1. 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

2. Broadband access for e-health applications Tuxtla, 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 Services Banknote New Business Government 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

3. Broadband access for e-health applications Tuxtla, 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)

4. Broadband access for e-health applications Tuxtla, 18-19 May 2006 The Smart Card – A SECURE PC in Your Pocket Processor and Memory 19906 Bit CPU 7 kB ROM 3 kB EEPROM 128 Byte RAM 200632 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. Broadband access for e-health applications Tuxtla, 18-19 May 2006 New medical technologies Higher life expectancy Cost increase Stone age: 21 Romans: 22 Increase of insurance premiums MFMF Life Expectancy (Years) Insurance Premium (% of Gross Salary) The healthcare cost dilemma: a vicious circle

6. Broadband access for e-health applications Tuxtla, 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

7. Broadband access for e-health applications Tuxtla, 18-19 May 2006 Higher-quality medical care Strengthened patient rights Cost reduction More transparency Well timed regulations Increased profitability (offsets IT and infrastructure costs) Better communication/information between providers Efficient processes (eBilling, eAdministration) P rovider P ayer P atient P olicymakers Benefits of Card enabled e-Health Networks

8. Broadband access for e-health applications Tuxtla, 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 Initial Health Card Functions: Emergency data DMP-Data (Disease Management Programme) e-Referral The National Health Card System in Taiwan

9. Broadband access for e-health applications Tuxtla, 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 insurance certificate (on back) Right to receive medical service Access to online services Eventual evolution to a citizen card - digital signature Initial e-Card Functions: Health insurance certificate European insurance certificate (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

10. Broadband access for e-health applications Tuxtla, 18-19 May 2006 Initial Health Card Functions: Online verification of insurance status e-Prescription/drug interaction Emergency Data European insurance certificate (on back) 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 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 The German Gesundheitskarte to be issued in 2007

11. Broadband access for e-health applications Tuxtla, 18-19 May 2006 The German Gesundheitskarte – Drug Interaction

12. Broadband access for e-health applications Tuxtla, 18-19 May 2006 The German Gesundheitskarte – e-Prescription

13. Broadband access for e-health applications Tuxtla, 18-19 May 2006 HPC: Health Professional Card PDC: Patient Data Card PhysicianPharmacist Issuing e-Pres- cription Physician software Signing of e-Pres- ciption HPC Encrypt e- Presciption with ses- sion key Connector Encrypt session key with public key of patient PDC Writing on e-Prescrip- tion server Connector Physician software Decrypt e- Prescription with session key and dispense Connector Pharmacy software Decrypt session key with private key of patient PDC Neccessary Modules/Software Connector Reading e-Prescription from server Pharmacy software PDC Use Case: Issuing and Dispensing an e-Prescription

14. Broadband access for e-health applications Tuxtla, 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 Operational Tasks Secure Medical Network (Telematics-Platform) Health Insurance Companies CAMS C C C C C Status Inquiry, Directory- Services Card-DB PDC Medical Doctors Association Trust Center C HPC PDC, HPC C Health Professional Card Patient Data Card Secure Connector to the Network HPC PDC Overview of System Architecture in Germany

15. Broadband access for e-health applications Tuxtla, 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 Operational Tasks Secure Medical Network (Telematics-Platform) Health Insurance Companies CAMS C C C C C Status Inquiry, Directory- Services Card-DB PDC Doctors Associ. Trust Center C HPC Secure Connector and Card Reader Security services for Medical Network Providers and Trust Centres Data registration customer hotline, Patient Card and Card Management System Health professional card Solution offering from Giesecke & Devrient

16. Broadband access for e-health applications Tuxtla, 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 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 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 Co-Payment e-Additional insurances (eg. 2 bedroom in hospital) Current co-payment status, automatically accumulated Potential Additional Applications

17. Broadband access for e-health applications Tuxtla, 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, Secunet M = millions bn = billions Significant Health Care Savings

18. Broadband access for e-health applications Tuxtla, 18-19 May 2006 Structure of the population Patient rights Medical and insurance coverage Number of providers (physicians, hospitals, pharmacists) Current issues P rovider P ayer P atient Number of health insurance companies Structure of the health insurance / social security system Current problems Governmental / administrative environment Decisionmakers P olicymakers Understanding the 4Ps

19. Broadband access for e-health applications Tuxtla, 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)

20. Broadband access for e-health applications Tuxtla, 18-19 May 2006 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