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Electronic Health Service Smart Cards

Various countries with national health care programs have deployed smart card systems. The largest is the German solution which deployed over 80,000,000 cards to every person in Germany and Austria.

These memory cards are issued by the health insurance organisations and contain the insured person's personal data which used to be entered on the paper insurance form. The smart patient data stored in the chip can be read very simply with the aid of the appropriate smart card reading device and facilitates the secure sharing of patient clinical data amongst multiple healthcare providers. Altogether they have been responsible for a considerable reduction in administrative work for the insurance organisations and in the hospitals and medical practices seeking smart health solutions.

Patients will no longer need to fill out their personal information each time they visit their doctors since the cards will contain pertinent critical information such as medications, allergies and chronic conditions along with demographics and insurance history. By inserting the patient card in a computer in the exam room, the physician can have instant access to accurate and up-to-date information on the patient. Patients can also check their stored information by using a computer kiosk in the physician's office or they may purchase a card reader to use with a home computer. For the patient, a PIN is required to gain access to their data.

When visiting a doctor's office, emergency room or clinic, upon presentation of the patient's card, a form specific to the site visited will print out. The card will maintain a record of clinical history such as blood pressure, pulse, and medications. In the future, the cards will be used to fax medical records from incoming ambulances to the destination emergency rooms.

Here are three health-related examples. In Germany, the Krankenversichertenkarte is used to manage billing to various health-insurance companies for all services received by the public. In Wyoming, the Health Passport Card is used, right in the grocery store, to check how pregnant and breast-feeding women spend their allowance for nutritional supplements (on food rather than on diapers, for example). Ontario plans to use a smart card to reduce fraudulent access to public health services.

The goal is to streamline treatment, reduce test duplication and automate interactions between patients, healthcare providers and payer organisations. The three critical aspects addressed are quality of care, patient safety and costs through an advanced approach to Information Management.

It provides a means of reducing existing operational and administration costs by introducing uniform, convenient information management. Electronic patient health cards would speed up routine consultations, safeguard confidential medical information, and provide patients with access to their own medical information. The Consumers Association (U.K.) found that one in four patients have experienced problems with medical records being unavailable or lost.

Doctors, other care providers and staff spend hours per week on the phone, playing telephone tag and returning calls to exchange information. Smartcard-based patient data makes patient information available to participating care providers at the point of care.

It provides:

· Availability of clinical information to doctors and other providers
· Improvements in the quality of care by making critical information available at all points of care
· Mitigation of risk through better provision of information
· Reduced administrative costs of disseminating clinical information, including reducing telephone calls, faxes, mail and courier charges
· Ensuring that patients' privacy is protected by the implementation of secure systems, procedures and storage of clinical data.

Shared Electronic Health Records

Smart Cards provide the enabling of shared Electronic Health Records amongst doctors and other healthcare providers. It is simple to use, low cost and proven. 

The cost savings to healthcare providers and payers that use shared EHRs are substantial.

The many-to-many Patient Centric shared EHR approach provides support for clinicians in their normal practice environments: homes, offices, private clinics, outpatients or a hospital ward. Many-to-many means that once information is posted to the secure data repository, it is available to all of the many health care providers that may provide care to that patient in the future.

The program is compatible with and enhances existing healthcare software solutions. To implement the Smart Health Approach healthcare providers require recent model workstations (PCs) with Internet connectivity. Patients and healthcare providers require secure tokens (such as smart cards) to use the product over the Internet. The card is the electronic system key. The industry needs access to patients' clinical information. Patients want secure, confidential records and knowledge based care.

The approach provides on-line access to event summaries provided by healthcare peers (radiology, pathology, specialists, etc.). It provides doctors in the community with immediate access to hospitalisation information. Many of these communications are currently paper-based, rely on the patient's memory or are simply non-existent. Doctors waste valuable time trying to communicate with each other to learn about patient treatment. 

It enables general practitioners, specialists, hospitals and other authorised healthcare providers to share patient information in a simple, user friendly and secure manner. 

As each patient is treated, the patient's card is used to "point" directly to the individual patient's data on the server. When a patient leaves a hospital, discharge information is posted to the secure data repository. When the patient visits a general practitioner, the doctor can access the patient's clinical records, including the latest information, on-line. The record can then be supplemented with a new visit event summary. In this way the patient's clinical history is built up over time, providing essential clinical information to all authorised healthcare providers.

Italian Smart Cards for Health Professional Providers

12/04 Health care facilities in Northern Italy are in the midst of a major smart card rollout that requires adding smart card readers to roughly 35,000 computers. Each computer is equipped with a reader that can communicate with both the doctor’s and the patient’s smart cards; it also has a PIN pad.

This type of reader ensures that a patient’s data is read only by authorized health professionals and only after the patient has handed over a new smart card that citizens are being issued in a test of a card that eventually may be adopted throughout the European Union.

The operator–such as a doctor or nurse–also must insert his or her card into a reader and enter their PIN before the reader will access the data on the patient’s card.

The citizen card certifies both identity and will to allow the operator to access his clinical data stored in the system. The health professional’s profile stored on the card specifies what data that individual can access.

Hospital Patient Smart Cards

01/05 - NASHVILLE, TN - Saint Thomas Hospital has announced a new benefit for patients and a first for healthcare in Middle Tennessee - SmartCards.

The new SmartCard is the first phase of a pilot program and will consist of a patient's ID photo and a computer chip housing the patient's medical history, personal and insurance information.

SmartCard reader stations will be located in the admissions area at Saint Thomas Hospital, in the emergency department and in cardiology offices on the Saint Thomas campus.

SmartCard technology will provide patients with faster registration and easily accessed medical history.

"One of the most difficult things patients encounter when visiting doctors or hospitals is the very lengthy process of registration. This new technology will decrease the time spent on forms and expedite their entry into various parts of the hospital in minutes," said Chris Young, chief information officer.

Instant Access Medical Records on a Smart Card

02/05 - Ostara Corporation announced that Health One Global LTD. plans to launch the Instant Access Medical system "I-AM", an Internet personal health record, combined with the world-leading patented I-AM Smart card in the fourth quarter of 2005. The application allows people to carry their entire medical history on a smart card.

The I-AM personal health record stores an individual's lifelong health data securely on the Internet along with a synchronized copy on the I-AM Smart card giving Instant Access to Medical data whenever and wherever the patient, or their physician, needs it regardless of access to the Internet.

The patient controls access so the data is only available when the patient activates the I-AM Smart card. All access to the personal health record is logged and entered in an audit trail. For even greater security a fingerprint reader is available.

The card is applicable at home and overseas. For those away from home, I-AM displays the health data in a multi-lingual format, providing foreign doctors access to all pertinent medical history to ensure proper care is administered.

The I-AM personal health record is based on Health One Global's international professional electronic health record software. The software is built around international standards, and is already used by physicians in the USA, Ireland, Belgium, France, Switzerland and South Africa. The I-AM Smart card patented technology is an ISO-approved design and is supplied by IntelCard Inc. Health One Global Ltd is the exclusive healthcare Global Distributor for the Smart card technology.

I-AM offers global healthcare convenience for travelers, international workforces, business executives, military and medical personnel, insurers, airlines and travel companies.

Smart Cards to Access Sun Ray Clients in VA Hospitals

02/05 - Sun Microsystems and its partners are delivering innovative technology solutions to meet the latest IT needs of healthcare providers.  Healthcare facilities can improve the efficiency of the services they deliver using systems for radio frequency identification (RFID) and electronic medical records (EMR).

Upon inserting a smart card and entering a password, doctors at VA Hospitals now have immediate access to patient files and other critical applications. Once the doctor has finished reviewing files, removes the smart card and walks away, the ultra- thin client display automatically turns blank and is locked.

Sun Ray ultra-thin clients are located throughout VA Hospitals and clinics, in convenient locations such as emergency rooms and admission centers, allowing doctors to have easy and secure access to patient records as they move throughout the hospital.

Australian Medicare Smartcards

03/05 - AUSTRALIA Post has emerged as the surprise leader of a consortium testing Medicare smartcards in Tasmania.

The 12-month project is based on the smartcard technology developed by French payment and security card developer Oberthur. Neotech Australia will supply touchscreen kiosks for installation in Medicare offices, and plastic card maker Placard will produce the cards.

Australia Post is the systems integrator for the pilot, which is the first phase of the Health Insurance Commission's plan to adopt smart Medicare cards that store large amounts of data. To date, 800 Tasmanians have registered for the trial and received smartcards.

By the end of this month each of the state's seven Medicare offices will be equipped with a kiosk that gives people access to the information stored on their smartcards, and internet access to government health websites and audiovisual messages.

The Medicare smartcard trial is part of the planned $128 million federal roll-out of the HealthConnect e-health record network.

The Medicare smartcard includes a HealthConnect Access Number that in the future will apply to individual e-health records in the nationwide system.

It is hoped that in the future it will store emergency information that can be used by ambulance officers and doctors to avoid medical mistakes. With a 32KB chip, it's envisaged the smartcard could be used for immunisation records and organ donor information.

The smartcards are presently "used in exactly the same way as current Medicare cards", with an option for the consumer to include a photograph.

Ms Stonebridge said the smartcard was designed to remain under the control of the health consumer, while further security enhancements – such as a PIN or password – would be introduced later.

Health care system in France uses smart card technology

11/06 - The French health care system has selected a smart card chip technology company to help develop the cutting-edge Sesam-Vitale2 health card. NXP Semiconductors will help develop a card with which users can sign invoices and have safe access to their personal medical files electronically.

France has been using the Sesam-Vital contact card since 1998, but the original version could only store a small amount of data and had no photographic identification. The new version, Sesam-Vitale2, includes a photograph and a much greater capacity to store information such as complementary health insurance details. It also allows holders to have secure access to their personal medical files electronically. In addition, with the increased storage capacity, administrative processes can also be performed faster.

The latest identity protection technology, based on IAS (Identification, Authentification and Signature) application software, is used in Sesam-Vitale2. The new card contains Common Criteria EAL5+ security certified NXP SmartMX chip technology. The 36K EEPROM public key infrastructure contact microcontroller offers highly advanced encryption hardware and physical hacking counter measures. The chip's software is using NXP's advanced common criteria security certified cryptographic software library.

Sesam-Vitale is a smart card-based infrastructure incorporating many components, including a telecoms network and a message service, 223,000 health care professionals, 230 health software applications, 210,000 card readers, 25 servers handling the flows and 23,000 terminals for card updating, this enables insurers nationwide to access personal information and expedite claims as quickly as possible. NXP is based in the Netherlands and was formerly a division of technology giant Phillips.

Smart Health Cards - Discussion of problems with government implementation of smart health card, designing the architecture and ergonomics of electronic consent given the potential multitude of complexities involved, and the need for public consultation.

Social and political risks involved in identification schemes - research paper

Smart Health Solutions - Australia

Will Smart Cards Reduce Health Care Fraud?

Health eSignature Authority - Australia health medical smart card - Healthcare Digital Keys and Certificates.

U.K. based E-Health Insider - Latest health care IT news - very informative site

U.K. National Health Service Occupational Health Smart Cards OHSC Initiative FAQ

U.K. Doctors wishing to get a National Health Service NHS smart card.  - pdf brochure from Department of Health - for GMC-registered medical practitioners, doctors' smart card from General Medical Council (GMC) Registration Department.

Occupational Health Smart Card scheme - U.K. Department of Health website search results