Large-scale test set for smart cards

A group of nine hospitals in New York and New Jersey are launching a pilot project in which they will use smart cards to share patient information among themselves.

Under the Patient Health Smart Card Initiative, which is scheduled to be launched in midyear, Mount Sinai Medical Center, a 1,171-bed teaching hospital in New York, and eight affiliated hospitals and clinics in New York and New Jersey will issue wallet-sized photo identification cards embedded with a 64-kilobyte chip to 100,000 patients.

The participants, who believe their project is the largest deployment of smart cards in the United States, will test cards for up to a year. "What we're primarily concerned with is showing the utility of the exchange of data between the institutions," said Paul Contino, Mount Sinai's vice president for information technology and enterprise applications. "Any participating institution will be able to view a card plus add their own data on the card."

Other goals of the project include determining whether the cards can improve patient care, speed up patient registration, reduce medical errors and deliver value to physicians.

The cards will be loaded with patient demographic information, allergies, medications, laboratory results, problem list, treatment history and other data that will enable hospitals and physicians to quickly access critical information they normally could not. For example, if Mount Sinai treats a new patient and that patient has a smart card, its clinicians will be able to quickly access accurate and up-to-date information to take better care of the patient, Contino said. Mount Sinai also will update the card to reflect the care it delivered so that the patient's regular hospital will have access to the information next time he or she seeks care, he added.

Data on the cards will be encrypted. Those data can be decrypted only after patients enter their personal identification number on the card reader, said Jack Nelson, senior vice president chief information officer at Mount Sinai. But the hospitals will be able to override that security safeguard in emergency departments for patients who are unconscious or unable to enter their PIN.

The participating hospitals view the cards as a building block to implementing a regional health information organization, a concept that the Bush administration is promoting heavily as part of its effort to implement a national health network in 10 years. "When those networks are in place, we're still going to need ways to gain access to patients' information and pull that information from the different providers that are part of the regional health information network," Nelson said. "Smart cards make a perfect key to open that door."

The hospitals will issue the cards to patients who regularly visit their facilities and clinics for treatment because they are the ones who will benefit the most, he said. Recipients will include those who are undergoing chemotherapy and dialysis, Nelson said, adding that the hospital eventually plans to roll out smart cards to 36 affiliated hospitals and clinics as well as private-practice physicians.

But before the pilot can be expanded, Mount Sinai and other participants must address how to pay for the expansion. This project is being funded by Siemens Communications, a unit of Siemens AG, which sells information systems to hospitals.

In addition to funding, participants will face other challenges for their project to be successful, some observers say.

Some earlier smart card initiatives "were not successful because they couldn't get traction across a broad enough population of users," said Marc Holland, research director at Health Industry Insights, a unit of IDC, a Framingham, Mass-based consulting firm. But he said physicians, patients and others are more comfortable with smart-card technology today, and also are more easily sold on its usefulness.