Smart cards burst into the global scene in 1974, when Frenchman Roland Moreno paid for a telephone call with an electronic card. Once considered the vanguard of technological innovation, Smart cards have now firmly moved into mainstream America. From usage by the federal government for a host of purposes (employee identification cards, passports), to private sector usages of network and personal authentication, Smart cards have found their way into virtually every industry, including healthcare.

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How would it work in healthcare?

Some of Smart cards greatest successes have been in the healthcare arena. Countries with national healthcare systems such as France and Germany have issued over 150,000,000 Smart cards that carry health and identification data. As in other countries, the importance of Smart cards has proven to be beneficial to the healthcare market for data access, accuracy and management.

Technology adoption within the U.S. healthcare market has certain challenges unknown to other industries (i.e. HIPAA mandates). However, over the years, standards have been established along with best practices to facilitate wide-scale implementation of Smart cards to the benefit of all participants.

LifeMed Card : Patient Identification & Admission

The program

The LifeMed Card program takes the best from the web and marries it with the portability and security of off-line systems. The program has several components that all work together to save time for the patient, reduce costly errors for the hospital or physician, and enhance the overall experience. Patient data includes basic demographic data, insurance information, emergency information, allergies, medical conditions, and recent prescriptions. Information is uploaded by patients through the hospital's web site and securely encrypted onto a Smart card. When patients come to the hospital, they present the Smart card. The Smart card information, which can be updated, is then accessed by a hospital's admissions unit and matched to the hospital's data management software. Kiosks at the hospital also allow a patient to pre-register using data stored on the Smart card to populate standardized patient forms. Additionally, ambulances and EMT's will have portable readers that can view the patient's Smart card data in emergency situations, providing richer and more accurate information

What is a typical implementation?

Each of the above components has its subset of deliverables. Assuming a reasonable lead-time for implementation being 60-90 days, SMART will deliver and install each of the following elements as part of your marketing strategy:

• Desktop software at registration terminals and at the seniors program office to read/write Smart cards. Thesoftware will allow information stored on Smart cards to be displayed on desktop screens, will have ability to manipulate data, and can be printed in hard copy form.
  
  
• Integration of a software bridge to capture the unique patient number from Smart card and push it to ADT admissions software.
  
  
• Two-part security authentication for users to be certified to view and update data.
  
  
• Web site interface for gathering patient information for populating Smart cards.
  
  
• Security/usage log with passive transmission to SMART.

Smart Cards

• Given the need to be able to re-write (update) data, the patient Smart cards MUST be microprocessor cards. This choice is prudent for a hospital because microprocessor cards afford additional data security features (encryption) as compared to memory-only Smart cards. Additionally, the life cycle costs of microprocessor cards are far less than their memory-only counter parts because re-issuance costs for memory cards nearly always exceed single-issuance costs over the course of a project.
  
  
• Administrator cards will also be microprocessor cards, but with more advanced cryptographic capabilities and encryption keys. For example, Administrator cards will be able to utilize PKCS-11 protocol for two-part authentication.

Readers

• Desktop readers will be attached to several admission stations at the hospital, as well as being available at the senior’s program management site. Readers will attach to local desktops via USB connection. Alternatively, a hospital may consider purchasing keyboards that have Smart card readers built directly into the keyboards.
  
  
• Ambulance personnel as well as other “First Responders” will use portable readers. These hand held devices will be able to display the entire Smart card record (scrolling format) for the healthcare professional.

Kiosks

• A free-standing kiosk will be deployed with software that allows for patient data entry, review, and updates. The patient as part of the registration process can use information from the Smart cards (via the kiosk). Pre-registration tasks, including (printing of updated “Consent Of Treatment,” “Conditions Of Service,” and “HIPAA Disclosure Policies”) need to be finalized as part of the Client Requirements Document. Final physical kiosk design will be determined by the client hospital.

Future Considerations

In almost every situation, future enhancements to the current system are desirable. Fortunately, each functional element for future launches can build upon existing hardware and software. Thus, no additional “upgrade” costs are related to future modules. Some components considered for future implementations include:

• Kiosks with additional functionality
• Additional customized data on Smart cards including pharmacy
• Integration into other related software systems
• Financial transaction management (credit, debit, Smart card e-cash)
• Integration into local physician offices
• Area-wide data integration

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