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