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First US-German Summit on Primary Care

Current Implementation and Technologiesof a Secure Network für 50,000 Physiciansin Germany

Frank LöberCIO/ CTO HÄVG Rechenzentrum

Washington, 9th April 2010

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Agenda

Initial Situation in Germany – Facts & Figures

Overview current solution in Germany for 50,000 Physicians

Current Situation & Next Steps

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Initial Situation in GermanyFact & Figures

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Initial Situation in GermanyFact & Figures

� New reimbursement system (payment system) since June 2008

� 50,000 familiy physicians & 70,000,000 sick fund covered people

� 160 sick funds, recently substantial decrease in number due to mergers

� 60 different software-solutions (doctor´s IT-system) for familiy physicians with different operating systems

� Different ways of communication (paper, CD-Rom, online)

� High requirements for data protection for transmission and storage

� Main medical data to transfer: reimbursement items, diagnoses, drugs, referrals, form-data

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Hausaerzte-verband

(Clearing)

Send medical data by software

Check & clearing data & create and send billing file

Initial Situation in Germany Billing Process in new reimbursement system

Physician

Sick FundCheck billing file & Payment

Create billing & send it & do payment

Receive billing & Payment

Documenting medical data (diagnoses, drugs ..)

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Initial Situation in GermanyDifferent business needs for different parties

� Physicians: No additional costs for hard- & software, software must be easy to use

� Software-Developers / Manufacturers:Easy integration, installation & configuration of new software

� Hausaerzteverband:scalable solutions, authenfication of physicians, exchange medical data between family and special physicians, increase quality of primary care

� Sick Funds:Reduce costs of drugs and remedies, increase quality of primary care

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Initial Situation in Germany Legal Requirements for protection & authentification

High requirements for data protection & authentification:

� Files with medical and personal data must be encrypted

� Transmission must be encrypted

� Files with medical data must be signed by a physician

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Initial Situation in Germany Conclusion

Regarding all business needs of all parties means:

�Development of a specific software-module („Core“) without GUI for integration in existing software-solutions

�Development of requirements and technical specifications for existing software-manufacturers

�Develop own software with GUI for physicians with basic functions to manage our contracts (stand alone solution)

�Usage of this software is part of our contracts

�Develop own data-center

�Develop own infrastructure to connect doctors for data exchange

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Developed Solution in Germany for 50,000 Physicians

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Transmission & Encryption

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2 ways of online transmission:

Current Solution – Encryption & Transmission Medical Data from doctor´s practice to data center

Hardware-Router with certicate of doctor´s practice

Software-VPN with certicate of doctor´s

practice

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Current Solution – Encryption & Transmission Transmission Encryption

Secure Communication between doctors practice and our data-center based on legal requirements using:

� IPSec-Tunnels

� Secure TLS-Connections

� Key-Exchange-Protocol: Diffie-Hellman

� Digital Certificates: X.509 (v3) Certificates with 2048 Bit key-length

� Software VPN is based on OpenVPN (open source)

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Current Solution – Encryption & Transmission File Encryption

� Medical data (reimbursement items, drugs, …) will be compressed and encrypted with a hybrid method before transmission

� Payload (Content of the file) will be symmetric encrypted with AES (Advanced Encryption Standard) with 256 Bit key-length

� Encryption Key will be asymmetric encrypted with the public certificate of the receiver with 2048 Bit key-length by SHA1-RSA

� Data will only decrypted in our data-center

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Core-Module

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Doctor´s IT-System

OpenVPN

Database

Core-Functions

Core

Contract1

Modules

Online-Updates

HTTPS VPNKonnektorXMLSOAP

Usable on clients,

servers and as ASP-Solution

Modular specific Contract-Data using open source database SQLite

Software Run Time Environment Interface

Contract2

Contract3

Data-Center

Current Solution – Core-ModuleOverview Technical Solution

Doctor`s Practice

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Core

Current Solution – Core-ModuleFunctions

� Validate medical data in doctor´s practice

� Provide steering algorithms i.e. substitutionsfor low priced drugs

� Provide specific data i.e. special catalogues of ICD10-diagnoses

� Provide Online-Services i.e. „check enrolled patients“

� Encrypt medical data before transmission

� Receive daily-updates

� No graphical user interface

� Easy to integrate in existing software solutions

� Defined data structure for medical data

Existing Software with GUI

Core

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Example for drug substitution

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Current Solution – Core-ModuleExample for Substitution Drugs I / III

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Current Solution – Core-ModuleExample for Substitution Drugs II / III

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Current Solution – Core-ModuleExample for Substitution Drugs III / III

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Authentification

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Current Solution – AuthentificationDoctor & Practice

Authentification is used for following purposes

� Identification

� Signing medical data

Current Solution: Rollout of software-based certificates

Planned: Rollout of hardware-based certificates (health professional card)

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Data-Center

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� Provide Online-Services i.e. „check enrolled patients“

� Receive data from the physicians

� Approval & Decryption & Clearing & Storage

� Billing & Accounting-Services

� Provide Online-Updates

� Interfaces to several Sick Funds for data exchange

� Exchange Data in XML

� Multiple & Mass Data Processing

� Provide Trust Center to manage certificates

Current Solution – Data-CenterOverview of Services

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Current Situation & Next Steps

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Current Situation & Next StepsUsing our system since June 2008

� 2,000 physicians using Hardware-Router, 8,000 physicians using Software-VPN for transmission encryption

� 10,000 integrated Cores in existing 35 software-solutions

� 6,000,000 insured persons are enrolled in the new system

� 500,000,000 medical data, diagnoses, drugs, remedies, referrals every 3 months to validate

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Current Situation & Next Steps

� Provide Core-Module in Java

� Provide Core-Module as ASP-Solution

� Provide billings for doctors online as PDF to download

� 30,000 physicians and 30,000,000 insured persons in the new system

���� And…. It will work!!!

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Questions & Answers

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Thanks for your attention