October 1, 2007

Sharing Patient Data: Is It in the Cards?
By Kim M. Norton
For The Record
Vol. 20 No. 19 P. 28

Despite interoperability concerns, smart card supporters suggest the technology can be an economical way of exchanging medical information across organizations.

Protecting patient records and reducing paperwork are two of HIPAA’s primary goals. Partly because of this, the use of smart card technology has been rising in popularity across the healthcare community. In addition to protecting patient data and reducing paperwork, the smart card can also help curb fraud and streamline the registration process by preventing the creation of duplicate records.

As the healthcare industry shifts more toward consumerism, the desire for patients to have greater access to their personal health records (PHRs) grows. By using a smart card, patients control who can access their PHR. Smart cards also address security concerns through a high level of data encryption and the two-factor authentication process: the card plus the patient’s personal identification number (PIN) or other biometric parameter.

To ensure the card bearer’s identity, the issuing hospital must verify the patient’s identity. In doing this, the institution accomplishes two important functions. Fraud is reduced because the card bearer must know the PIN code associated with the account, and the photo printed on the card must match. Also, the card contains the patient’s medical record number, providing an immediate link. With all this information already established and readily available, the registration process takes less time and errors are less likely to occur.

Assessing Smart Cards in the Healthcare Sector
At present, the healthcare industry’s more sophisticated smart cards house patient demographic information such as name, date of birth, any known health conditions, medications, drug interactions, other pertinent medical history, and insurance information. Depending on the size of the microchip installed, the card can also hold the most recent pages of the patient’s PHR and be updated when the patient is seen by an affiliated healthcare provider, explains Randy Vanderhoof, executive director of the Smart Card Alliance in Princeton Junction, N.J.

“As the [healthcare] industry moves toward smart cards, we will see a reduction in paperwork, which will make for faster reimbursement, less review and oversight, and less administrative burden overall. With this more streamlined approach in healthcare, we will see greater efficiency, increased safety in patient care, and greater patient satisfaction,” he says.

Despite the card’s assets, there are still implementation and interoperability hurdles to overcome. “The lack of standardization in healthcare in regards to a standard data set must be addressed before any real widespread implementation of the cards is addressed,” says Bruce P. Eckert, MBA, CPHIMS, a senior information systems manager with Beacon Partners in Weymouth, Mass. Although there has been great headway made on the Health Level Seven standard data set, each healthcare organization records information according to its current data set, which presents an issue with interoperability outside the home hospital. For smart cards to truly make an impact, data must be entered uniformly across the board, Eckert explains.

In an attempt to understand the enormity of this undertaking, consider a few examples. Should vital signs be recorded in metric or English units? When entering a pulse rate, was it taken when the patient was sitting up, after an activity, or resting? “With just these few considerations, it is easy to see that no matter the size of the microchip, the space will be devoured quickly because each and every recording must be entered in a separate data field,” says Eckert.

Another barrier to widespread smart card usage is its lack of accessibility to community health providers such as emergency medical technicians (EMTs). “When an EMT responds to a call and is unable to access the information on the card because of the lack of a reader or the patient has a card that is not compatible with their system, the fact that the patient has the card is irrelevant because the data is unable to be accessed,” Eckert says. Because the possibilities are endless in how and what data should be recorded, interconnectivity between hospital systems is limited until industry standardization is addressed, he says. However, Eckert does see the technology’s value if it’s used in the closed environment of a hospital or connected network.

According to Eckert, smart cards would increase their usefulness if they were able to be individualized. “I see great potential for the smart card if it is condition-specific and the patient can interact with the data on the card. If a patient is diabetic and requires insulin, he could enter into the card when and how much insulin he took so his physician can monitor compliance and how well he is doing on his current medications and dosages,” he says.

Technical Specs
There are two types of smart cards currently available: contact and contactless. In the healthcare setting, the contact card is used most often. The card is roughly the size of a credit card and has an embedded memory chip. Depending on the applications it runs and the amount of data storage needed, memory can range from 2 to 128 kilobytes (KB). Larger capacity versions are currently in development.

To access the data, a smart card reader, viewer software, and the patient’s PIN code or other biometric parameter are required. If the patient is unconscious, the provider can use a specifically configured viewer to perform a PIN override to access the data. The card design and what information it can hold will dictate how much space it requires. Most cards designed to hold the most recent pages of a patient’s PHR will have a minimum of 64 KB, which is the equivalent to approximately 30 pages of text, according to Aaron Zitzer, senior product marketing manager with Siemens Medical Solutions.

In addition to a reader, software—a free download from the vendor’s Web site—to manipulate the data is also required, says Zitzer. Patients also have the ability to view their records at home, although they are unable to add or manipulate any data, he says. A consumer package is available for a nominal fee and includes a reader and directions to download the software from the Web site.

Mount Sinai Pilot Program
Mount Sinai Medical Center in New York City has worked closely with Siemens during the last three years to develop the Patient Health Card solution and began deploying smart cards in February as part of its 10-institution pilot program.

The project was designed to demonstrate the benefits and value of smart cards locally and across organizations as a way to exchange medical information among disparate institutions. The network created with smart cards will allow facilities with varying information systems to share and exchange medical data in a secure and patient-controlled manner. The HealthSmart Network will initially link nine hospitals and one community clinic using smart cards. The intent is to expand the network throughout the New York metropolitan area.

“Smart cards provide an economical way to share data across institutions while at the same time promoting better patient identification and linkage to medical records,” explains Paul B. Contino, vice president for IT at Mount Sinai Medical Center.

The smart card used at Mount Sinai has a 64 KB memory chip that can be increased to 128 KB if needed. As the card is filled with information, the oldest data will roll off the card as new data is written. However, certain types of data can be flagged as permanent, such as demographics, allergies, and medical history, and remain on the card, explains Contino.

As for the type of information housed on the card, it need not all be in text format, says Zitzer. Electrocardiogram results or a PDF file of a test can be loaded onto the card and will fall off as it is replaced by newer data, he says.

Besides its storage capabilities, the Mount Sinai smart card is also a trusted identity tool, says Contino. “Each card that is issued is linked to a patient’s medical record number, which greatly reduces the possibility of creating a duplicate record. When the patient checks in, all the information pertinent to insurance coverage and billing is merely verified to streamline the registration process,” he says.

With the free viewer software, their smart card, and a low-cost reader, patients can view everything on their card. “We want to engage our patients in their own healthcare and empower them to take a more active role,” says Contino.

A Look Ahead
The ambitious pilot program underway at Mount Sinai, where officials expect to roll out 100,000 cards, could change how doctors and hospitals view smart card technology. It is no secret that pen and paper are preferred and still widely used among doctors and hospitals, but as smart cards advance and become more mainstream, they could become a viable replacement to the paper chart and a way to provide portable medical data and support exchange. “As hospitals and doctors interact more and more with patients carrying a smart card and download the software to utilize and update the card, the momentum behind the technology will grow,” says Contino.

Despite the initial expense of a smart card start-up, which can be rather expensive, the technology to utilize and maintain the cards is now far less expensive. “Not too long ago, a single smart card could have cost upward of $40. But now the cards are less than $10 a piece and a consumer-grade reader is about $20. The software needed to view the card is free and can be downloaded from the Internet,” explains Contino.

The next logical step in smart card technology is attaining greater usability through a wider array of applications. “We see great potential in the convergence of services onto the smart card such as financial transactions,” Contino says. “If the smart card was also an HSA [health savings account] debit card, a patient could make his copayment with the same card.” Mount Sinai is in discussions with financial institutions about just such an idea.

Another application being considered for the smart card is e-prescriptions. By connecting the smart card to a pharmacy network, the visiting doctor can upload the prescription to the smart card and have the patient take the card to the pharmacy, where the pharmacist reads the card and fills the prescription with the security of knowing the patient requesting the medication is the patient it was meant for, says Contino.

As the number of smart card programs increases, the technology could make a significant impact on healthcare’s bottom line by reducing fraud, paperwork, and duplicate records. With smart card programs underway in Florida, Texas, New York, Pennsylvania, France, and Germany, the trend appears to be gaining steam. But, according to Eckert, the true large-scale success of the technology will be dependent on incorporating a large network of hospitals, doctors, pharmacies, community health providers, and other health professionals with the capability to utilize and manipulate the smart card within a universal data set.

— Kim M. Norton is a New Jersey-based freelance writer specializing in healthcare-related topics for various trade and consumer publications. She can be contacted at kim_norton1@hotmail.com.

Using smart cards to increase profits

Smart card technology could be the future of healthcare, with its capabilities to reduce fraud, streamline the registration process, and eliminate paperwork. But, in addition to creating a more efficient records department, the card can also increase patient loyalty and satisfaction.

The Smart Card Alliance in Princeton Junction, N.J., has identified the following key aspects of the smart card that can help grow a hospital’s patient base and retention:

• Strengthening patient loyalty by embracing consumerism. When patients are empowered by their ability to view their medical records and know they are secure, they place more trust in the card and, in turn, in the healthcare provider.

• Simplifying patients’ and healthcare professionals’ lives. The smart card’s ability to support multiple applications means patients no longer need various forms of identification, and insurance, prescription, and credit cards.

• Increasing patient retention through brand recognition. If patients are happy with how they are treated and the smart card’s ability to make their lives easier, they are more apt to associate the facility with a pleasant experience.

• Increasing patient knowledge. By providing patients with their medical records and information on how to access their records, they become more informed.

— KMN