Abstract:
A method and apparatus for managing electronic medical records is disclosed. One method for managing medical records includes defining a tiered hierarchy of medical record storage categories. A first tier may store electronic medical records for the individual and a second tier may store links to medical records not stored on the portable electronic storage device. Once a collection of electronic records related to an individual is defined, at least some of the records may be stored on a portable electronic storage device (such as a smartcard), according to the tiered hierarchy specified by the record categories.

Description:
BACKGROUND OF THE INVENTION 
       [0001]    1. Field of the Invention 
         [0002]    The present invention generally relates to electronic health records. More specifically, the present invention relates to a methods and apparatus for distributing electronic health records with a portable electronic storage device. 
         [0003]    2. Description of the Related Art 
         [0004]    Electronic data is pervasive; electronic data records have been created to capture details about almost any conceivable transaction or event. Medical records, for example, contain various data about patients, including medical history data, test data, medication data, etc. Some records may be of critical importance (e.g., a record of an allergy to medication) while other records may be much less significant (e.g., records of a healed injury). Electronic medical records (EMRs) have become a vital resource for doctors, researchers, laboratories, insurance providers, and claims-processors, etc. 
         [0005]    One of the problems created by the proliferation of data is the management and accessibility of the data. Currently, EMR&#39;s are often stored by multiple unrelated entities, none of which are specialized in providing data storage or retrieval services. For example, a health care provider may maintain an internal set of electronic records for individual patients treated by the provider. Similarly, a pharmacist may maintain records for prescriptions dispensed to a patient at a particular location or pharmacy chain. Another health care provider, however, will not normally have on-demand access to the records of either. As illustrated by even this simple example, the electronic medical records related to a patient may be spread across many entities, and each entity is often limited to accessing EMRs created by that particular entity. 
         [0006]    Providing access to a complete collection of electronic medical records from this widely distributed data has proven to be very difficult. One proposed solution for creating a comprehensive EMR system involves creating a data federation. In such a federation, the electronic medical records related to a particular patient may be maintained at individual organizations (e.g., the healthcare provider, pharmacist, clinic, etc.), or at a number of repositories established to consolidate some EMR data. For example, the Cross Enterprise Document Sharing (XDS) profile (defined by the Integrating the Healthcare Enterprise (IHE) organization) is representative of a federated model. The XDS profile describes a clinical domain where institutions that join the domain share electronic medical records with one another. The clinical domain may include one to many data repositories storing electronic medical records. 
         [0007]    Such models will typically rely on some form of federated query or retrieval operation when a request is made to view electronic health records for a given patient. That is, federated systems may respond to an EMR data request by (i) identifying each node that may include EMR data for the patient, and (ii) attempting to retrieve the relevant EMR data from each such provider node. Unfortunately, identifying each node that may include EMR data for the patient may be an imprecise process, and may be error prone. Additionally, if the patient previously received care at a facility outside the federation, the results of a federated query may not contain any record of the medical data generated during this care. 
         [0008]    Furthermore, during emergency situations, doctors in a treatment center must quickly make life and death decisions. The medical history of a patient, including known allergies and drug interactions may play a large role in these decisions. If the patient has never before received medical care at the particular treatment center, the doctor may not have quick access to the patient&#39;s relevant medical history, and performing a comprehensive federated query to locate the necessary medical records may be a time consuming and, as previously described, imprecise process. 
         [0009]    Accordingly, what is needed is a versatile method and system for distributing a user&#39;s medical data and locations of where further medical data may be found. 
       SUMMARY OF THE INVENTION 
       [0010]    The present invention generally relates to electronic health records. More specifically, the present invention relates to methods for and systems for distributing electronic health records with a portable electronic device. 
         [0011]    One embodiment of the invention includes a method of managing medical records. The method generally includes identifying a collection of electronic records related to an individual and storing at least some of the collection of electronic medical records on a portable electronic storage device according to a tiered hierarchy of medical record storage categories. The tiered hierarchy may include patient data for the individual, a first tier for storing electronic medical records for the individual, and a second tier for storing one or more links to medical records not stored on the portable electronic storage device. 
         [0012]    Once medical records are available on the portable electronic storage device, the method may further include receiving the portable electronic storage device, and reading the electronic medical records stored on the portable electronic storage device using a storage device reader. 
         [0013]    In a particular embodiment, the patient data may include a variety of information such as patient demographic information, allergies, prescriptions, contact information for a primary care physician, a home address, medical conditions, insurance information, and contact information for the patient 
         [0014]    Another embodiment of the invention includes a computer-readable medium containing a program which, when executed, performs an operation for managing electronic medical records. The operations generally include identifying a collection of electronic records related to an individual; and storing at least some of the collection of electronic medical records on a portable electronic storage device according to a tiered hierarchy of medical record storage categories. The tiered hierarchy may includes patient data for the individual, a first tier for storing electronic medical records for the individual, and a second tier for storing one or more links to medical records not stored on the portable electronic storage device. 
         [0015]    Still another embodiment of the invention includes a system. The system may generally include a portable electronic storage device configured to store a collection of electronic records related to an individual according to a tiered hierarchy of medical record storage categories, wherein the tiered hierarchy includes at least patient data for the individual, a first tier for storing electronic medical records for the individual, and a second tier for storing one or more links to medical records not stored on the portable electronic storage device and a reading device configured to access the collection of electronic medical records stored on the portable electronic storage device. 
     
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0016]    So that the manner in which the above recited features, advantages and objects of the present invention are attained and can be understood in detail, a more particular description of the invention, briefly summarized above, may be had by reference to the embodiments thereof which are illustrated in the appended drawings. 
           [0017]    It is to be noted, however, that the appended drawings illustrate only typical embodiments of this invention and are therefore not to be considered limiting of its scope, for the invention may admit to other equally effective embodiments. 
           [0018]      FIG. 1  is a block diagram illustrating a portable electronic storage device containing medical information and links to medical information, according to one embodiment of the invention; 
           [0019]      FIG. 2  is a block diagram illustrating a system for reading medical data stored on a portable electronic storage device, and providing a physician with the stored medical data, according to one embodiment of the invention; 
           [0020]      FIG. 3  is a flow diagram illustrating a process for reading information from a portable electronic storage device containing medical information, and retrieving medical records stored or referenced on the portable electronic storage device, according to one embodiment of the invention; and 
           [0021]      FIG. 4  is a flow diagram illustrating a process for updating medical records information stored on a portable electronic storage device, according to one embodiment of the invention. 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0022]    The present invention generally relates to electronic health records. More specifically, the present invention relates to methods for and systems for distributing electronic health records with a portable electronic device. 
         [0023]    In the following, reference is made to embodiments of the invention. However, it should be understood that the invention is not limited to specific described embodiments. Instead, any combination of the following features and elements, whether related to different embodiments or not, is contemplated to implement and practice the invention. Furthermore, in various embodiments the invention provides numerous advantages over the prior art. However, although embodiments of the invention may achieve advantages over other possible solutions and/or over the prior art, whether or not a particular advantage is achieved by a given embodiment is not limiting of the invention. Thus, the following aspects, features, embodiments and advantages are merely illustrative and are not considered elements or limitations of the appended claims except where explicitly recited in a claim(s). Likewise, reference to “the invention” shall not be construed as a generalization of any inventive subject matter disclosed herein and shall not be considered to be an element or limitation of the appended claims except where explicitly recited in a claim(s). 
         [0024]    One embodiment of the invention is implemented as a program product for use with a computer system. The program(s) of the program product defines functions of the embodiments (including the methods described herein) and can be contained on a variety of computer-readable media. Illustrative computer-readable media include, but are not limited to: (i) non-writable storage media (e.g., read-only memory devices within a computer such as CD-ROM or DVD-ROM disks readable by a CD- or DVD-ROM drive) on which information is permanently stored; (ii) writable storage media (e.g., floppy disks within a diskette drive or hard-disk drive) on which alterable information is stored. Other media include communications media through which information is conveyed to a computer, such as through a computer or telephone network, including wireless communications networks. The latter embodiment specifically includes transmitting information to/from the Internet and other networks. Such computer-readable media, when carrying computer-readable instructions that direct the functions of the present invention, represent embodiments of the present invention. 
         [0025]    In general, the routines executed to implement the embodiments of the invention, may be part of an operating system or a specific application, component, program, module, object, or sequence of instructions. The computer program of the present invention typically is comprised of a multitude of instructions that will be translated by the native computer into a machine-readable format and hence executable instructions. Also, programs are comprised of variables and data structures that either reside locally to the program or are found in memory or on storage devices. In addition, various programs described hereinafter may be identified based upon the application for which they are implemented in a specific embodiment of the invention. However, it should be appreciated that any particular program nomenclature that follows is used merely for convenience, and thus the invention should not be limited to use solely in any specific application identified and/or implied by such nomenclature. 
       Personal Electronic Storage Device and Medical Information 
       [0026]    As described above, electronic medical records (EMRs) have become a vital resource for doctors, researchers, laboratories, insurance providers, claims-processors, etc. in providing healthcare and healthcare related services. However, in today&#39;s medical environment, a given patient may have one or more primary care physicians and a host of specialists, all generating medical information about the patient, and most not sharing such medical information with other physicians. Additionally, a patient may receive medical treatment at several locations, each of which may generate and store records about the patient which may not be accessible at another location. In one embodiment, to resolve management and data accessibility problems created by the proliferation of medical data, the patient may carry a device that contains a hierarchy of medical information. 
         [0027]      FIG. 1  is a block diagram illustrating a portable electronic storage device (PESD)  100  containing medical information  102 ,  106  and links to medical information  108 ,  110 , according to one embodiment of the invention. The PESD  100  may be any portable device capable of storing medical information. Advantageously, the PESD  100  may be a smartcard, which may be credit card-sized and may contain memory and at least one processor. Furthermore, the smartcard may be either a smartcard with electrical contacts for interfacing with a smartcard reader, or may be “contactless,” and may utilize RFID (radio-frequency identification) technologies to input and output data. The PESD  100  may store various types of medical information, which may be categorized according to a tiered hierarchy (e.g., critical medical records are stored directly on the PESD  100 ). By categorizing medical information into tiers, critical medical information may be stored directly on the PESD  100 , while less critical information may be stored elsewhere linked from the PESD  100 , as is described in more detail below. 
       Patient Data 
       [0028]    In one embodiment, the medical information on the PESD  100  may include patient data  102 . Patient data  102  as used herein may refer to demographic information about a patient. Such information may include patient name, a home address, insurance information, and contact information for the patient. 
       Category I Records 
       [0029]    In one embodiment, the medical information stored on PESD  100  may include medical records. Medical records may be any health-related record or information about the patient. For example medical records stored on PESD  100  may be records from a doctor visit, records indicating known allergies, records indicating medical conditions or current medications, organ donor status, a patient&#39;s vaccination history, results of a vision test, and/or a patient&#39;s prescription history, to name but a few. In one embodiment, medical records may be stored directly on PESD  100 . As used herein, these records are called category I records  106  and typically include the patient&#39;s highest-priority medical records (e.g. recent critical care records), allergies, and/or chronic conditions (e.g., diabetes), which a physician may use to make important decisions when the patient is in an emergency care situation. 
         [0030]    In one embodiment, a category I record  106  may include related metadata, which may give a brief description about the associated medical record. For example, a MRI image stored on the PESD  100  may include the metadata: “MRI of left ventricle illustrating a predisposition for mitral valve prolapse,” thus describing the contents of the related image. Additionally, the metadata may include an indication of the priority of a specific medical record so that the physician may easily determine the criticality of the category I record. 
       Category II Records 
       [0031]    In one embodiment, a category II record  108  is a medical record that is not stored on the PESD  100 , but rather may be linked from the PESD  100 . Storage space on the PESD  100  may be limited; therefore, not every medical record may be stored on the PESD  100 . For records that are less critical than category I records  106 , or that are simply unable to be stored on the PESD  100 , a link to the medical record  108  may be stored on the PESD  100 . There are a number of reasons why a medical record may not be able to be stored on the PESD  100 , including record size, availability of the information, and record priority. For example, when a patient gives a blood sample during a doctor visit, a thorough laboratory analysis of the blood may not be available for a few days. Therefore, the PESD  100  may be updated during the doctor visit to include a link to the location where the lab results will be stored as well as a date the records should be available. The link to the category II record  108  may be a link to an electronic copy of the associated medical record (e.g., an Internet address). Alternatively, the link may contain a physical location where the record may be found, including contact information of the healthcare provider who has the corresponding record. 
         [0032]    In one embodiment, the links to category II records may have associated metadata. Similar to the category I metadata, category II metadata may contain priority information, and may be used by the physician to determine whether the record would be relevant or appropriate to a given situation. 
         [0033]    In one embodiment, a record-link, similar to the link to a category II record, may be stored with a category I record. While the link may not be needed as long as the medical record is a category I record (and therefore is stored on the PESD  100 ), the link may be used if the category I record is ever downgraded to a category II record. Therefore, the removal of the medical record from the PESD  100  may not result in the complete loss of access to the medical data with the PESD  100 . 
       Category III Records 
       [0034]    In one embodiment, in addition to medical information stored on the PESD  100  and/or medical information directly linked from the PESD  100 , a third category of medical information, category III records  110 , includes medical records linked indirectly from the PESD  100 . An indirect link may be a reference to a general location which may be queried to locate a patient&#39;s medical records. The link may include reference to a particular physician who treated the patient, a hospital where the patient was treated, and/or a region where the patient lived. In a preferred embodiment, the PESD  100  may include a link (e.g., a URL) to an electronic repository containing one or more of the patient&#39;s category III medical records  110 . The repository may be queried by the user of the storage device reader in order to locate the one or more category III medical records  110 . In other words, a category III record is a record stored in a data repository, and a link to the data repository may be stored on PESD  100 , whereas a category II record  108  is a record linked directly from the PESD  100 . 
         [0035]    In one embodiment, the PESD  100  may contain category III metadata related to the category III record(s)  110  contained within the repository. The metadata may contain information about how to communicate with the repository, such as login requirements, system type, accessibility constraints, and/or query parameters. Furthermore, the metadata may describe content of category III medical record(s)  110  contained within the repository as well as record priority, to aid the user of the storage device reader in determining whether to obtain category III medical record(s)  110 . 
         [0036]    In one embodiment, the presence on the PESD  100  of a link to a repository containing category III medical data may confirm that category III data  110  exists in the repository, and that a query on the repository should return a valid result. Alternatively, the presence on the PESD  100  of a link to a repository containing category III medical data may signify that the repository may contain relevant medical information, but that a query must be performed to determine whether relevant category III data  110  actually exists in the repository. 
         [0037]    In one embodiment, a query of the repository may be limited by a healthcare provider to return the most critical category III information and not all records associated with a given patient. Similarly, a query of the repository may be limited to return results pertaining to the capabilities of a physician. For example, when a patient sees an eye doctor, the results from the patient&#39;s last visit to the cardiologist may be irrelevant. 
         [0038]    In one embodiment, category I and  11  records  106 ,  108  have a related electronic storage repository, and therefore a related category III record. Therefore, when updating the PESD  100  with a category I record  106  or a link to a category II record  108 , a storage device reader may also include a corresponding link to the category III record, so that reference to the category I or II record  106 ,  108  will persist on the PESD even after the category I record  106  or a link to the category II record  108  is replaced by a higher priority record or link. In other words, records on the PESD  100  may be dynamic, and including the link to a repository containing a corresponding category III record  110  may improve the utility of the PESD  100 . 
         [0039]    In one embodiment, physical contact/location information (e.g., addresses, names, and phone numbers) associated with a category II record and/or a category III record may also be stored on the PESD  100 . A physician or a user of the storage device reader may use the contact/location information stored on the PESD  100  to contact an originating source of the medical record. Thus, the PESD  100  may facilitate obtaining an electronic medical record (EMR), even when an electronic resource containing the EMR is unavailable. 
       Data Storage Policy 
       [0040]    In one embodiment, the four types of medical data (patient data  102  and category I, II, and III medical records  106 ,  108 ,  110 ) may be used to establish a hierarchy of medical information stored on and/or referenced from the PESD  100 . The medical information may be categorized according to a storage policy  104  which governs the type and amount of data and/or links that may be stored on the PESD  100 . 
         [0041]    In one embodiment, a storage device reader may analyze the storage policy  104 , and then organize the medical data accordingly. The storage device reader may use the storage policy  104  to determine whether to update PESD  100  with information associated with a given patient care episode. Furthermore, if there is insufficient storage on the PESD  100 , the storage policy  104  may be used to determine which records or references to records to remove from the device, as is described in more detail below. In an alternative embodiment, a processor embedded in the PESD  100  may categorize and organize the medical data stored on and/or linked from the PESD  100  in accordance with the storage policy  104 . 
         [0042]    In an alternate embodiment, there may be no data storage policy  104  stored on the PESD  100 . Rather, the storage policy  104  may be built into the storage device reader. Alternatively, decisions on categorization and storage of medical information may be made by a physician, potentially overriding or supplementing an existing data storage policy  104 . 
         [0043]    In one embodiment, the data storage policy  104  is static, and cannot be updated. Alternately, the data storage policy  104  may be dynamic and may be updated by a healthcare provider. 
       Storage Device Reader 
       [0044]      FIG. 2  is a block diagram illustrating a system for reading medical data stored on the PESD  100 , and providing a user  204  of a storage device reader  202  with the stored medical data, according to one embodiment of the invention. As described above, the storage device reader  202  may be used to access patient data  102 , category I medical data  106 , category II medical data  108 , and category III medical data  110 . The storage device reader  202  may include a reader for interfacing with the PESD  100 , a screen for displaying the PESD  100  data to the user  204 , a network connection for communicating with other sources of medical information over a network  210 , and input and output devices. 
         [0045]    In one embodiment, the storage device reader  202  may read patient data  102  and category I medical data  106  directly from the PESD  100 . Additionally, storage device reader  202  may read a link to category II data  108  on the PESD  100 . Reader  202  may then use the link to locate the category II data  108  in a grouping of remote records  206  stored on a network  210 . Similarly, storage device reader  202  may read a link to a repository containing category III data  110  on the PESD  100 . Reader  202  may use the link to locate the repository/registry  208  containing category III data  110 . Storage device reader  202  may then query the repository/registry  208  for relevant category III data  110  stored in a grouping of remote records  206 . 
         [0046]    In one embodiment, the storage device reader  202  may locate and retrieve category II and III data  108 ,  110  automatically after locating links to the data on the PESD  100 . Alternatively, the storage device reader  202  may report the links and associated metadata to the user  202 , and the user  202  may select which records to retrieve via the network  210 . 
         [0047]    In one embodiment, the storage device reader  202  may not retrieve all the data on the PESD  100 , but rather may simply retrieve information pertinent to a specific situation, or may retrieve specific records requested by a doctor. For example, instead of presenting all the data stored on the PESD  100  to a physician, the storage device reader  202  may be configured to return data related to the physician&#39;s specialty. 
       Security/Features 
       [0048]    In one embodiment, the PESD  100  may include built-in security protection from misuse of the device, including unauthorized access to information stored on the PESD  100 . There are numerous methods for securing information on an electronic device, and all such methods are contemplated for inclusion with the present invention. Illustrative methods for securing information include one or more of: encrypting the data on the PESD  100 , including public-key, private-key, and shared-key encryption, where the encryption/decryption is performed by a processor local to the PESD  100  or within the storage device reader  202 ; requiring a password to access the information stored on the device; restricting access to the PESD  100  to storage device readers  202  containing an updated digital certificate of authenticity; and/or any other traditional and non-traditional security measures. Using one or more of the above described security techniques may prevent theft of a patient&#39;s personal and/or medical information if the device is lost or stolen. 
         [0049]    Further, the PESD  100  inherently offers security of medical information. Since category II and III medical information  108 ,  110  are not stored directly on the device, providers of category II and III information  108 ,  110  may be alerted when a PESD  100  is lost or stolen. Therefore, the providers of category II and III medical records  108 ,  110  may add additional security measures to be passed before allowing access to a patient&#39;s medical records. 
         [0050]    In one embodiment, the PESD  100  may include a log file detailing all changes to the information stored on the PESD  100 . The log file may be used by a healthcare professional to detect if the device  100  has been tampered with. This may reduce misuse of the PESD  100  by patients, for example, trying to falsely obtain a prescription or other unauthorized medical treatment. 
       Distribution 
       [0051]    The PESD  100  may be a useful tool for management of medical records. However, the benefits of the PESD  100  are reduced if patients do not have access to a PESD  100 , or if healthcare providers do not have a storage device reader  202 . Accordingly, there are a variety of techniques for distributing the PESD  100  and reader  202  into the hands of patients. 
         [0052]    Much like a birth certificate, in one embodiment, everyone may be issued a PESD  100  at birth. The PESD  100  may contain information normally contained on a birth certificate. Furthermore, the PESD may serve as an electronic-birth certificate (e-certificate), and may include a digital authentication system to further validate the e-certificate&#39;s authenticity. The e-certificate may be stored in a read-only portion of the PESD  100  to ensure that the e-certificate is never accidentally erased from the PESD  100 . Additionally, issuance of the PESD  100  at this early stage of life may aid in establishing a comprehensive medical history on a user&#39;s PESD  100 . 
         [0053]    Given the potential for quick access to patient data  102  and category I records  106 , in one embodiment, the PESD  100  may be given by hospitals and/or physicians to critical care patients, high-risk patients, and/or patients with sensitive medical conditions. Therefore, if one of these patients is in a situation requiring rapid or emergency care, relevant information about the patient&#39;s medical history may be easily accessible. 
         [0054]    In one embodiment, the PESD  100  may be issued to a patient by his/her insurance company. Insurance companies may benefit greatly from the use of the PESD  100 , since the added mobility of medical information may reduce duplicative medical procedures and tests, and may therefore save insurance companies the costs of these procedures and tests. Additionally, the insurance companies may issue storage device readers  202  to physicians for the same reason. 
         [0055]    In another embodiment, the PESDs  100  and the storage device readers  202  may be offered for sale by a third party, and may be part of a program that patients and healthcare providers opt into. Alternatively, a government sponsored program may control the distribution of PESDs  100  and storage device readers  202 . 
         [0056]    Regardless of how a patient obtains a PESD  100 , to be useful, the PESD  100  should contain information about the patient. Therefore, in one embodiment, the PESD  100  may initially be loaded with patient data  102 . Furthermore, the institution providing the PESD  100  may pre-load the PESD  100  with medical data resulting from a federated query of one or more medical record registries  208  for medical records pertaining to the patient. In this manner, the PESD  100  may include medical information about a patient from physician visits and medical tests which occurred long before the patient was issued the PESD  100 . As described above, a data storage policy  104  may be used to determine the most appropriate set of medical records to include on the PESD  100 . Additionally, a new PESD can be re-issued if an original PESD is damaged or lost. Since the PESD contains a copy of records and links to records, they can be regenerated in the event a new PESD needs to be provided to an individual. 
       Process for Reading a PESD and Retrieving Medical Records 
       [0057]    Many factors may influence how the information stored on PESD  100  is read by storage device reader  202 . Such factors influencing information retrieval include the presence/lack of a connection to network  210 , a medical specialty of the physician retrieving information from PESD  100 , and/or the criticality of a individual&#39;s medical condition. Therefore, numerous processes may be used for reading medical information from PESD  100 .  FIG. 3  illustrates one such process. 
         [0058]    Process  300  is a process for reading information from a PESD  100  containing medical information and retrieving medical records stored or referenced on the PESD  100 , according to one embodiment of the invention. The process  300  begins at step  302 , where a PESD  100  is interfaced with a storage device reader. The PESD may be any portable device capable of storing medical information, including a smartcard which may interface with the storage device reader  202  through electrical contacts and/or a “contactless” smartcard which may interface with the storage device reader  202  through RFID technology. 
         [0059]    At step  304 , the storage device reader  202  reads metadata and patient data  102  from the PESD  100 . From the metadata, the storage device reader  202  generates a list of all the data stored on or linked from the PESD  100 . 
         [0060]    At step  306 , the storage device reader  202  presents the list to a user  204  of the storage device reader  202 . From this list, the user  204  may select whether to view category I records  106 , view category II records  108 , view category III records  110 , or exit the PESD reading session. Further, the storage device reader  202  may also display all patient data  102  stored on the PESD  100 . 
         [0061]    At step  310 , a determination is made as to whether the user  204  elected to view category I records  106 . If the user elected to view category I records  106 , at step  316 , the records are retrieved from the PESD  100  and presented, along with any related metadata, to the user  204  of the storage device reader  202 . 
         [0062]    Otherwise, at step  312 , a determination is made as to whether the user  204  elected to view category II records  108 . If the user elected to view category II records  108 , at step  318 , storage device reader  202  locates and retrieves records  108  from remote records  206  via network  210 . The retrieved records are presented, along with any related metadata, to the user  204  of the storage device reader  202  at step  322 . 
         [0063]    Otherwise, at step  314 , a determination is made as to whether the user  204  elected to view category III records  110 . If the user elected to view category III records  110 , at step  320 , storage device reader  202  locates and queries a medical information repository  208  for relevant medical records. At step  324 , the storage device reader  202  retrieves relevant category III records  110  from the repository  208  and presents the retrieved records  110 , along with any related metadata, to the user  204  of the storage device reader  202  at step  324 . 
         [0064]    Whether or not the user  204  elected to view category I, II, and/or III records  106 ,  108 ,  110 , the storage device reader  202  determines, at step  310 , whether the user  204  has elected to exit the PESD  100  reading session. If so, the reading of the PESD  100  terminates at step  326 . 
         [0065]    Otherwise, processing of the PESD  100  by the storage device reader  202  returns to step  306 . 
       Process for Updating Medical Information on a PESD 
       [0066]      FIG. 4  illustrates a process  400  for updating medical information stored on the PESD  100 , according to one embodiment of the invention. The process  400  begins at step  402 , where an update of the information on the PESD  100  is initiated. 
         [0067]    At step  404 , the storage card reader  202  reads a data storage policy  104  from PESD  100 . Storage card reader  202  then uses data storage policy  104  to classify a new record as a category I, II, or III record  106 ,  108 ,  110 . Storage card reader  202  determines, at step  406 , whether the new record is a category I record  106 . If the new record is not a category I reference  106 , at step  408  storage card reader  202  determines whether the new record is a category II record  108 . As described above, the data storage policy  104  may be contained on the PESD  100 , may be stored on the storage card reader  202 , or may be specifically dictated by a physician when storing medical records on the device. 
         [0068]    If the new record is not a category II reference  108 , at step  428 , the storage card reader  202  determines whether the new record is or has a related category III reference  110 . As described above, category I and II records  106 ,  108  may have a related storage repository  208 , and therefore a related category III record  110 . Furthermore, records that do not qualify as category I or  11  records  106 ,  108  may also have a related storage repository  208 . By always including a link to category III information  110  (when available), a more complete medical profile may be contained on the PESD  100 . Therefore, if the new record is or has a related category III reference  110 , the PESD  100  is updated with the link to the repository containing the category III data  110  as well as any available metadata at step  430 . The process  400  terminates at step  432 . It should be noted that the storage on the PESD  100  is limited, and therefore links to older category III references  110  may occasionally need to be removed to make room for links to higher priority category III references  110 . 
         [0069]    If, at step  428 , no category III records  110  were located for the new record, the process  400  terminates at step  432 . 
         [0070]    If, at step  406 , the new record was determined to be a category I reference  106 , storage card reader  202  then determines, at step  410 , whether there is sufficient space on the PESD  100  for the new record. If there is sufficient storage space on the PESD  100 , storage card reader  202  updates PESD  100  with the category I record  106  and related metadata at step  426 . Processing of the PESD  100  update continues to step  428 , as described above. 
         [0071]    Otherwise, if the storage space on the PESD  100  is insufficient, at step  412 , the category I records  106  stored on the PESD  100  are reviewed to determine if any existing record has a lower priority than the new category I record  106 . If there is an existing record with lower priority, the existing record is removed from the PESD  100  at step  418 . However, to preserve reference to the existing record, any links to category II and/or III records  108 ,  110  related to the existing record, as well as any metadata may be preserved on the PESD  100 . As noted, the storage on the PESD  100  is limited; therefore, links to older category II and III references  108 ,  110  may occasionally need to be removed to make room for links to higher priority category II and III references  108 ,  110 . Processing of the PESD  100  update proceeds to step  426 , where, as described above, storage card reader  202  updates PESD  100  with the category I record  106  and related metadata. 
         [0072]    If, however, at step  412  no existing category I record  106  has a lower priority than the new record, the storage card reader  202  determines whether the new record has an associated category II reference  108  at step  416 . If such a record exists, storage card reader  202  updates PESD  100  with a link to the associated category II reference  108  and related metadata. Processing of the PESD  100  update continues to step  428 , as described above. 
         [0073]    Otherwise, if there is no category II reference  108  related to the new reference, processing of the PESD  100  update continues to step  428 , as described above. 
         [0074]    As described above, at step  408 , storage card reader  202  determines whether the new record is a category II record  108 . If the new record is a category II record  108 , storage card reader  202  updates PESD  100  with a link to the category II reference  108  and related metadata. As previously noted, the storage on the PESD  100  is limited, and links to older category II references  108  may occasionally need to be removed to make room for links to higher priority category II references  108 . Processing of the PESD  100  update continues to step  428 , as described above. 
         [0075]    Advantageously, a PESD, such as a smartcard, may be used to manage a patient&#39;s medical information. The device may contain medical records and information that can be used to locate additional medical records for the patient. The PESD may be presented by the patient when receiving care and accessed by a physician through a storage device reader. The storage device reader is responsible for reading information stored on the PESD, accessing remote information referenced on the PESD, and updating information on the PESD based on policies for data storage associated with the PESD. 
         [0076]    While the foregoing is directed to embodiments of the present invention, other and further embodiments of the invention may be devised without departing from the basic scope thereof, and the scope thereof is determined by the claims that follow.