health systems relying on smart cards

Broadband access for e-health applicationsTuxtla, 18-19 May 2006

Health Systems Relying on Smart Cards

Dr. Klaus VedderExecutive Vice President, Giesecke & Devrient GmbH

Chairman, ETSI TC Smart Card Platform


• 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 joint-ventures 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.

Cards and ServicesBanknote New BusinessGovernment Solutions

Electronic payment Telecommunications

ID documents Passports Health cards Transit Security printing

Banknotes Security paper / foils Banknote processing systems and identif. modules

IT security Security systems Embedded Systems New technologies

Giesecke & Devrient – Innovation based on tradition


Smart Card, Module and Chip

CPU, RAM, ROM, EEPROM, Crypto-unit on a single piece of silicon Structure today: 0,18 µm; metallised surface Sensors for Low Voltage, Frequency, Passivation Layer, Light, …..

Over 4 billion SIMs delivered to the market (all based on ETSI / 3GPP specifications)


The Smart Card – A SECURE PC in Your PocketProcessor and Memory

1990 6 Bit CPU7 kB ROM3 kB EEPROM128 Byte RAM

2006 32 Bit CPU500 kB ROM512kB EEPROM16kB RAMIn addition: 512 MB Flash

Crypto-unit for enciphering, digital signatures and other security functionsEvaluation of HW and SW against Common Criteria (CC)


4145

64

75

83

41

47

68

81

86

30

40

50

60

70

80

90

1850 1900 1950 2000 2050

MW

New medical technologies

Higher lifeexpectancy

Cost increase

Stone age: 21Romans: 22

8.2

11.4

12.6

13.514

7

8

9

10

11

12

13

14

15

1970 1980 1990 2000 2010

Increase ofinsurance premiums

MF

Life Expectancy (Years)Insurance Premium(% of Gross Salary)

The healthcare cost dilemma: a vicious circle


Smart Card enabled e-Health Networks Three examples: Taiwan, Austria, Germany

Better education of the medical / technical personnel?

Better medical / technical equipment in hospitals and practices?

Reduction of cost per delivered service?

Reduction of fraud?

Better communication between all partners in healthcare?

Increasing efficiency and effectiveness:Cost reduction and quality improvement


Higher-quality medical careStrengthened patient rights

Cost reductionMore transparencyWell timed regulations

Increased profitability (offsets IT and infrastructure costs) Better communication/information between providers Efficient processes (eBilling, eAdministration)

Provider Payer

Patient

Policymakers

Benefits of Card enabled e-Health Networks


Migration of a paper-based system to an information technology based one

Project management, production, personalization and issuance of

24 M "Patient Data Cards" 150.000 HPCs together with a

local partner

Country-wide implementation in under 2 years

Total investment volume: 170 Mio US $,

Estimated savings 190 Mio. US $ p.a., break-even in the first year

Initial Health Card Functions: Emergency data DMP-Data (Disease Management Programme)

e-Referral

The National Health Card System in Taiwan


Production and delivery of 11 million chip cards for the

insured 24.000 health professional

cards Delivery completed by G&D

on schedule in late 2005

Customer: Austrian Social Security Association

Operation and service of the card management system

Possibility of post-issuance application loading

Initial e-Card Functions:Health insurance certificate

European insurancecertificate (on back)

Right to receive medical service

Access to online services Eventual evolution to a citizen card -digital signature

Front

Back

The e-Card in Austria


Initial Health Card Functions: Online verification of insurance

status e-Prescription/drug interaction Emergency Data European insurance certificate (on back)

Customers: 270 Insurance Companies in Germany

Driving factor: Seamless data interchange, drug interaction, reduction of malpractice, emergency data, replacement of present "dumb" card

Production and delivery of 80 M chip cards for the insured 370.000 health professional

cardsSmart card with 64kB "user

memory"

Operation and service of the card management system (G&D)

About 10 CAMS Implementations

Total project volume: about € 1,6 – 1,8 bn

The German “Gesundheitskarte” to be issued in 2007


The German “Gesundheitskarte” – Drug Interaction


The German “Gesundheitskarte” – e-Prescription


HPC: Health Professional CardPDC: Patient Data Card

Physician Pharmacist

Issuinge-Pres-cription

Physiciansoftware

Signingof e-Pres-ciption

HPC

Encrypt e-Presciptionwith ses-sion key

Connector

Encryptsession keywith publickey ofpatient

PDC

Writing one-Prescrip-tion server

Connector

Physiciansoftware

Decrypt e-Prescriptionwith sessionkey anddispense

Connector

Pharmacysoftware

Decrypt session keywith privatekey of patient

PDC

Neccessary Modules/Software

Connector

Reading e-Prescriptionfrom server

Pharmacysoftware

PDC

Use Case: Issuing and Dispensing an e-Prescription


Self-Service Kiosk

Physician´s Practice

PDC

Pharmacy

PDC, HPC

Hospital

PDC, HPC

Security,Transaction,

and other Services

Applications, e.g.

• e-Prescription• Medication Log• Referral Letters• Electronic Patient

Health Record

gematik (Planning, Implementation, Operation)Setting

Standards & Guidelines

OperationalTasks

Secure Medical Network(„Telematics-Platform“)

Health InsuranceCompanies

CAMS

C

C

C

C

CStatus Inquiry,Directory-ServicesCard-DB

PDC

Medical Doctors‘Association

TrustCenter

C

HPC

PDC, HPC

C

Health Professional Card

Patient Data Card

Secure Connector to the Network

HPC

PDC

Overview of System Architecture in Germany


Self-Service Kiosk

Physician´s Practice

Pharmacy

Hospital Security,Transaction,

and other Services

Applications, e.g.

• e-Prescription• Medication Log• Referral Letters• Electronic Patient

Health Record

gematik (Planning, Implementation, Operation)Setting

Standards & Guidelines

OperationalTasks

Secure Medical Network(„Telematics-Platform“)

Health InsuranceCompanies

CAMS

C

C

C

C

CStatus Inquiry,Directory-ServicesCard-DB

PDC

Doctors‘ Associ.

TrustCenter

C

HPC

Secure Connector and Card Reader

Security servicesfor Medical Network Providers

and Trust Centres

Data registration customer hotline,Patient Card and

Card Management System

Health professional card

Solution offering from Giesecke & Devrient


Bonus Schemes

• eBonuspass dentist(reminder letter, SMS)

• DMP/family doctor programme (10 € practice fee does not apply)

• Health check (2*year)

• General bonus scheme(with sport partners,members attract members)

• Fitness programme

Passes

• eVaccination pass(with reminder function)

• Maternity pass

• eOrgan donation pass

• eX-ray pass

• Leisure time pass

Co-Payment

• e-Additional insurances(eg. 2 bedroom in hospital)

• Current co-payment status, automatically accumulated

Potential Additional Applications


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.

This amounts to approximately US $ 17–33 bn p.a.

Effect Process Optimization Co-payment Information for Medications Prevention of adverse reactions from

administration of different medications

Total

Annual Savings* US $ 180 M US $ 320 M

US $ 640 M

US $ 1140 M

Example e-Prescription

*) Source: Debold & Lux, SecunetM = millionsbn = billions

Significant Health Care Savings


Structure of the population Patient rights Medical and insurance coverage

Number of providers (physicians, hospitals, pharmacists)

Current issues

Provider Payer

Patient

Number of health insurance companies

Structure of the health insurance / social security system

Current problems

Governmental / administrative environment

Decisionmakers

Policymakers

Understanding the “4Ps”


The next (additional) step: Mobile e-Health

Storing some e-Health information on a SIM The user has his/her handset and thus his/her e-Health information

"always" at hand Immediate check of e-prescription using the display of the handset Data transfer may be done via an additional contactless interface

between SIM and outside world subject to security constraints future handsets will have a contactless interface for e-ticketing,

e-access, e-payment, ….)Technology demonstrator shown by Vodafone and G&D at CeBIT 2006

Secure download of personal data Typical scenario: fallen ill on a holiday abroad Data will be enciphered and secured by home server system, sent

via GPRS or 3G and deciphered by the SIM (shown on handset display or special terminals)


Contact:Fabiola Bellersheim, Segment Adviser eHealthPhone: + 49 89 4119 [email protected]

Your local contact:Ing. Laura Gomez, Subdirector Ventas Industria y GobiernoGiesecke y Devrient de México, S.A. de C.V.Tel: (+5255) 5039 9950Cel: 5413 [email protected]

Contact:Dr. Klaus Vedder, Head of Telecom DivisionPhone: + 49 89 4119 1542Fax: +49 89 4119 [email protected]

health systems relying on smart cards

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