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Health Systems Relying on Smart Cards
Dr. Klaus Vedder
Executive Vice President, Giesecke & Devrient GmbH
Chairman, ETSI TC Smart Card Platform
Broadband access for e-health applications
Tuxtla, 18-19 May 2006
Giesecke & Devrient – Innovation based on tradition
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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
systems and identif.
modules
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Electronic payment
Telecommunications
Broadband access for e-health applications
Tuxtla, 18-19 May 2006
New Business
Government Solutions
Cards and Services
Banknote
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ID documents
Passports
Health cards
Transit
Security printing
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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 /
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, …..
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 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)
Broadband access for e-health applications
Tuxtla, 18-19 May 2006
The healthcare cost dilemma: a vicious circle
New medical
technologies
Insurance Premium
(% of Gross Salary)
Life Expectancy (Years)
90
15
14
14
81
80
13.5
75
13
12.6
70
68
12
Increase of
insurance premiums
11.4
11
64
Higher60life
expectancy
10
M
M
F
W
50
47
45
9
8
86
83
40
8.2
7
1970
1980
1990
2000
30
1850
2010
Cost increase
Broadband access for e-health applications
Tuxtla, 18-19 May 2006
41
Stone age: 21
Romans: 22
1900
1950
2000
2050
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
Broadband access for e-health applications
Tuxtla, 18-19 May 2006
Benefits of Card enabled e-Health Networks
Patient
 Higher-quality medical care
 Strengthened patient rights
Policymakers
Provider
 Increased profitability (offsets IT and infrastructure costs)
 Better communication/information between providers
 Efficient processes (eBilling, eAdministration)
Broadband access for e-health applications
Tuxtla, 18-19 May 2006
Payer
 Cost reduction
 More transparency
 Well timed regulations
The National Health Card System in Taiwan
 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
Initial Health Card Functions:
 Emergency data
 DMP-Data (Disease Management
Programme)
 e-Referral
Broadband access for e-health applications
Tuxtla, 18-19 May 2006
 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 e-Card in Austria
Initial e-Card Functions:
Health insurance certificate
European insurance
certificate (on back)
Front
Right to receive medical
service
Access to online services
Eventual evolution to a
citizen card digital signature
Back
 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
Broadband access for e-health applications
Tuxtla, 18-19 May 2006
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
Initial Health Card Functions:
 Online verification of insurance
status
 e-Prescription/drug interaction
 Emergency Data
 European insurance
certificate (on back)
 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
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 ePresciption
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 ePrescription
with session
key and
dispense
PDC
Physician
software
HPC
Connector
PDC
Physician
software
PDC
Connector
Connector
Connector
Pharmacy
software
Neccessary Modules/Software
Broadband access for e-health applications
Tuxtla, 18-19 May 2006
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
Status Inquiry,
DirectoryServices
Card-DB
PDC, HPC
Hospital
C
PDC, HPC
Security,
Transaction,
and other
Services
C
Applications, e.g.
• e-Prescription
• Medication Log
• Referral Letters
• Electronic Patient
Health Record
PDC
Medical Doctors‘
Association
C
HPC
Self-Service Kiosk
C
PDC
Trust
Center
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
CAMS
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,
DirectoryServices
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
• eBonuspass dentist
(reminder letter, SMS)
• eVaccination 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
• 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
Significant Health Care Savings
Example e-Prescription
 Effect
 Annual Savings*
 Process Optimization
 US $ 180 M
 Co-payment Information for Medications
 US $ 320 M
 Prevention of adverse reactions from
administration of different medications
 US $ 640 M
 Total
 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.
Broadband access for e-health applications
Tuxtla, 18-19 May 2006
M = millions
bn = billions
*) Source: Debold & Lux, Secunet
Understanding the “4Ps”
Patient
 Number of providers
(physicians, hospitals,
pharmacists)
 Current issues
Provider
Broadband access for e-health applications
Tuxtla, 18-19 May 2006
Policymakers
 Governmental /
administrative
environment
 Decisionmakers
 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
Payer
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)
Broadband access for e-health applications
Tuxtla, 18-19 May 2006
Contact:
Fabiola Bellersheim,
Segment Adviser eHealth
Phone: + 49 89 4119 8618
[email protected]
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
[email protected]
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
[email protected]