Health Systems Relying on Smart Cards Dr Klaus

Health Systems Relying on Smart Cards Dr. Klaus Vedder Executive Vice President, Giesecke & Devrient Gmb. H Chairman, ETSI TC Smart Card Platform Broadband access for e-health applications Tuxtla, 18 -19 May 2006

Giesecke & Devrient – Innovation based on tradition • • • Established in 1852, G&D initially specialized in banknote and securities printing, later adding automatic currency processing equipment. Today, G&D is a leading supplier of smart cards and system solutions in the fields of telecommunications, electronic payments, transportation, health care, identity, customer loyalty, multimedia and IT security. G&D is a globally operating technology group comprising 52 subsidiaries and jointventures in all parts of the world. The G&D Group is based in Munich/Germany, employing 7, 300 people, with around 3, 800 outside Germany. G&D Mexico was founded in 1952 and has today about 450 employees. § Banknotes § Security paper / foils § Banknote processing § § Electronic payment Telecommunications systems and identif. modules Broadband access for e-health applications Tuxtla, 18 -19 May 2006 New Business Government Solutions Cards and Services Banknote § § § ID documents Passports Health cards Transit Security printing § § IT security Security systems Embedded Systems New technologies

Smart Card, Module and Chip Over 4 billion SIMs delivered to the market (all based on ETSI / 3 GPP specifications) n CPU, RAM, ROM, EEPROM, Crypto-unit on a single piece of silicon n Structure today: 0, 18 µm; metallised surface n Sensors for Low Voltage, Frequency, Passivation Layer, Light, …. . Broadband access for e-health applications Tuxtla, 18 -19 May 2006

The Smart Card – A SECURE PC in Your Pocket Processor and Memory 1990 6 Bit CPU 7 k. B ROM 3 k. B EEPROM 128 Byte RAM 2006 32 Bit CPU 500 k. B ROM 512 k. B EEPROM 16 k. B RAM In addition: 512 MB Flash Crypto-unit for enciphering, digital signatures and other security functions Evaluation of HW and SW against Common Criteria (CC) Broadband access for e-health applications Tuxtla, 18 -19 May 2006

The healthcare cost dilemma: a vicious circle Insurance Premium (% of Gross Salary) New medical technologies Increase of insurance premiums Life Expectancy (Years) Higher life expectancy M F Stone age: 21 Romans: 22 Cost increase Broadband access for e-health applications Tuxtla, 18 -19 May 2006

Increasing efficiency and effectiveness: Cost reduction and quality improvement n Better education of the medical / technical personnel? n Better medical / technical equipment in hospitals and practices? n Reduction of cost per delivered service? n Reduction of fraud? n Better communication between all partners in healthcare? Smart Card enabled e-Health Networks Three examples: Taiwan, Austria, Germany Broadband access for e-health applications Tuxtla, 18 -19 May 2006

Benefits of Card enabled e-Health Networks Patient n Higher-quality medical care n Strengthened patient rights Policymakers Provider n Increased profitability (offsets IT and infrastructure costs) n Better communication/information between providers n Efficient processes (e. Billing, e. Administration) Broadband access for e-health applications Tuxtla, 18 -19 May 2006 Payer n Cost reduction n More transparency n Well timed regulations

The National Health Card System in Taiwan n Migration of a paper-based system to an information technology based one n Project management, production, personalization and issuance of n 24 M "Patient Data Cards" n 150. 000 HPCs together with a local partner Initial Health Card Functions: n Emergency data n DMP-Data (Disease Management Programme) n e-Referral Broadband access for e-health applications Tuxtla, 18 -19 May 2006 n Country-wide implementation in under 2 years n Total investment volume: 170 Mio US $, n Estimated savings 190 Mio. US $ p. a. , break-even in the first year

The e-Card in Austria Initial e-Card Functions: n. Health insurance certificate n. European insurance certificate (on back) Front n. Right to receive medical service n. Access to online services n. Eventual evolution to a citizen card digital signature Back n Production and delivery of n 11 million chip cards for the insured n 24. 000 health professional cards n Delivery completed by G&D on schedule in late 2005 n Customer: Austrian Social Security Association n Operation and service of the card management system n Possibility of post-issuance application loading Broadband access for e-health applications Tuxtla, 18 -19 May 2006

The German “Gesundheitskarte” to be issued in 2007 n Customers: 270 Insurance Companies in Germany n Driving factor: Seamless data interchange, drug interaction, reduction of malpractice, emergency data, replacement of present "dumb" card Initial Health Card Functions: n Online verification of insurance status n e-Prescription/drug interaction n Emergency Data n European insurance certificate (on back) n Production and delivery of n 80 M chip cards for the insured n 370. 000 health professional cards Smart card with 64 k. B "user memory" n Operation and service of the card management system (G&D) n About 10 CAMS Implementations n Total project volume: about € 1, 6 – 1, 8 bn Broadband access for e-health applications Tuxtla, 18 -19 May 2006

The German “Gesundheitskarte” – Drug Interaction Broadband access for e-health applications Tuxtla, 18 -19 May 2006

The German “Gesundheitskarte” – e-Prescription Broadband access for e-health applications Tuxtla, 18 -19 May 2006

Use Case: Issuing and Dispensing an e-Prescription Physician Issuing e-Prescription Signing of e-Presciption Encrypt e. Presciption with session key Pharmacist Encrypt session key with public key of patient Writing on e-Prescription server Decrypt Reading session key e-Prescription with private from server key of patient Decrypt e. Prescription with session key and dispense PDC Physician software HPC Connector PDC Physician software Connector PDC Connector Pharmacy software Neccessary Modules/Software Broadband access for e-health applications Tuxtla, 18 -19 May 2006 Connector Pharmacy software HPC: Health Professional Card PDC: Patient Data Card

Overview of System Architecture in Germany gematik (Planning, Implementation, Operation) Setting Standards & Guidelines Operational Tasks Health Insurance Companies Physician´s Practice C PDC, HPC Pharmacy C PDC, HPC Hospital C PDC, HPC Status Inquiry, Directory. Services Card-DB Security, Transaction, and other Services Applications, e. g. • e-Prescription • Medication Log • Referral Letters • Electronic Patient Health Record PDC CAMS Medical Doctors‘ Association C HPC Self-Service Kiosk PDC C C Secure Medical Network („Telematics-Platform“) HPC Health Professional Card PDC Patient Data Card Secure Connector C to the Network Broadband access for e-health applications Tuxtla, 18 -19 May 2006 Trust Center

Solution offering from Giesecke & Devrient Data registration customer hotline, Patient Card and Card Management System gematik (Planning, Implementation, Operation) Setting Standards & Guidelines Operational Tasks Security services for Medical Network Providers and Trust Centres Physician´s Practice C Status Inquiry, Directory. Services Card-DB Pharmacy C Security, Transaction, and other Services Hospital C Health Insurance Companies C Applications, e. g. • e-Prescription • Medication Log • Referral Letters • Electronic Patient Health Record PDC Doctors‘ Associ. C HPC Self-Service Kiosk CAMS Trust Center Secure Medical Network C („Telematics-Platform“) Secure Connector and Card Reader Broadband access for e-health applications Tuxtla, 18 -19 May 2006 Health professional card

Potential Additional Applications Bonus Schemes Passes • e. Bonuspass dentist (reminder letter, SMS) • e. Vaccination pass (with reminder function) • DMP/family doctor programme (10 € practice fee does not apply) • Maternity pass • Health check (2*year) • General bonus scheme (with sport partners, members attract members) • Fitness programme Broadband access for e-health applications Tuxtla, 18 -19 May 2006 • e. Organ donation pass • e. X-ray pass • Leisure time pass Co-Payment • e-Additional insurances (eg. 2 bedroom in hospital) • Current co-payment status, automatically accumulated

Significant Health Care Savings Example e-Prescription n Effect n Annual Savings* n Process Optimization n US $ 180 M n Co-payment Information for Medications n US $ 320 M n Prevention of adverse reactions from administration of different medications n US $ 640 M n Total n US $ 1140 M The overall savings potential in the health care system through the e-health networks and patient data and health professional cards is estimated to be 10– 20% of current expenditures. èThis amounts to approximately US $ 17– 33 bn p. a. Broadband access for e-health applications Tuxtla, 18 -19 May 2006 M = millions bn = billions *) Source: Debold & Lux, Secunet

Understanding the “ 4 Ps” Patient n Number of providers (physicians, hospitals, pharmacists) n Current issues Provider Broadband access for e-health applications Tuxtla, 18 -19 May 2006 Policymakers n Governmental / administrative environment n Decisionmakers n Structure of the population n Patient rights n Medical and insurance coverage n Number of health insurance companies n Structure of the health insurance / social security system n Current problems Payer

The next (additional) step: Mobile e-Health n. Storing some e-Health information on a SIM n The user has his/her handset and thus his/her e-Health information "always" at hand n Immediate check of e-prescription using the display of the handset n Data transfer may be done via an additional contactless interface between SIM and outside world subject to security constraints n future handsets will have a contactless interface for e-ticketing, e-access, e-payment, …. ) Technology demonstrator shown by Vodafone and G&D at Ce. BIT 2006 n. Secure download of personal data n Typical scenario: fallen ill on a holiday abroad n Data will be enciphered and secured by home server system, sent via GPRS or 3 G and deciphered by the SIM (shown on handset display or special terminals) Broadband access for e-health applications Tuxtla, 18 -19 May 2006

Contact: Fabiola Bellersheim, Segment Adviser e. Health Phone: + 49 89 4119 8618 fabiola. bellersheim@gi-de. com Your local contact: Ing. Laura Gomez, Subdirector Ventas Industria y Gobierno Giesecke y Devrient de México, S. A. de C. V. Tel: (+5255) 5039 9950 Cel: 5413 4997 Laura. Gomez@mx. gi-de. com Broadband access for e-health applications Tuxtla, 18 -19 May 2006 Contact: Dr. Klaus Vedder, Head of Telecom Division Phone: + 49 89 4119 1542 Fax: +49 89 4119 1540 Klaus. Vedder@gi-de. com