Health Systems Relying on Smart Cards

1. Health Systems Relying on Smart Cards Dr. Klaus Vedder Executive Vice President, Giesecke & Devrient GmbH Chairman, ETSI TC Smart Card Platform

2. 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 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. New Business Government Solutions Cards and Services Banknote • Electronic payment • Telecommunications • ID documents • Passports • Health cards • Transit • Security printing • IT security • Security systems • Embedded Systems • New technologies • Banknotes • Security paper / foils • Banknote processing systems and identif. modules

3. Smart Card, Module and Chip Over 4 billion SIMs delivered to the market (all based on ETSI / 3GPP specifications) • 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, …..

4. The Smart Card – A SECURE PC in Your Pocket Processor and Memory 1990 6 Bit CPU 7 kB ROM 3 kB EEPROM 128 Byte RAM 2006 32 Bit CPU 500 kB ROM 512kB EEPROM 16kB 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)

5. New medical technologies Insurance Premium(% of Gross Salary) Life Expectancy (Years) Increase ofinsurance premiums Higher lifeexpectancy M F Stone age: 21 Romans: 22 Cost increase The healthcare cost dilemma: a vicious circle

6. Increasing efficiency and effectiveness:Cost reduction and quality improvement • 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? Smart Card enabled e-Health Networks Three examples: Taiwan, Austria, Germany

7. Benefits of Card enabled e-Health Networks Patient • Higher-quality medical care • Strengthened patient rights Policymakers Provider Payer • Cost reduction • More transparency • Well timed regulations • Increased profitability (offsets IT and infrastructure costs) • Better communication/information between providers • Efficient processes (eBilling, eAdministration)

8. Migration of a paper-based system to an information technology based one Project management, production, personalization and issuance of 24 M "Patient Data Cards" 150.000HPCs 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 The National Health Card System in Taiwan Initial Health Card Functions: • Emergency data • DMP-Data (Disease Management Programme) • e-Referral

9. The e-Card in Austria 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 • 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 Front Back

10. The German “Gesundheitskarte” to be issued in 2007 • 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 cards Smart 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 Initial Health Card Functions: • Online verification of insurance status • e-Prescription/drug interaction • Emergency Data • European insurance certificate (on back)

11. The German “Gesundheitskarte” – Drug Interaction

12. The German “Gesundheitskarte” – e-Prescription

13. Physician Pharmacist Encrypt session key with public key of patient Decrypt e- Prescription with session key and dispense Encrypt e- Presciption with ses- sion key Decrypt session key with private key of patient Issuing e-Pres- cription Signing of e-Pres- ciption Writing one-Prescrip- tion server Reading e-Prescription from server PDC Connector Physician software HPC Connector PDC Physician software Connector PDC Pharmacy software Connector Pharmacy software Neccessary Modules/Software Use Case: Issuing and Dispensing an e-Prescription HPC: Health Professional Card PDC: Patient Data Card

14. PDC PDC , HPC , HPC PDC , HPC Overview of System Architecture in Germany gematik (Planning, Implementation, Operation) Setting Standards & Guidelines OperationalTasks Health InsuranceCompanies Physician´s Practice C C Status Inquiry, Directory-Services Card-DB • Applications, e.g. • e-Prescription • Medication Log • Referral Letters • Electronic Patient Health Record Pharmacy PDC CAMS C Medical Doctors‘Association Security,Transaction, and other Services Hospital C C HPC TrustCenter Self-Service Kiosk Secure Medical Network(„Telematics-Platform“) C HPC Health Professional Card PDC Patient Data Card PDC Secure Connector to the Network C

15. Solutionoffering from Giesecke & Devrient Data registration customer hotline,Patient Card and Card Management System gematik (Planning, Implementation, Operation) Setting Standards & Guidelines OperationalTasks Security servicesfor Medical Network Providers and Trust Centres Health InsuranceCompanies Physician´s Practice C C Status Inquiry, Directory-Services Card-DB • Applications, e.g. • e-Prescription • Medication Log • Referral Letters • Electronic Patient Health Record Pharmacy PDC CAMS C Doctors‘ Associ. Security,Transaction, and other Services Hospital C C HPC TrustCenter Self-Service Kiosk Secure Medical Network(„Telematics-Platform“) C Health professional card Secure Connector and Card Reader

16. Potential Additional Applications • Co-Payment • e-Additional insurances(eg.2 bedroom in hospital) • Current co-payment status, automatically accumulated • 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

17. Effect Process Optimization Co-payment Information for Medications Prevention of adverse reactions from administration of different medications Total Significant Health Care Savings Example e-Prescription • Annual Savings* • US $ 180 M • US $ 320 M • US $ 640 M • 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. • This amounts to approximately US $ 17–33 bn p.a. M = millions bn = billions *) Source: Debold & Lux, Secunet

18. Patient Provider Payer Understanding the “4Ps” • Structure of the population • Patient rights • Medical and insurance coverage • Number of health insurance companies • Structure of the health insurance / social security system • Current problems Policymakers • Number of providers (physicians, hospitals, pharmacists) • Current issues • Governmental / administrative environment • Decisionmakers

19. 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)

20. Contact: Fabiola Bellersheim, Segment Adviser eHealth 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 Contact: Dr. Klaus Vedder, Head of Telecom Division Phone: + 49 89 4119 1542 Fax: +49 89 4119 1540 Klaus.Vedder@gi-de.com