Passport to knowledge: It’s all in the cards
Providers share information in pilot program
Pregnant women and mothers enrolled in public health programs tire of the bureaucratic paperwork. They spend 40 minutes filling out enrollment forms or medical histories at one program provider — just to turn around and fill out the same type of forms at another.
Now participants in the nation’s largest demonstration of state-based, health-related "smart" cards can keep health and demographic information on an electronic card that is common to several federal programs.
It will test how the cards can be used to improve information sharing and administrative efficiency among public and private health care providers.
The Health Passport is an initiative of the Western Governors’ Association (WGA), an independent, nonprofit organization representing the governors of 18 states, American Samoa, Guam, and the Northern Mariana Islands. The project was launched in June in Bismark, ND, and will continue a four-month rollout in Cheyenne, WY, and Reno, NV.
The 18-month trial program, funded by federal health and nutrition agencies and other organizations, will target more than 25,000 pregnant women and mothers and children in the pilot communities. Participants will come from public health programs such as Medicaid; Immunization; Women, Infants and Children (WIC); Head Start; and Maternal and Child Health services (MCH).
According to the WGA, The Health Passport is expected to streamline patient check-in, provide current health information, support referrals among providers, facilitate parent access to immunization and other records, automate patient appointment reminders, and promote access to preventive health information.
In Nevada, the focus will be the development of an automated electronic benefits transfer (EBT) system to facilitate the delivery of WIC benefits. Wyoming already has a chip-based EBT system for WIC and food stamps, so its plan will be to integrate the Health Passport Project with the system in a single-card application.
"Our first goal is to see whether this technology can improve health care for parents and their children by having accurate, complete records from doctors and public health programs stored in a secure smart card," says North Dakota Gov. Ed Schafer, the lead governor for the demonstration. "We also want to determine if the Health Passport can reduce health care costs — in terms of time and money — for both parents and health care providers."
Block it out
The program was designed over 18 months and implemented by Siemens Information and Communication Networks in Boca Raton, FL. Computer chips from Siemens’ Infineon Technologies are being used in the smart card devices. Open Domain of San Ramon, CA, is programming the smart cards, and Louisville, KY-based Stored Value Systems is responsible for the WIC EBT application.
Dreifus Associates of Orlando, FL, is providing site management services, training, and educational materials. These include a help desk, provider training courses, and videos and a brochure that explain the use and benefits of the system to cardholders.
Siemens received input on the project from more than 90 local health care providers, retailers, program administrators, and contractors from across the United States. This collaboration helped develop the application, database, and operating systems, and those giving input decided what design to print on the cards, says Gary Paris, vice president of Siemens’ Advanced Customer Solutions. "Demographic information [on the card] is generic to all agencies," he explains. "Then there is a finite number of data fields. We had all the stakeholders come together and decide what would be the data elements that they needed to be put on the card."
Program participants can use their Health Passport cards at any participating clinic, doctor’s office, or grocery store; at Head Start; and at Health Passport kiosks. The kiosks will be located throughout the pilot communities.
The cardholder controls the information on the card with a confidential personal identification number (PIN). Each provider also will have a PIN, and the combination of the two numbers will give the provider access to information only authorized for that person.
For example, the card may contain a file with the results of the client’s last physical exam, Paris says. If the cardholder goes into a Head Start program, personnel at Head Start won’t be able to view that file. "Through the PIN access codes, we have blocked information so users only have access to information relevant to them," he adds.
Personnel within provider organizations will also have varying access to the information on the cards. Administrative personnel — or anyone with access to information on the card — can view its demographic information, such as the client’s address and phone number, routinely shared health information such as height and weight, the location date and time for follow-up appointments; and in Nevada and Wyoming, WIC food benefits.
A physician, however, would have access to more comprehensive medical information. "Ensuring that the privacy of the information would be maintained was a big concern of all the stakeholders of the various agencies involved in the project," Paris says.
When the client visits a participating health care provider, the information from the card is read directly into the provider’s existing information health information system. The provider then updates the card after each visit from its existing records and includes information on the client’s next visit.
Clients who forget the appointment information can view it at one of the kiosks or print it out at a provider’s office. The information from the visit is written both to the card and to a central database, Paris says. This allows the information on the card to be recreated if any cards are lost.
The card reduces duplication of services and paperwork, Paris says. "The project will make the delivery of health care more efficient for both the provider and for the cardholder."
The project also gives the client responsibility for the health information, Paris says. "Whenever clients visit a provider, they must make sure they bring the cards with them." Siemens has developed a passport-type holder for the card that includes information in various languages.
Once the pilot program is completed, it will be independently evaluated by the Urban Institute in Washington, DC, to see whether it should be expanded to other cities and states throughout the region.
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