# Presentation: 405074

## Healthcare Data Cards

**Daniel L. Maloney**
**Director, Technology Innovation**
**Department of Veterans Affairs**
**Silver Spring, MD., U.S.A.**
**maloney.dan@forum.va.gov**
**http://www.va.gov/**

## Healthcare Data Cards

**Functions of Health Care Cards**
**Card Technologies**
**Projects in USA**
**Framework Projects**
**EUROCARDS**
**TrustHealth**
**G-7 Healthcare Data Card Project **
**European Projects**
**Influencing Events**
**Card Technologies**
**Summary**

## The Department of Veterans Affairs

**27 Million Veterans and 43 Million dependents**
**Nearly one-third of the nation’s population are potentially eligible for VA benefits, includes dependents**
**Second largest of the 14 Cabinet departments**
**Facilities in all 50 states, Washington D.C., Puerto Rico and the Philippines**
**Nation’s largest medical system with 159 hospitals, 129 nursing homes, 35 domiciliaries and 362 outpatient clinics**
**58 regional Benefit offices providing monetary, disability, pension, educational and vocational rehabilitation benefits**
**13 million home loans, and the nation’s largest insurance programs**
**114 national cemeteries**

## Functions of VA’s Public Domain Integrated Hospital Information System (VISTA / DHCP)

**Clinical and Administrative Support**
**Clinical Results Reporting**
**Order Processing**
**Patient’s Medical Record**
**Accounting and National Reporting**
**Medical Care Cost Recovery**
**Integrated Medical Images at pilot sites**
**60 Applications**
**National Electronic Network for inter facility Communication**

## Why Use Cards In Healthcare?

**Cards are a part of local or networked system **
**Deliver Better Service Faster**
**Decrease Fraud**
**Increased Patient Convenience**
**Improve the Quality Health Care **
**Quicker retrieval of Data (from card or using card as key to data lookup)**
**Improve Access / Secure Access to On-line Data**
**Increase Privacy and Confidentiality**
**Decrease Date Entry Error**
**Lower Costs**
**Save Lives**

## Functions of Healthcare Data Card

**Identification**
**Information Transfer to paper or an on-line data base**
**Access Control**
**Data Carrier**
**Authentication**
**Encryption / Decryption**

## Card Technology    Unit Cost ($)     Major Benefits      Options 

**Paper, bar code option   ****	****.01-.04****	**** ****	****Inexpensive, bar code**
**Plastic, embossed   ****	****.10-.15 ****	****familiar, paper transfer**
**Serial Memory card  ****	****1.50-4.00 ****	****additional storage**
**Computer chip card  ****	****3.50-15.00 ****	****additional data security,**
**  ****	****	****	****	****	****	****	****difficult to copy**
**Optical card   ****	****	****6.00- 8.00 ****	****much more storage**
**IC Optical Card****	****          10.00-15.00****	****large storage and data ****	****	****	****	****	****	****security**
**PC Card****	****	****       60.00 - 100.00****	****more storage and ****	****	****	****	****	****	****	****computational capability**

## Card Technology    Unit Cost ($)     Major Benefits       Options 

**Plastic, embossed   ****	****.10-.15 ****	****familiar, paper transfer**
** ****add Magnetic stripe     ****	****.02-.10 ****	****electronic readable**
** ****add Bar Code  ****	****	****.00-.10 ****	****electronic readable**
** ****add signature panel     ****	****.02-.05 ****	****visual authentication**
** ****add photograph, B+W     .00-.15 ****	****visual authentication**
** ****add photograph, color   ****	****.20-.25 ****	****visual authentication**
** ****add hologram laminate   .06-.07 ****	****	****deter fraud**
** ****add hologram stamp ****	****.05-.06 ****	****deter fraud**

## Department of Veterans Affairs

**Upgrade cards from simple plastic embossed card**
**New cards  have printed and  embossed information, magnetic stripe, bar code, black and white picture**
**Function as identifier and carrier of small amount of information**
**Speeds patient look-up on medical information system, allows mini registration**
**Personalized at the facility**
**2.5 million cards the first year**
**mag stripe - date of birth, period of service and service related disabilities**
**Enhancements are planned**

## Department of Defense MARC

**Multifunction and Multitechnology card**
**Testing in Hawaii and used for deployment**
**40,000 cards in use**
**Smart Card, bar code, magnetic stripe, picture, signature block and embossed characters**
**Non Medical Functions include manifesting and deployment, food services and security**
**Medical Information includes Identification, Emergency Data, Blood Type, Immunizations, Allergies and Registration**
**Additional functions planned**
**Highly successful program**

## Oklahoma MediCard Project

**Emergency Smart Card by Precis Smart Card Systems**
**8000 cards**
**Oklahoma City Area**
**Medical Information includes:**
**Identification**
**Emergency**
**Allergies**
**Diagnoses**

**Medical Procedures**
**Medications**
**Physicians**
**Insurance Information**

## Western Governors Association Health Passport Project

**Objectives: Improve Delivery of Benefits**
**Lower Administrative Barriers to Care, and **
**Improve Data sharing Between Programs**
**RFP for system with 30,000 cards.  Award in June**
**Locations - Nevada, North Dakota, Wyoming**
**Preventative Health Care Programs**
**Womens Infant and Children (WIC)**
**Medicaid (EPSDT)**
**Immunizations**
**Head Start**
**Maternal and Child Health**

## EUROCARDS Framework

**EUROCARDS is a European Union (EU) Advanced Informatics in Medicine (AIM) Concerted Action on Data Card Applications in the Healthcare system**
**Created in late 1993**
**Final reports delivered in 1995**
**Developed a technical, social and legal framework for data card applications**
**European Union (EU) -Austria, Belgium, Britain, Denmark, Finland, France, Germany (originally West Germany), Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, and Sweden**

## EUROCARDS

**Healthcare Professional Cards uses**
**Identification in machine readable form**
**Access control to information systems, local and remote**
**Keys for Electronic signatures of stored and transmitted electronic documents**
**Access control to patient data based on the possession of cryptographic class keys indicating certain professional status**

## EUROCARDS

**EUROCARDS priority for implementation**
**Administrative Cards and the creation of the infrastructure (readers, workstations)**
**Healthcare Professional Cards as a means of enhancing Security**
**Emergency Cards for national and international purposes**
**Patient Cards containing medical and pharmaceutical information, or pointers to the data**

## EUROCARDS - Outcomes

**Book - “Healthcare Card Systems, EUROCARDS Concerted Action Results and Recommendations”, A. Pernice, H. Doare and O. Rienhoff, IOS Press, 218 pages**
**Detailed material from EUROCARDS WG1-WG4 From DGXIII of EU**
**G7 Healthcare Data Cards - An initiative extended to US, Canada and Japan**

## TrustHealth Project Framework

**Demonstrate trustworthy telematic systems using modern security techniques in an open systems connectivity environment with trans-European interoperability**
**Using smart cards and RSA asymmetric encryption for health care information security**
**User authentication, digital signatures and exchange of session keys for confidentiality protection, proof of professional registration and as access control devices**
**European Commission sponsored and started in 1995 **
**National Trusted Third Parties to issue key cards and maintain link between the user and the public key**
**9 countries and multiple suppliers, **
**Spri in Sweden**

## What is G-7

**Group of Seven (G-7) is an organization of seven major industrial democracies who meet periodically to discuss world economic and other issues. **
**G-7 was established September 22, 1985. **
**Members are Canada, France, Germany, Italy, Japan, United Kingdom, and United States.**

## G-7 Healthcare Data Card Project

**At the Ministerial Conference held in Brussels on February 25-26, 1995, the G-7 and the European Commission established a number of projects where international cooperation could be an asset. **
**These projects would aim at demonstrating the potential of the **_**Global Information Society **_**and stimulate its deployment. **
**The projects will be initially undertaken by the G7 partners but are open.  The participation of other partners, including international organizations, is encouraged.**

## G-7 Healthcare Data Card Project

**11 Theme Areas**
**Global Healthcare Applications is Theme 8**
**Clinton Administration originally suggested the Healthcare Theme**
**Healthcare Data Card is Sub-Project 6 with an official title of "International Harmonization of Use of Data Cards in Healthcare".**
**G-7 Healthcare Data Card WWW page - http://www.va.gov/card/**

## G-7 Healthcare Data Card Project

_**the card is a carrier of data**_**: where the telematic infrastructure is not available, the patient, moving from one point of care to the other, and carrying in a card his/her own data and **_**pointers to remote databases**_**, actually makes a sort of "virtual" flexible infrastructure that can substitute and complement a more “physical” infrastructure (cabled or wireless).**
_**the card is a key to access the network**_**: both the **_**patient's card**_**, containing the pointers to federate remote data bases, and the **_**doctor's professional card**_**, containing the profile of the user and the associated rights to access the system and its services, constitute essential elements for the overall networked system.**

## G-7 Healthcare Data Card Project

**Two pilot areas were initially identified for a global project approach**
**an **_**international emergency card **_**with an international harmonized emergency and administrative data set (Cardlink Project)**
**an **_**international professional card **_**that will allow the **_**secure identification **_**of healthcare professionals when accessing medical data and network services (TrustHealth Project)**
**Other pilot area and projects to be sanctioned  - Canada **

## G-7 Healthcare Data Card Project

**Plans for **_**Technical Interoperability **_**- The functional goal is to allow data to be exchanged between different projects in multiple countries using equipment and cards from multiple vendors**
**International Industrial cooperation of governments, users, card manufacturers and system integrators**
**Multiple **_**levels of standardization**__** **_**are required - Standard in areas of Nomenclature,  Data Sets for emergency data, data sets for administrative data, and Standards related to various aspects of security**

## Germany

**Germany has completed a project distributing 80 million cards to all citizens during 1994 and 1995, along with the reader/printer infrastructure**
**Memory chip cards used for insurance identification.**
**Printing of Health Insurance forms**
**Options for electronic submission to insurance fund, eliminating paper**

## CARDLINK Project

**Portable Emergency Record as well as pointers stored in a chip card**
**User driven, supported by European Commission**
**Interoperable European emergency data set**
**5 pilot sites - Saint-Nazaire, France; Dublin, Ireland; Milan and Rome, Italy; Valencia, Spain**
**Demonstrate standards based card and reader interoperability with multiple manufacturers**
**Measure usefulness in emergency situations**
**Begun in 9/1994, initial pilot will finish in 1997**
**CARDLINK 2 will expand to 10 countries and integrate with TrustHealth **

## French Vitale Card

**4 Pilots for Administrative Data Card**
**2 Pilots for CPS Health Professional Card**
**Santal Card - Medical Card converging with Vitale**
**Vitale 1 - 10 million family cards starting in December 97**
**CPS Health Professional Card with crypto chip - 300,000 cards starting in December 97**
**Vitale 2 - French patient data card**
**patient card with medical data pilot in 1998**
**50 million card distribution starting in 1999**
**Emergency Data Sets Compatible with G-7 framework**

## Quasi Niere Renal Dialysis 

**Quality Assurance and Renal Dialysis Treatment**
**Medical Association in Berlin, Ministry of Health in Germany**
**Operational with 35,000 cards as of March  1997**
**50,000 patients, 3,000 doctors**
**Secure collection of confidential medical information over the Internet**
_**Includes TrustHealth concepts**_** for authentication, digital signature and communication over Internet**
**providers and patients**
**Begun discussions with North West Kindney Center in Washington State**

## Influencing Events

**Health Insurance Portability and Accountability Act of 1996**
**HHS responsible for identifying or developing security standards**
**Feb 1998 deadline**
**Standards Groups have accelerated activities**
**National Research Council report “For the Record: Protecting Electronic Health Information” - March 5, 1997**
**“****password or PIN in conjunction with a token”**

## Trends

**National and International Access is expanding as Healthcare Industry utilizes Internet**
**Authentication, Privacy, Confidentiality**
**Microsoft announced support of portable wallets and smart cards**
**Encrypted channels - SSL - for privacy **
**PC/SC Workgroup developing specifications of the OpenCard Framework architecture**
**interoperable smart cards, readers and computers**
**Web Commerce is driving pursuit of solutions**
**Netscape Secure MIME**
** ****Hewlett Packard / Informix / Gemplus data base access control system**

## Trends

**Public / Private Key systems are emerging**
**National Performance Review reported 43 existing government PKI pilots**
**Medical Information Data Exchange Standards are beginning to include references to asymmetric keys for individual and system authentication**
**G-7 Healthcare Data Card Project using public / private key mechanisms for healthcare provider authentication to access data on card and across network.  Also used by patients to give permission to access data on a card or on a network**
**Social Security Web experience is part of public and institution education process**

## Summary

**Use of cards for identification, portable data base and network access**
**Internet growth and popularity is driving force to find a technical standard for safeguarding payment-card purchases made over open networks such as the Internet**
**Multiple projects working to solve this problem and we can use the same technology solutions**
**Emphasis on open standards and multiple vendor interoperability on a global scale**
**Standards lead to larger market for vendors, and lower prices for consumers**
**This will be an exciting year with rapid progress leading to opportunities in healthcare**