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Healthcare CouncilMichael MagrathChairman, Smart Card Alliance Healthcare CouncilDirector, Business Development – Government & HealthcareGemalto, Inc.March 1, 2013

About the Smart Card AllianceHealthcare Council Brings together payers, providers, and technologists to promotethe adoption of smart cards in U.S. healthcare organizations. Provides a forum where all stakeholders can collaborate toeducate the market on how smart cards can be used and to workon issues inhibiting the industry. Healthcare Council participation is open to any Smart CardAlliance member who wishes to contribute to the Council projects.Major activities Conferences, symposia, web seminars Educational workshops and on-line training Web-based resources: white papers, reports, industry productand services

What is a Smart Card? Contains an embedded integrated circuit(or chip) that can be either a securemicrocontroller with internal memory orsimply a memory chip. Chip is a powerful minicomputer with anoperating system that can be programmedin different ways. International standards, ISO/IEC 7816and ISO/IEC 14443 Hold various types of information inelectronic form and protect theinformation with sophisticated securitymechanisms; others provide a key thatunlocks a particular database on aparticular server. Portable and small providing an idealsolution for secure data exchange.3

Smart Card Benefits inHealth Care Systems Smart Card is a secure and convenient device Stand alone or combined with back end solutions Allows for enhanced privacy : sensitive citizen datais stored in the chip and protected with severalaccess conditions (PIN, Fingerprint,.) Can fight fraud thanks to proof-of-presence, proofof-consent, non-repudiation features Can benefit from for a reliable ecosystem thanks toInternational standards and tests which allowinteroperability Two-Factor Authentication mechanism for secureaccess to PHRs and EHRs (DEA compliant)4

eHealth Card DeploymentsAmericas Mexico Antigua (55K) U.S. HospitalsEurope & CIS France (60M, 600k pros) Germany (75M) Slovenia (2.1M, 70K pros) Belgium (11M) UK Finland Sweden (Professionals) Azerbaijan Bulgaria Austria (11M, 30K pros) Italy (14M) Turkey (25M) PolandAsia China (110M) Taiwan (24M, 345professionals) Ukraine (35M)Africa Algeria (7M tokens for profess) Gabon (1.5M)5

Today’s Presenters Roderick Bell, CIO, Resolute Health,Innovation Center for Vanguard Health, NewBraunfels, TX Lawrence Carbanero, Memorial Hospital,North Conway, NH

Michael Magrath, CSCIPDirector, Business Development – Government & HealthcareGemalto, Inc.Office: (512) 758-8911Email: [email protected] Card Alliance191 Clarksville Rd. · Princeton Junction, NJ 08550 · (800) 556-6828www.smartcardalliance.org

Roderick Bell, CIO - Resolute Health,Innovation Center for VanguardHealth, New Braunfels, TX

56 Acres Resolute Health is the innovation lab for new technology forVanguard Health a 6.5 billion company Providing population health management and innovativetechnology that helps physicians share quality metrics, andpatient data Providing wellness and prevention services that empowerpeople with tools that help them get and stay healthy

The Resolute Health BeneFIT CardBeneFIT Program was developed to provide incentives, rewards ®ister members making healthy choices that improve overall wellbeing like diet, exercise, medication, therapy & preventive measures.

The Resolute Health BeneFIT CardPatient Satisfaction and Safety Registration, it couldn’t be easier. The patient simply swipestheir card, photo appears on screen and each check-in at allvisit locations is complete in seconds Faster accurate admissions, less paper work equals higherpatient satisfaction Protects patient privacy. Patients check in without being askedfor additional personal information to prove identity with a datestamp and audit trail for reporting

Combining Marketing and Technology Technology Significantly decreased admissions & keystroke errorsEliminated duplicated records & Identity FraudDecreased duplicate proceduresMarketing and Community Engagement Chief Information Officers Mom (CHOM’s)Local High School - Comal ISD (RFID)Insurance CardRetail and Merchants

Goals and OutcomesPatient IdentityAuthenticationProvide Activity AuditTrailReduce Identity FraudEliminated Duplicate RecordsDiminished Keystroke ErrorsIncrease DatabaseIntegrity Going ForwardWorkflow Automation20 Second PaperlessRegistrationDecrease AdministrationRequirementsIncrease Patient Safety,Satisfaction and DataIncreased RevenueGrowthIncrease AdministrativeEfficiencies and ReportingROI Within a Year

Resolute Health “BeneFIT Card”Current and Future Expansion and IntegrationOne Identity for all Visits HospitalsClinicsPhysiciansWellness Campus’sHigh School Campus Insurance CardEmployersFirst RespondersB2BRetail

Smart Card SolutionLawrence CarbonaroDirector, Purchasing, Patient Access & Health Information SystemsThe Memorial HospitalNorth Conway, NH

The Memorial HospitalNorth Conway, NHSmart Health Card Initiative

The Memorial Hospital Community 59,412 annual visits – hospital 49,553 annual visits – clinics Average daily census: 16.5 25 bed criticalaccess hospital 45 bed long termcare facility Women’s clinic Orthopedic clinic Imaging &Ambulatory Care Primary Care ClinicServices Diabetes Clinic Wound Care Clinic Oncology / Infusion Sleep CenterCenter

Identity Management in HealthcareThe Memorial’s Smart Health Card‘patient service initiative’ Critical Importance of Patient Intake FlowMotivations for Deploying the CardResults of Phase 1Phase 2Future Intentions

Quality Control Environment Healthcare has a 5% clerical error rate in gathering patient dataPressure to register quickly at the expense of accuracyInadequate tools do not match the required tasksExtremely complex system yet zero tolerance for errors

Revenue Cycle ManagementThe Memorial’s Smart Health CardThe Start of the Revenue Cycle Move the collections process from post to preencounter Real time integration with eligibility tools Accurate data management to council patients Repository of required information: MSP from each visit HIPAA Privacy Notice Patient photo Insurance Card

Patient Identity ValidationRegistration: the critical system entry pointwhy we ask what we ask: legalities and life changes Clinical Identity Establishes Care Regimen Patient Account Number Medical Record Number EMR Demographic Identity Initiates Revenue Cycle Patient, Spouse, RelationsGuarantor VerificationInsurance Carrier VerificationType of Claim Incident Motor Vehicle Accident Work Related Accident Medicare/Medicaid Incident

Patient Identity in HealthcareOne Identity One Record Studies show 5%–15% of a hospital’s medical records areduplicated, overlaid or obtain errors and cost hundreds of millionevery years to correct Studies estimate 50%–90% of claim denials could be prevented bysecuring accurate patient information at the front desk. One 1 out of 5 claims submitted is delayed or denied by insurers, and96% of claims must be resubmitted at least once The National Health Care Anti-Fraud Association estimates that 3%of annual healthcare spending ( 68 billion in 2007) is lost due tohealthcare fraud Memorial Quote “Patient dissatisfaction started at registration beforethey visited our clinician.”

Memorial Identity EcosystemIT Hierarchy: 4 Hospital Registration Systems

IT Hierarchy With LifeMed

Improved Patient ExperienceVirtual Entry Points Silo Elimination Patient Access You register once, campus wide Unlimited Central Registration & Scheduling One call Coordination of care

Software Security FeaturesSMART CARDS Secure Microprocessor cards are contact & contactless, read & write data Administrator authentication cards are microprocessors, with advancedcryptographic capabilities and encryption keys for two-part authentication. Read, write, and create smart cards Desktop, kiosk, readers and internet software at registration & other pointsof encounter Bidirectional Integration of software to ADT, EMRs and disparate EMR’s for“Continuity of Care” as best record Audit trail and time-date stamp to validate record changes Two-part security authentication for users to certify, view & update data Security usage log with passive transmission to LifeMed for backup andauditing purposes

Identity Management:Real & Perceived Metrics Errant patient information: 6.8% average frequency Incorrect and missing corrected by Billing Dupes and overlays corrected by Medical Records Press Ganey Report Card Helpfulness:Average 91.1Memorial 89.1 12% rate Memorial “fair to poor” Ease:Average 91.1Memorial 81.3 17% rate Memorial “fair to poor” Wait Time:Average 87.5Memorial 81.1 22% rate Memorial “air to poor” Privacy:Average 85.1 6% rate Memorial “fair to poor”Memorial 92.1

Value PropositionSuccess Achieved Motivation for Smart Card Initiative Accurately Identify The Patient to Start Their Treatment Patient satisfaction: Eliminate Redundant Process System Wide Administrative: overlaid records at facilities missing corrected by Billing Improve Days in A/R Measurement Economic: labor and cash flow fix

ROI: Results Achieved Results: Phase 1 Press Caney results after 1st full quarter Ease of RegistrationImproved by 10 percentagepoints Wait time in RegistrationImproved by 10 percentagepointsErrors: reduced from 6.8% to less than 1%Duplicate medical records & PACS: reduced to less than .5%Patient waiting & desk time: reduced from 18 minutes to no waitBranded Smart Card extended reach to Patient Community: 95%coveragePatient access staff reduced from 21 FTEs to 15 FTEsPayback period of 18 months accelerated to 8 monthsDays In A/R Reduced to Less Than 41 Days

Phase 2: Pink OB Card &Pre-Registration Model The “One Time Registration” Process for All Expectant Mothers 100% Pre-Registration ModelLink Physician PracticesGoal: Arrive at Treatment Area – Be Treated – LeaveUniform Facilitated Phone Registration ProcessFlex StaffInternet Patient PortalKiosksWorking With EMR, The Smart Card is the Backbone of thisNew Model

Future Intentions Incorporate Continuity of Care Information on Card Data Set Link Emergency Services Providers Extend Information Exchange with Payers for improvedEligibility and Insurance Verification

Future Clinic Data Flow

Lawrence CarbonaroDirector, Purchasing, Patient Access & Health Information ServicesThe Memorial HospitalNorth Conway, NHSmart Card Alliance191 Clarksville Rd. · Princeton Junction, NJ 08550 · (800) 556-6828www.smartcardalliance.org

Two-Factor Authentication mechanism for secure access to PHRs and EHRs (DEA compliant) 4 . eHealth Card Deployments . France (60M, 600k pros) Germany (75M) Slovenia (2.1M, 70K pros) .