Hospital puts medical records snapshot on smart cards

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.

Private industry sees big dollars to be made in organizing medical records: Google's expressed interest and Microsoft made news last week with its HealthVault service, an advertising-supported Web portal where consumers can collate their medical records. Contino believes Microsoft's model asks a bit too much work of consumers.

"The card is portable," he adds. "A Web site doesn't have a security token that you can carry with you as you travel through institutions."

Contino advocates an arrangement where consumers use a smart card with a medical history snapshot, combined with a personal health portal run by a trusted third-party like a hospital or medical practice. The portal becomes important since the Web has unlimited space, whereas a 64K smart card doesn't, says Contino, who also serves as co-chair of the Smart Card Alliance's healthcare council, helping the non-profit industry group share expertise and best practices.

The key for patients is control, Contino says. "The patient can see everything on the card," Contino says. "This gets rid of the fear factor that a lot of patients have." Today Mount Sinai patients can view card data using a kiosk at the hospital; in the future, Contino envisions consumer kits including card readers for home use. Mount Sinai has already learned some interesting technology and organizational lessons since rolling out the first 2000 or so health cards since February, and since forming a network of 10 New York area medical institutions to use the system.