# Presentation: 661201

## Card Technology in Healthcare

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

## Overview

**Technical Developments**
**Pressures in Health Care**
**How Cards contribute to the solutions**
**Roles of Card in Health Care**
**Applications using Cards**
**What is the VA doing?**
**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**

## 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**
**Many applications can be supported**
**What critical Business Problem do YOU need to solve?**

## 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**

## 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 Inrastructure**
**Large software vendors like Microsoft are delivering software and API’s to support smart cards**

## Interoperability

**Interoperability will make it easier to deliver smart card solutions**
**G-7 technical interoperability specification is being used in Healthcare (CardLink)**
** **
**Application - EMV, GSM, SET**
**On the Workstation - PC/SC Specification and OpenCard Framework**
**On card - Java Card and MULTOS**
**Hardware level - ISO 7816**

## Public Awareness

**Smart card articles are appearing in the popular press, not just professional journals**
**Many articles about electronic cash and smart cards**
**Articles about Internet and the need for  better electronic identification**
**Discussions about Public /Private Key Infrastructure in many different industries**
**People immediately understand the need for confidentiality in Healthcare**

## Influencing Events

**Health Insurance Portability and Accountability Act of 1996 (PL 104-191)**
**HHS responsible for identifying or developing EDI, privacy and security standards**
**Original Feb 1998 report deadline, reports being written**
**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**

## 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 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 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**
**Digital Signatures**
**Support Financial Transactions**

## Roles for a Card

**Multiple roles including:**
**Visual Identification**
**Electronic identification (Keys and certificates)**
**Portable Data Carrier or Pointers to Data**
**Electronic Payment **
**Two Card Present model - patient and doctor cards at the same time to access data located either on the card or on the network**

## Applications on a Healthcare Data Card

**Patient Medical **_**Identifier**_**, visual ID**
**Insurance Identifier and Data**
**Administrative Data, Demographics for registration**
**Specialty Medical **_**Data Bases**_**, Medication, Dialysis,  Pregnancy History, Portions of Medical Record**
**Emergency Data, Immunization History, Allergies, Primary Physician, Locations of Treatment**
**Information carrier: Prescriptions**
**Preventative Health Care, i.e. WIC**
_**Electronic ID:**_** Keys to access data on the network, Secure Authentication / Digital Signature**
_**Financial Transactions:**_** Credit/debit Cards for Payments, EBT**

## Department of Veterans Affairs - Patient Card

**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**

## The Veteran ID Card

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

## 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**

## VA Electronic Purse

**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**

## VA Electronic Purse

**up to 4,000 reloadable cards **
**will be used as identification badges. **
**Approximately 10,000 cards will be issued for meal tickets, and **
**1,000 for personal patient checking accounts.   **
**The Tampa pilot will ****also**** have 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 - 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 to begin during May**
**Plans to establish and use PKI**

## Summary

**Opportunities in administrative simplification, data transfer, improved security/ privacy, decreased fraud**
**Widespread Implementations of non-chip cards**
**Many Health Cards are not electronically readable**
**Multiple Chip Cards pilots: HPP, Secure Telemedicine**
**Multiple roles including:**
**Visual Identification**
**Electronic identification (Keys and certificates)**
**Portable Data Carrier or Pointers to Data**
**Electronic Payment **
**The use of chip cards are gradually becoming more common in North America**
**Will the future be gradual or explosive?**

## 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**
**Many applications can be supported**
**What critical Business Problem do YOU need to solve?**