States find cards a smart solution for health care
- By Joyce M. Kelly
- Aug 07, 2000
The Western Governors' Association has gotten "smart." The association
is leading a $3.5 million initiative that allows residents and social
service providers in three states to use smart cards, which WGA says will
allow for more efficient and secure delivery of services.
Health Passport, a pilot program, has been launched in Bismarck, N.D.;
Cheyenne, Wyo.; and Reno, Nev. It is the largest use of smart-card technology
in the United States. Some 30,000 residents are participating in the project,
which encompasses more than a dozen programs including the Women, Infants
and Children program (WIC) and Head Start.
Although Health Passport works in conjunction with the delivery of a
number of services, its primary focus is health care. Smart cards, credit
card-sized devices with silicon memory chips, can carry an person's entire
medical history for use by physicians or social workers.
"I think that all of us feel that when we go into health care, things get
done to us," said Terry Williams, a Health Passport manager. "You kind of
go into this black box and get a prescription for medication and...10 days
later, hopefully you feel better. If you don't, you go in for surgery. The
Health Passport card allows families to become fully engaged in terms of
medical care because they're the ones carrying the relevant and timely information
among providers, and I think that's the way it should be."
Williams says WGA recognized the technology's potential for administering
social services and medical care nearly a decade ago. After examining a
series of initiatives involving information technology and government services,
WGA embarked on Health Passport in 1997.
The association began by posing a series of questions: What's the best
way to facilitate communication across programs? What should be the vehicle?
Should it be online or offline? Should it be a mag stripe? Should it be
an optical laser card? The driver, Williams says, was determining the common
information that patients and health care providers needed to share data
across different programs.
For the standard card, WGA selected a hybrid 8K plate that can hold
about eight pages of single-spaced information and has the ability to read
and write 30,000 times over the life of the chip.
One of the most important benefits of the smart card, Williams said,
is that its microchip makes it very secure. But WGA also developed a "security
hierarchy" with partners, which enables each program manager to determine
who can access the information on the card by using personal identification
numbers. Clients also have their own PINs to make them feel secure.
A secretary in a doctor's office, for instance, can't read the medical
or clinical data but can only view administrative, demographic and eligibility
information. On the other hand, nurses, nutritionists, social workers and
mid-level professionals can view clinical data. Other than the card owner,
only physicians or other primary-care providers have access to all of the
information on the card.
An attractive feature of the cards is their ability to be constantly
updated. "In our case, because we are rural states, frequently those laboratory
results aren't back for a week or so because they are sent to Denver or
Salt Lake or San Francisco or some place for analysis," Williams said. "If
you run into a situation like that, there is a flag that is built into the
design of the card that says not all of the information is available. [The
provider] can go out on the Internet and go to a secured host and pick
up that information and add it to the card before the next service is rendered."
Smart-card technology has proven especially useful with patients who
see several doctors, such as cancer patients. In those cases, the card is
updated with each doctor visit, and physicians can have immediate access
to those records. Information can be stored on the cards that patients might
forget, such as the types of medication they are taking.
This helps doctors prescribe new medications and diagnose conditions.
If a physician knows a patient is taking a certain medication, he or she
might realize that a symptom points to a possible drug reaction rather than
An important benefit for patients is that they can take their cards
to kiosks at libraries or community colleges and read the data on them.
Also, each time a patient uses his or her card to receive services, a receipt
is printed that shows pending appointments at other participating programs.
And even more features are possible. David Armour, manager of Siemens
Health Services, the largest systems integrator of smart-card technology,
sees great potential for smart cards. In Germany, which has a national health
care system, 80 million citizens carry the cards.
"It's on the very early growth curve in this country, but ultimately
everyone will carry one," Armour predicted. He said the card has "limitless
potential" because it can be used in so many ways. Williams said it is likely
that the technology will eventually be applied in all 17 states under WGA's
At the Mayo Clinic in Jacksonville, Fla., which serves a large senior
population, smart cards have eliminated the need for patients to wait in
line at the outpatient laboratory to announce their arrival for an appointment.
Patients now insert their smart cards into a card reader to alert the staff
that they have arrived.
"The system eliminates the No. 1 complaint of patients: clipboards,"
said Chris Lotz, a business solutions manager at Siemens.
Meanwhile, WGA is seeking to enhance its smart-card use. While some
European programs have incorporated biometrics, including the use of fingerprints,
into their smart-card systems, Williams said digitized signatures will likely
fit better into the United States' use of the technology.
"We feel that the digitized signature is, from the perspective of health
information, probably the most valuable additional tool that we could add
to our application," he said. "The digitized signature is unique. It can
be handled within the parameters of the microchip itself so that when your
health information goes out to a secure Web site or another provider, it's
unique to you. The probability is one in 10 billion...that you would be
able to crack a digitized signature."
Williams said that in the future, all information, including health
data, will be managed using both online and offline solutions. "If I am
unconscious, it's going to be real important in terms of blood types and
what medicine I'm on and what my chronic disease history is," he said.
The WGA's pilot program will end in 2001. Next summer, the Urban Institute
will present its evaluation of the project at the WGA's annual meeting.
—Kelly is a freelance writer based in Chicago.