# Presentation: 672668

## Healthcare Applications

**Moderator - Daniel L. Maloney**
**Director, Emerging Technologies**
**Department of Veterans Affairs, VHA**
**Silver Spring, MD., U.S.A.**
**daniel.maloney@med.va.gov**
**http://www.va.gov/**
**http://www.va.gov/card/**

## Slide 2

## Card Technology in Healthcare

**Daniel L. Maloney**
**Director, Emerging Technologies**
**Department of Veterans Affairs, VHA**
**Silver Spring, MD., U.S.A.**
**daniel.maloney@med.va.gov**
**http://www.va.gov/**
**http://www.va.gov/card/**

## Overview

**Major Events**
**Future Vision**
**What is the VA doing?**

## Major Events

**French Patient Card**
**French CPS Health Professional Card**
**CardLink 9 Country Pilot Evaluation**
**German Health Card **
**Microsoft Expands Support for Smart Card Business**
**Web Continues to Expand**
**Security and Privacy are becoming a higher priority**

## French Health Patient Card - Vitale

**Vitale 1 being distribute now**
**40 million family cards  distributed as of 4/1999**
**ID and Administrative data**
**Smart card with operating system similar to M9 used on French Bank card**
**5 million cards distributed per month from 4 suppliers**
**target of 42 million cards by May 1999**

## The French Health Professional Card - Carte "CPS"

**2 Pilots for CPS Health Professional Card**
**CPS Health Professional Card with crypto chip to be distributed with a total of 300,000 cards**
**Goals similar to patient card (simplicity, reliable information Confidentiality, limitation of frauds)**
**Electronic Reimbursement**
**Access key to the Healthcare Intranet**
**Access key to the medical data set on the patient card**

## The French Health Professional Card - Carte "CPS” (cont’d)

**50,000 Health Professional Cards distributed as of 4/1999**
**10,000 distributed each month**
**currently being distributed to physicians.  **
**identification of healthcare provider, RSA public /private keys, PIN protected**
**distribution to nurses, pharmacists, and hospitals next**
**negotiations ongoing with health professional organizations**

## CARDLINK Project

**Portable Administrative, Emergency, Medical and Prescription Data - 100,000 cards**
**User driven, supported by European Commission**
**Interoperable European data set with language translation**
**10 sites in 9 countries include France; Dublin, Ireland; Germany; Holland; Spain; Greece; Portugal; Italy; Finland**
**Demonstrate standards based card and reader interoperability with multiple manufacturers**
**Measure usefulness in travel or emergency situations**
**Begun in 9/1994, pilot to be completed in 1999**
**Use of card is voluntary**

## 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 and reducing insurance processing costs**

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## Why Use Cards In Healthcare?

_**Cards are a part of local or networked system**_** **
**Deliver Better Service and Benefits 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**
**Secure Access to On-line Data**
**Enable secure and private communications**
**Support Digital Signatures**
**Support Financial Transactions**

## Slide 13

## Major Concepts

**Card functions as part of the System**
**Works with the networked data**
**As the Network improves, the location of the data can change**
**Network means Local and World Wide Network (Internet)**
**Continuum with Essential data on card**
**Many applications can be supported**
**What critical Business Problem do YOU need to solve?**

## Roles for a Card

**Multiple roles including:**
**Visual Identification**
**Secure Portable Data Carrier or Pointers to Data **
**Electronic identification (Keys and certificates) for logical access, digital signature and physical access**
**Electronic Payment - insurance or e-cash**
**“****Two Keys /Cards Required” model - patient and doctor cards to access data located either on the card or on the network**

## <footer>

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## Major Trends

**The Web Changes Everything**
**Customer Convenience /Humanize Interactions**
**Electronic Service Delivery and EDI - saves time, money for corporation AND the customer **
**Providers and patients interact from many locations**
**Major obstacle - User authentication, Security and Privacy**
**Major solution - Keys - Public /Private Key Infrastructure, encryption and Digital Signature**
**Safely carry keys on smart card**
**Multi-application cards reduce the cost per program**
**User Opt In**

## Slide 18

## G-8 Healthcare Data Card Project

**Members are Canada, France, Germany, Italy, Japan, United States (United Kingdom, Russia.)**
**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 (NetLink Project,  PKI)**
**http://www.sesam-vitale.fr/Projects/Netlink-G7-En/**

## G-8 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**
**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**
**More information and links at http://www.va.gov/card/ and http://www.sesam-vitale.fr/Projects/Netlink-G7-En/**

## NetLink Project

**The NETLINK project aims at establishing recommendations and technical specifications for :**
**Health Professionals to access to Patient Data Cards (free or controlled access to data stored in Patient cards)**
**Health Professionals to securely exchange documents (including digital signature and confidentiality services)**
**Health Professionals secure access to on-line servers****	**
**Involves smart cards (used by Health Professionals and Patients), computers (used by Health Professionals, Hospitals, Health Insurance Funds), large networks, and Security architectures including data encryption**
**France, Germany, Italy and the Province of Québec**

## Technology

**Cards with cryptographic capabilities**
**32 bit computer chips on cards**
**Decreasing costs of biometrics fingerprint readers**
**Combination cards with contact and contactless communications**
**Reader Infrastructure**
**Large software vendors like Microsoft are delivering software, API’s and now a card operating system to support smart cards**

## Interoperability

**Interoperability will make it easier to deliver smart card solutions**
**G-8 technical interoperability specification is being used in Healthcare (CardLink)**
**Application - EMV, GSM, SET**
**On the Workstation - PC/SC Specification and the OpenCard Framework**
**On card - Java Card, MULTOS and Microsoft Card Operating System (6/99)**
**Hardware level - ISO 7816**

## What is the VA doing?

## 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**

## Department of Veterans Affairs - Patient Card Upgrade

**Rollout began in Dec 1996, finished in April 1997, Planning began in Dec 1993**
**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 facility, 2.5 million cards first year**
**magnetic stripe - date of birth, period of service and service related disabilities**
**Enhancements are planned**

## The Veteran ID Card

- Photo Image
- SC Indicator
- Barcode
- Embossed Info
- Name
- SSN, DOB
- MAG Stripe
- 1-800 Number

## Department of Veterans Affairs - Home Health Care Initiative- Design Stage

**Store commonly needed data on card to improve communications between different home health care providers**
**Always available to home health care provider**
**Also to be used at Emergency rooms and health care providers offices**
**Use of portable devices to read and update patient card**
**Begin Summer of 1999**

## Department of Veterans Affairs - Lab Test of New Technology

**Microsoft Windows Card Operating System (Beta now, projected release in June 1999)**
**Workstation Development Tools**
**ActiveX for Healthcare to transfer data bi-directionally between chip and VA VistA Medical Information System**
**Shown at HIMSS in February 1999 in DataCard booth and CardTech 99 in May 1999 in DataCard and Microsoft booth**

## Department of Veterans Affairs - Pilot of Secure Access from Internet

**Strong Authentication with smart card to control access from Internet to selected VA networked Resources**
**Levels of Control ****by person, by target resource (system, directory, file or URL), and by protocol**
**Pilot began in May 1998**
**60 users for telnet and web access**
**FTP and Exchange delayed**
**Plans to migrate to system that uses PKI**
**Support and coordination problems**

## VA PKI Pilot

**Established VA wide project to investigate and implement VA PKI**
**Steering Committee to advise project**
**Participate on Federal PKI Steering Committee**
**Drafting Decision documents and policy**
**Initial Capabilities Demonstration**
**Issuing VA Branded public keys / certificate**
**testing secure electronic mail**
**demonstration of PKI based access control**
**demonstration of digitally signed forms and data**
**supporting pilots**

## VA Electronic Purse

**Department of Veterans Affairs,**
** ****U.S. Treasury, Nations Bank and Visa began an electronic purse pilot with smart cards**
**Announced Phase 1 on Oct 20, 1997 at the Bronx Veterans Affairs Medical Center located in New York City**
**Announced Phase 2 on Nov 24, 1997 at the Tampa Florida Veterans Affairs Medical Center**
**25,000 cards will be issued at Bronx and 23,000 in Tampa**
**Used by staff and patients**

## Visa Cash in the hands of patients, 
physicians, visitors, volunteers and employees 
test numerous applications including:
combining identification badge and electronic purse
vending machine acceptance
integrated cash registers and terminals
reloadable cards; and 
cashless ATMs that transfer cash value onto reloadable cards, rather than distribute currency

**physicians, visitors, volunteers and employees **
**test numerous applications including:**
**combining identification badge and electronic purse**
**vending machine acceptance**
**integrated cash registers and terminals**
**reloadable cards; and **
**cashless ATMs that transfer cash value onto reloadable cards, rather than distribute currency**

**VA Electronic Purse**

## At the Bronx site, 
up to 4,000 reloadable cards used as identification badges. 
Approximately 10,000 cards issued for meal tickets, and 
1,000 for personal patient checking accounts.   
The Tampa pilot also has a special purpose card to be distributed by Veterans’ organizations for special events hosted at the medical center throughout the year

**up to 4,000 reloadable cards used as identification badges. **
**Approximately 10,000 cards issued for meal tickets, and **
**1,000 for personal patient checking accounts.   **
**The Tampa pilot ****also**** has a special purpose card to be distributed by Veterans’ organizations for special events hosted at the medical center throughout the year**

**VA Electronic Purse**

## Department of Veterans Affairs - VA / DoD Multi-application Initiative- Planning Stage

**Reviewing Technical Interoperability Standards**
**Reviewing Medical Emergency Data Standards**
**Multi-application card**
**Healthcare Functions - Identification of patient, data sharing and possibly electronic purse**
**Select Site **
**Select potential applications (registration, emergency, contract provider, access, finance)**
**Select data fields (ID, Administration, Emergency, provider, treatment locations, keys and cash)**
**Initiate Pilot in Summer or Fall of 1999**

## Summary

**National patient projects in Europe: Germany, France, with plans in Spain, Italy and Quebec **
**National Initiative for Health Care Provider Card in France**
**Opportunities in administrative simplification, data transfer, improved security/ privacy, data access**
**Multiple Chip Cards pilots in US: HPP, Secure Telemedicine, Oklahoma, DoD MARC**
**The use of chip cards are gradually becoming more common in North America**
**Secure access  and communications - NETLINK**
**Next - Patient uses keys of smart card to control access to their record**

## G-8 Healthcare Data Card Panel- Overview of their projects and how G-8 participation helps or hurts their project- Questions

**Juergen Sembritzki - Germany**
**Julie Kresge- USA**
**Masuyoshi Yachida - Japan**
**Jacque Sauret - France **
**Ravi Raman - USA**
**Denis Morency - Quebec**
**Philippe Bedere - France**
**Dan Maloney - USA**