me/services/telehealth-solutions).

In France, the[decree of October 18, 2024](https://esante.gouv.fr/actualites/nouvelle-version-opposable-referentiel-interoperabilite-securite-ethique-si-teleconsultation-v151) makes the **version 1.5.1** of the interoperability, security and ethics framework for teleconsultation IS. The ANS sums it up **13 sections** : RGPD, ADM, ANN, INS, PSC, PGSSI-S, ETHT, FAC, ETH, DMP, CDA, MSS, ORD. Compliance with this standard (ANS certificate) is an approval prerequisite for certain teleconsultation companies — **it's not** an EHDS marking, **it's not** a CE MDR.

The [HAS recommendations](https://www.has-sante.fr/jcms/p_3445779/fr/lieux-et-conditions-d-environnement-pour-la-realisation-d-une-teleconsultation-ou-d-un-telesoin-recommandations) on premises and the environment (February 2024) concern the quality and security of access. I am not making this a clinical protocol.

## Flow table: what comes out of the video booth

| Flow                   | Standard / requirement                          | Engineering proof                                        | What it is not                               |
| ---------------------- | ----------------------------------------------- | -------------------------------------------------------- | -------------------------------------------- |
| Patient identity       | **INS** + INSi teleservice; INS repository v2.1 | Slice FR Core Patient INS, `urn:oid:1.2.250.1.213.1.4.8` | A connection email, a home IPP               |
| Professional identity  | **Pro Health Connect**, Directory / RPPS        | PSC and ANN sections                                     | A Google Workspace account                   |
| Session                | `Appointment` + `Encounter` (virtual class)     | FR Core Encounter / Appointment                          | A 2029 EHDS bond                             |
| Report                 | **CDA** + food **DMP** / My health space        | DMP and CDA sections                                     | A PDF pasted into WebRTC chat                |
| Order                  | **Digital order**                               | ORD section                                              | A prescription photo in the datachannel      |
| Coordination Messaging | **MSHealth**                                    | MSS section                                              | A Gmail SMTP                                 |
| Video/audio            | Encrypted WebRTC, TURN                          | PGSSI-S, GDPR                                            | **EEHRxF**, Patient Summary, category 1 2029 |
| Access traces          | Logs, preservation                              | GDPR + PGSSI-S                                           | A substitute NIS2 Art. 23                    |
| Health data            | GDPR **Art. 9**                                 | Basis Art. 6 + condition Art. 9                          | “Cookie consent = legal basis for care”      |

`Encounter.class` virtual: in FHIR R4, the v3-ActCode codesystem provides `VR` (virtual). It's not `IMP` (inpatient) and it is not an EEHRxF document. A `Appointment.status=fulfilled` does not power My health space on its own.

Video can — and often should — remain **out** of the exchange DPI. The file that the next doctor will see is the CDA / DMP / prescription, identified INS, not the SRTP flow.

## Europe: MyHealth\@EU is not your SFU

A cross-border teleconsultation is not, by magic, a flow [MyHealth@EU](https://alabenaicha.me/insights/cross-border-patient-data-exchange-europe). The Patient Summary EEHRxF (category 1, **March 26, 2029**) is a folder artifact, not a WebRTC session. Don't promise "EHDS-ready" because the codec is VP8 and the hosting is in the EU.

Outside France: the ANS repository v1.5.1 **don't oblige** a Belgian or Swiss publisher. In Switzerland, a report intended for the DEP follows [CH EPR FHIR / MHD](https://alabenaicha.me/insights/swiss-patient-dossier-fhir-api), with `languageCode` and EPR-SPID — another contract. In Belgium or Luxembourg, pinching the national framework *before* to copy the 13 ANS sections.

GDPR: health data = Art. 9. Hosting in the EU does not exhaust the legal basis. The [people's rights](https://alabenaicha.me/insights/gdpr-health-data-rights-integration) (access, rectification, limitation) must be able to execute on the **folder** of teleconsultation, not just on the connection account.

## MDR: video is not automatically a device

A communications platform that **poster** a session without interpreting a physiological signal often remains outside the qualification of the device — to be decided by the regulatory owner, see [Software MDR](https://alabenaicha.me/insights/medical-software-mdr-engineering-evidence). A module that calculates a clinical score during the session is a **other** module. Don’t mix the two in the same destination statement.

HDS (health data hosting) is a French hosting obligation for certain data, **not** a substitute for the teleconsultation reference system, **not** a CE MDR, **not** NIS2.

## Illustrative Spike (not a quote)

| Week (illustrative) | Deliverable                                                   | Rollback                                       |
| ------------------- | ------------------------------------------------------------- | ---------------------------------------------- |
| 1                   | Mapping of the 13 sections: in / out / N/A for *your* product | Do not file an ANS file on a rehearsal         |
| 2                   | Identity: INSi + PSC in test tank                             | Local account only, no real NIR                |
| 3–4                 | A de-identified CR CDA + a digital test prescription          | No production DMP power supply                 |
| 5                   | `Appointment` / `Encounter` FR Core + access log              | Purging fixtures                               |
| 6–8                 | “Video vs file” matrix signed product + legal                 | Prohibit the “EHDS / CE” claim on the brochure |

## What this page is not

It is not an ANS certificate, not a Health Insurance approval, not a clinical HAS opinion, not an MDR qualification, not an EHDS Patient Summary, not legal advice. I do not declare your solution compliant with the v1.5.1 repository. Nothing here is a remote care protocol.

If you build the platform and its interfaces (identity, documents, messaging, video), it is [telehealth solutions](https://alabenaicha.me/services/telehealth-solutions). For a bounded spike, use the [contact with project intention](https://alabenaicha.me/contact?intent=project).