# Presentation: 672343

## Healthcare Data Cards in North America

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

## Overview

**Pressures in Health Care**
**How Cards contribute to the solutions**
**North American Projects**
**Related Trends**
**Summary**

## Pressures in Health Care

**Profitability of the healthcare organization**
**Insurance and government organizations are concentrating on cutting health care costs and fraud**
**Citizen Choice**
**Different Information Systems that are often fragmented and do not communicate**
**The patient’s difficulty accessing their own record **
**The patient’s fear of uncontrolled access to their medical records**
**The provider’s inability to access accurate and appropriate /complete information about the patient’s treatment**

## Why Use Cards In Healthcare?

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

## Canada

**Rimouski Project 1993 to 1995**
**Québec is building on the experiences of European and Canadian projects  **
**Administrative and Clinical purposes (Identification, data transport, security and privacy)**
**Large Scale Smart Card Distribution for providers and patients starting in 1998**
**Patient and Professional Smart Card project at Unité de Médecine Familiale de l’Enfant-Jésus in Quebec starting in 1999 emphasizing patient access to their data**

## 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**
**Women’s Infant and Children (WIC)**
**Medicaid Eligibility (EPSDT)**
**Immunizations**
**Head Start**
**Maternal and Child Health**

## Secure Collaborative Telemedicine Over Public Networks

**West Virginia University in Morgantown, West Virginia under NLM Grant **
**Secure and private Telemedicine involves policy, administration, regulation and technology systems**
**Building on standards**
**Using Smart Cards for identification, authentication and data storage**
**Building upon EUROCARDS, TrustHealth, G-7 Healthcard Interoperability Specifications and CARDLINK data sets **
**CORBA, Public Key Infrastructure, and cypto-aware applications **

## Department of Defense MARC

**Multifunction and Multitechnology card**
**Testing in Hawaii and used for deployment**
**50,000 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**
**DoD defining applications and identifying funding sources for MARC implementation**
**Highly successful program**

## Southern Oklahoma Physician Hospital Organization (SOPHO)

**Share Patient Data throughout the healthcare community**
**Smart Card to be used as the first step to integrated health card delivery network**
**Includes pharmacists and ambulance workers**
**Begun in September 1997**
**Insurance, demographics, allergies, medications, treatment history, notes, emergency contact information**

## 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**
**magnetic stripe - date of birth, period of service and service related disabilities**
**Enhancements are planned**

## VA Electronic Purse

**Department of Veterans Affairs,**
**U.S. Treasury and Nations Bank began a pilot of smart cards for electronic purse **
**Announced on Oct 20, 1997**
**Bronx Veterans Affairs Medical Center located in New York City**
**25,000 cards will be issued and used to test numerous applications**
**Up to 4,000 reloadable cards will also be used as identification badges**
**Used by staff and patients**
**Second site to be announced**

## Influencing Events

**Health Insurance Portability and Accountability Act of 1996 (PL 104-191)**
**HHS responsible for identifying or developing EDI, privacy and security standards**
**Feb 1998 report 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”**
**GSA Government wide procurement for Cards and for PKI Services in 1998**

## The Administration’s Goal

**The President’s budget for 1998**
**“****The administration wants to adopt a “smart card” technology so that, ultimately, every employee will be able to use one card for a wide range of purposes, including travel, small purchases, and building access.”**

## Status in North America

**Widespread Implementations of non-chip cards**
**Many Health Cards are not electronically readable**
**Opportunities in administrative simplification, data transfer, improved security/ privacy, decreased fraud**
**Multiple Chip Cards pilots**
**Multiple roles including:**
**Identification and administrative simplification, **
**data access, security and privacy, **
**a portable data carrier**
**electronic payment **
**The use of chip cards are gradually becoming more common in North America**
**Will the future be gradual or explosive?**