Smart Cards for Smart Doctors

This week an article in American Medical News touted the first large scale implementation of patient "smart cards." Smart cards test These cards are photo ID cards that have an integrated 64 bit chip which contains encrypted patient information. The type of ingformation on the chip is to the tune of pt. demographics, health history, allergies, meds, and lab results. This information can only be decrypted when the pt. enters their PIN on a card reader. This feature can be overrided in emergent situations when the pt. is unconscious or can't type in the PIN.

These cards will be implemented at Mount Sinai hosptial, New York, along with eight affiliated hospitals and clinics in the New York area. The cards will be used to facilitate patient information between physicians. If this trial, which will begin sometime midyear, is successful, it can be expanded to the entire New York area or the nation. This is part of President Bush's initiative to create a national health network in 10 years.

With the implementation of these cards in the New York area, information can be passed seamlessly between hospitals and clinics. For those of you that aren't in the health care industry, this has the potential to be a revolutionizing move. There are programs now that allow transfer of pt. information between hospitals and related clinics. Unfortunately, if the patient goes to a clinic outside of the network, their labs or films are not accessible. Also, this can facilitate the taking of a pt. history. This can be a decievingly difficult thing. Patients seem to delete or add information depending on who is taking the history. This way their past medical history can be followed and accurately treated.

The potential downside of this is identity fraud. Of course, why would one want to steal the health history of an 81 year old man with a history of type 2 diabetes and congestive heart failure? I don't know either, but I suppose it could happen. What happens if these people lose their cards? What if they keep their ID card next to their credit card and it erases it? What if they don't have a card? Will they still receive the same level of care if they are not included in this study? What type of patients will be given cards? Will they be only patients with chronic disease (DM2, COPD, CHF, hypercholesterolemia, CAD), or will they also be patients like myself with little to no significant past medical Hx? How will they track the efficiency of patient information transfer? This is a hard thing to track, as one might imagine.

With all these questions about data management, patient management, and study composition, the trial should be controversial regardless of the outcome. I'm hoping that the clinical trial shows the cards to be of benefit to patients and physicians. Unfortunately, the results of the clinical trial won't be available for a couple years if that early.