Card Technology in Healthcare

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Card Technology in Healthcare

• Daniel L. Maloney
• Director, Emerging Technologies
• Department of Veterans Affairs, VHA
• Silver Spring, MD., U.S.A.
• daniel.maloney_at_med.va.gov
• http//www.va.gov/
• http//www.va.gov/card/

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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
• Network means Local and World Wide Network
  (Internet)
• Continuum with Essential data on card
• Many applications can be supported
• What critical Business Problem do YOU need to
  solve?

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Roles for a Card

• Multiple roles including
• Visual Identification
• Portable Data Carrier or Pointers to Data
• Electronic identification (Keys and certificates)
• Electronic Payment - insurance or e-cash
• Two Keys /Cards Required model - patient and
  doctor cards to access data located either on the
  card or on the network

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Major Trends

• The Web Changes Everything
• Customer Convenience /Humanize Interactions
• Electronic Service Delivery and EDI - saves time,
  money for corporation AND the customer
• Providers and patients interact from many
  locations
• Major obstacle - User authentication, Security
  and Privacy
• Major solution - Keys - Public /Private Key
  Infrastructure, encryption and Digital Signature
• Safely carry keys on smart card
• Multi-application cards reduce the cost per
  program
• User Opt In

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G-8 Healthcare Data Card Project

• Members are Canada, France, Germany, Italy,
  Japan, United States (United Kingdom, Russia.)
• Two pilot areas were initially identified for a
  global project approach
• an international emergency card with an
  international harmonized emergency and
  administrative data set (CardLink Project)
• an international professional card that will
  allow the secure identification of healthcare
  professionals when accessing medical data and
  network services (NetLink Project, PKI)
• http//www.sesam-vitale.fr/Projects/Netlink-G7-En/
  

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G-8 Healthcare Data Card Project

• Plans for Technical Interoperability - The
  functional goal is to allow data to be exchanged
  between different projects in multiple countries
  using equipment and cards from multiple vendors
• Multiple levels of standardization are required -
  Standard in areas of Nomenclature, Data Sets for
  emergency data, data sets for administrative
  data, and Standards related to various aspects of
  security
• More information and links at http//www.va.gov/ca
  rd/ and http//www.sesam-vitale.fr/Projects/Netlin
  k-G7-En/

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NetLink Project

• The NETLINK project aims at establishing
  recommendations and technical specifications for
  
• Health Professionals to access to Patient Data
  Cards (free or controlled access to data stored
  in Patient cards)
• Health Professionals to securely exchange
  documents (including digital signature and
  confidentiality services)
• Health Professionals secure access to on-line
  servers
• Involves smart cards (used by Health
  Professionals and Patients), computers (used by
  Health Professionals, Hospitals, Health Insurance
  Funds), large networks, and Security
  architectures including data encryption
• France, Germany, Italy and the Province of Québec

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What is the VA doing?
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Department of Veterans Affairs - Patient Card
Upgrade

• Rollout began in Dec 1996, finished in April
  1997, Planning began in Dec 1993
• 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 facility, 2.5 million cards first
  year
• magnetic stripe - date of birth, period of
  service and service related disabilities
• Enhancements are planned

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The Veteran ID Card

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

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Department of Veterans Affairs - Home Health
Care Initiative- Design Stage

• Store commonly needed data on card to improve
  communications between different home health care
  providers
• Always available to home health care provider
• Also to be used at Emergency rooms and health
  care providers offices
• Use of portable devices to read and update
  patient card
• Begin Summer of 1999

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Department of Veterans Affairs - Lab Test of New
Technology

• Microsoft Windows Card Operating System (Beta
  now, projected release in June 1999)
• Workstation Development Tools
• ActiveX for Healthcare to transfer data
  bi-directionally between chip and VA VistA
  Medical Information System
• Shown in DataCard booth at HIMSS in February 1999
  and CardTech 99 in May 1999

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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 began in May 1998
• 60 users for telnet and web access
• FTP and Exchange delayed
• Plans to migrate to system that uses PKI
• Support and coordination problems

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VA PKI Pilot

• Established VA wide project to investigate and
  implement VA PKI
• Steering Committee to advise project
• Participate on Federal PKI Steering Committee
• Drafting Decision documents and policy
• Initial Capabilities Demonstration
• Issuing VA Branded public keys / certificate
• testing secure electronic mail
• demonstration of certificate based access control
• demonstration of digitally signed forms and data
• supporting pilots

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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

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VA Electronic Purse

• Visa Cash in the hands of patients,
• 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

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VA Electronic Purse

• At the Bronx site,
• up to 4,000 reloadable cards used as
  identification badges.
• Approximately 10,000 cards issued for meal
  tickets, and
• 1,000 for personal patient checking accounts.
• The Tampa pilot also has a special purpose card
  to be distributed by Veterans organizations for
  special events hosted at the medical center
  throughout the year

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Department of Veterans Affairs - VA / DoD
Multi-application Initiative- Planning Stage

• Reviewing Technical Interoperability Standards
• Reviewing Medical Emergency Data Standards
• Campus style multi-application card
• Healthcare Functions - Identification of patient,
  data sharing and possibly electronic cash
• Select Site
• Select potential applications (registration,
  emergency, contract provider, access, finance)
• Select data fields (ID, Administration,
  Emergency, provider, treatment locations, keys
  and cash)
• Initiate Pilot in Summer or Fall of 1999

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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 in US HPP, Secure
  Telemedicine, Oklahoma, DoD MARC
• National projects in Europe Germany, France,
  Spain with plans in Italy and Quebec
• The use of chip cards are gradually becoming more
  common in North America
• Secure access to medical data on the network
• Patient uses keys of smart card to control access
  to their record

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