| Smart
cards have been successfully used in health card applications
worldwide.
This section describes the efforts of several organizations
who have implemented smart health cards.
University
of Pittsburgh Medical Center
Mississippi Baptist Health Systems
Sesam Vitale / French Health Card
German Health Care Card
Taiwanese Health Care Smart Card
Project
University of Pittsburgh Medical Center
Faced with dramatic growth, the University of Pittsburgh Medical
Center (UPMC) found it difficult for their technology infrastructure
to keep up with their business requirements. Given their size
– 20 hospitals and a group of over 5,000 doctors in
over 400 offices – processes such as verifying the eligibility
of individuals while maintaining the confidentiality of sensitive
patient information became increasingly difficult. UPMC found
that it was obvious they were moving toward unmanageable administrative
processes, high and increasing operational costs and ineffective
intra-health system communications.
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Mississippi Baptist Health Systems
Starting with two doctors in 1911, Mississippi Baptist Health
Systems (MBHS) now comprises two hospitals (Mississippi Baptist
Medical center and Baptist Restorative Care Hospital), 500 doctors
on staff, 110,000 emergency room outpatients a year, and a host
of health-related services in the community. In an attempt to
stay ahead of the legislated requirements of HIPAA, MBHS has
begun work on a smart card-based program to replace their current
magnetic stripe identification card system. The added bonus
of being able to use multiple applications on a single card
was also a factor in deciding to use smart cards. To
the 70,000 current card-carrying members of their system,
MBHS hopes to reach new levels of patient convenience, safety
and privacy with the smart card program. Their goal is to
replace all legacy cards within two years of the institution
of the new program. In addition to the functionality provided
by the new smart card program, MBHS also hopes to gain visibility
from its initiative, marking it as a leader in health care
technology.
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Sesam Vitale
Sesam Vitale is a highly secure dual-card system. The cards
(one for patients and one for health care professionals) are
the heart of a French health care system that links every
individual with health care resources, including public hospitals,
private clinics, general practitioners, specialist doctors,
nurses, and midwives, all through a secure network. The Sesam
Vitale system simplifies the procedure by which health care
costs are cleared and also dramatically reduces the risks
that refunds to insured patients will be delayed by replacing
an annual 1 billion pages of health care information with
electronic transactions. The result is that the average reimbursement
time has been reduced from up to 6 weeks to 2 or 3 days. In
addition, payments are made directly to health professionals
by the insurance companies. The system also tracks health
care spending and, in the future, will be used to transfer
electronic prescriptions to the health care funds responsible
for reimbursement.
Sesam Vitale Patient’s
Card
The Sesam Vitale patient’s card is a microcontroller
card containing approximately 4 pages of text. The patient’s
surname, first name, and Numéro d’inscription
au Répertoire (NIR)24 are printed on the front of the
card. On the back is the card serial number.
The Sesam Vitale health care professional’s card, called
the Carte de Professionnel de Santé (CPS), is also
a highly secure smart card that is easily recognized by its
color. The MCU embedded in the card includes a crypto-processor
that manages public keys and generates digital signatures.
The card identifies the health care professional and provides
authentication, digital signatures, and data encryption. Pharmacists
and medical staff also receive a card. More than 425,000 cards
have already been issued to health care professionals, with
more than 90,000 to physicians.
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German Health Care Card
Health insurance is required in Germany, and the majority
of the population is served by public health insurance. Currently,
Germans carry a health care card that can be characterized
as an insurance card. Its primary function is administrative.
Current German Health Card Program
The current German health card program was rolled out in 1993
and is fully implemented. A total of 80 million people now
carry the card. The card contains a 256 byte protected memory
chip (not an MCU) and stores the following data:
- Identity
of the insurance.
- Insured
person’s name, address, and date of birth.
- Status
of the insurance.
- Expiration
date for the insurance.
This data supports for the following administrative benefits:
- Patient
identification.
- Elimination
of duplicate records.
- Reduced
paperwork and cost associated with mailing health insurance
forms.
- Streamlined
admission process.
- Reduced
transaction costs.
Next Generation Health Card
Program
Germany is now planning for the next generation of health
care cards. The new program is expected to include cards for
patients and cards for health care professionals. These more
advanced cards will be based on 16 KB or 32 KB microprocessors.
The cards are expected to provide multiple additional benefits,
such as enabling insurers to collect co-payments that are
currently uncollected and eliminating paperwork associated
with the current prescription drug program.
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The Taiwan Health Care Smart Card Project
The Taiwan health care smart card project is one of the largest
health care smart card solutions in the world and the first
of its kind in Taiwan, Republic of China. The total bid price
for the project was US$108 million, and contractors were requested
to finish within 25 months of the start date, April 12, 2001.
The smart card project infrastructure is integrated into the
original paper-based health care system.
Project Background
The total population of Taiwan is now 22.5 million, and 96%
of Taiwan citizens joined the National Health Insurance (NHI)
program that was established 8 years ago. A total of 16,558
hospitals and clinics (90% of the total) registered in the
NHI program, creating a service network for insured applicants
nationwide. Taiwan had a strong IT foundation: the original
paper-based health care system included 92% of contracted
medical institutions with a computerization rate of at least
70% and public satisfaction levels of 71%.
The smart card is a microcontroller-based card and has 32
KB of memory, of which 22 KB will be used for four kinds of
information:
- Personal
information, including the card serial number, date of issue
and cardholder’s name, gender, date of birth, ID number,
and picture.
- NHI-related
information, including cardholder status, remarks for catastrophic
diseases, number of visits and admissions, use of NHI health
prevention programs, cardholder’s premium records,
accumulated medical expenditure records and amount of cost-sharing.
- Medical
service information, including drug allergy history and
long-term
prescriptions of ambulatory care and certain medical treatments.
This information is planned to be gradually added depending
on how health care providers adapt to the system.
- Public
health administration information (such as the cardholder’s
personal immunization chart and instructions for organ donation).
The Taiwanese government has reserved the other 10 KB of memory
for future use. Moving to the smart card system has resulted
in the following
changes:
- Hospitals
and clinics upload electronic records daily to BNHI.
- After
every six patient visits, card information is uploaded online
for data analysis, audit, and authentication.
- The
reimbursement process is faster.
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