The following article appeared a few days ago.
Mt. Sinai Medical Center looks to open standards for patient smartcards
Hospital smartcard stores identity and health records
By Ellen Messmer , Network World , 08/27/2008
Mt. Sinai Medical Center in New York City, which five years ago pioneered the practice of giving out a smartcard to patients to store identity and healthcare records, is realigning its focus to support open standards that could get other hospital systems supporting smartcards, too.
"Patients have wanted the cards and consider them an important credential," says Paul Contino, vice president of information system at Mt. Sinai Medical Center, which has issued about 14,000 of the smartcards to patients through the pilot program that started at the Elmhurst Hospital Center affiliated with Mt. Sinai's School of Medicine. Mt. Sinai Medical Center now plans a redesign of its patient smartcard to adhere to an open standard known as the "Continuity of Care Record" (CCR) with the anticipation that other medical institutions in the New York area and elsewhere might support patient smartcards, too.
The Mt. Sinai-issued smartcard, which stores the patient's personal information, lab results and other medical records, is updated every time the smartcard is placed in a card reader with access to the specialized database of the hospital information system which acts as the smartcard data repository.
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The immediate effort, though, entails Mt. Sinai switching to an XML-based standard called CCR that was jointly developed by several organizations, including ASTM International, Massachusetts Medical Society and HIMSS.
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Contino says Mt. Sinai will be steering its patient smartcard project toward using CCR, with the goal of also encouraging other hospital systems to adopt it in order to establish a multi-hospital system where different healthcare providers one day will be able to accept each other's issued patient smartcards for purposes of sharing patient-related data.
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Full article is here:
http://www.networkworld.com/news/2008/082708-mt-sinai-open-standards-smartcards.html?hpg1=bn
This article follows up a much longer in depth article from late last year.
Hospital puts medical records snapshot on smart cards
By Laurianne Mclaughlin , CIO , 10/18/2007
Several years ago, Paul Contino and the IT team at New York's Mount Sinai Medical Center spent about $1.5 million on a project to clean up duplicate medical records. Duplicate records can lead to problems with quality and continuity of patient care, plus billing snafus. For a major hospital like Mount Sinai, delayed or lost billing revenue resulting from claims denials can add up to $1 million per week. And patient registration errors, leading to inaccurate records, account for 70% of those claims denials, says Contino, a VP of IT at Mount Sinai.
The records clean-up went well, Contino says. But three years later, the problem was back. The IT team became convinced of the need for a better system to register patients, and began exploring an idea that has now turned into a pioneering smart card system.
Today, Mount Sinai patients participating in the pilot test can choose to carry a "personal health card." This encrypted smart card with 64K of memory holds not only the patient's name, photo, and insurance information, but also a medical history snapshot, including notes on allergies, medications, recent treatment data, and even in some cases, a compressed EKG test result. The goal is to distribute 100,000 cards in the initial pilot project, Contino says.
Mount Sinai's registration staffers can use the cards to check in patients quickly and accurately; emergency room triage nurses can use the cards for quick access to relevant patient data.
Mount Sinai, one of the oldest, largest and most prestigious teaching hospitals in the U.S., with 1,171 beds and some 1,800 medical staff, has ambitious goals for the smart card system: It aims to reduce fraud, improve revenue cycles through the reduction of registration errors, and boost quality of patient care.
A smart card bearing a medical snapshot is portable, encrypted for privacy and security, and requires little IT infrastructure to connect facilities ranging from mega-hospitals like Mt. Sinai to community clinics. This is not a replacement system: Today, these hospitals have no efficient way of sharing registration data or urgent care clinical data. For patients, the card has the ability to speed check-in and supply some peace of mind. After all, what patient, arriving at an emergency room such as Mount Sinai's, doesn't want hospital staff to have immediate access to the correct, key medical facts -- even if the patient is not able to speak, or speaking a foreign language, or presenting an ID with a name that hundreds of other New Yorkers share.
Giving patients more control over their own medical records is a complicated problem that various companies and governmental groups have been trying to crack for years. President Bush backs the idea of a Nationwide Health Information Network to reduce costs and improve care, through making records electronic and more easily shared among institutions. As part of that NHIN effort, various RHIOs (regional health information organizations) are working on ways to connect records and make systems interoperable between institutions.
Much more here (well worth a read for the thinking behind the project):
http://www.networkworld.com/news/2007/101807-hospital-puts-medical-records-snapshot.html
Two of the major issues are addressed in these later paragraphs
“What about privacy? Because the cards have tough Triple-DES-level encryption, plus require a PIN code, they're "useless" if lost, Contino says. While Mount Sinai's privacy officer was initially concerned about the smart card project, that changed when everyone involved agreed that a patient entering a PIN code while using the smart card met HIPAA requirements quite well, Contino says.
Mount Sinai offers patients the cards upon registration at the hospital, and at check-in time for follow-up visits.
For the hospital, the card system has the ability to reduce fraud, improve revenue cycles through the reduction of registration errors, and boost quality of patient care. For patients, the card has the ability to speed check-in and supply some peace of mind.”
From what is described here it seems this project has been progressively refining its approach and as it learns what is working and what is not is making appropriate mid-course corrections. This is the way any really successful evolving e-health project should be progressed in my view. Start very simple, prove concept, value and usefulness and then incrementally evolve.
I look forward to the next instalment of the story and the establishment of interoperability between hospitals..that would be a real success indeed!
David.
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