The European healthcare sector has seen major growth over the past few years in the use of IT (Information Technology) for delivery of healthcare services and for the management of the healthcare system. Use of electronic medical records, electronic prescribing, appointment booking, telemedicine and so on are a few to name. These systems are being introduced in response to the need to reduce time, improve patient care and tackle organisational problems faced by healthcare providers everywhere. In many countries, one significant way of getting the best out of IT has proved to be the use of smart cards. Smart cards have become increasingly important in a number of sectors, such as mobile communications, banking, corporate uses and transport, globally. Smart card technology is now staking its place in the healthcare industry.
A smart card is a plastic card embedded with a computer chip that stores and transacts data between users. The data is associated with either value or information or both and is stored and processed within the card's chip. The card data is transacted via a reader that is part of a computing system. This is the common perception of a smart card, but the chip card is one among the three main smart card types.
The other two types of smart cards are the memory cards, which have an embedded memory not in the magnetic stripe but in the card itself and the contact-less cards, which use the wireless communication technology and can be read without inserting the card into a card reader. Smart card-enhanced systems are in use today in several key applications, including banking, entertainment and transportation. All applications can benefit from the added features and security that smart cards provide.
The upsurge of health care data brings up new challenges to the efficiency of patient care and privacy factors. Smart cards solve both challenges by providing secure storage and easy distribution of data. Among the various smart cards available, the chip cards are an excellent choice for privacy cards. Personal information such as social security number, medical insurance information, type of coverage, and critical data like blood type and known allergies can all be incorporated in the device. These data can be differentially encrypted so that what a medical facility can view cannot be viewed by others for whom the data are not relevant. At the same time, it can speed up the data capture for medical facilities. The data can be password-protected, so users, at their discretion, can make the information embedded in the card available to potential providers in need of it. Medical providers will be the biggest beneficiaries of chip card technology enabling them to capture accurate data.
Generally cards can be used to store data, to prove identity and as a key to accessing information. In healthcare that translates to storing medical data on the card, proving entitlement to healthcare benefits, giving access to healthcare networks and reduction of records maintenance costs. Originally, cards were marketed to healthcare for the storage of medical records, emergency data, administrative functions, records of specialty-specific care, but in fact data storage has become by far the least prevalent use in healthcare. The security features and ability to immediately provide access to information are being leveraged. The data carried by a healthcard can be broadly categorized into identification details of the card itself and demographic details of the individual to whom it belongs, administrative information and clinical information with or without prescription facility being linked.
Standardisation of data that is to be recorded in the healthcard is very important especially with the predominance of a mobile population which demands greater healthcare delivery and improved ambulatory care. Healthcards will be beneficial and prove crucial especially during accidents and trauma care as they would provide vital information to doctors and healthcare personnel.
Interoperability is one of the most important prerequisites for widespread use of healthcards. Interoperability between healthcard systems is the ability of one healthcard system to read, use and/or update the data, on healthcards issued by another healthcard system. Many of the potential clinical and administrative benefits depend on widespread use, thus interoperability is a key to unlocking these benefits to the realization of a global market for, and use of, healthcard.
Healthcards are currently most often used in Europe to prove entitlement to healthcare services, for example in France and Germany the healthcard is used to record insurance details. Belgium is soon to launch a smart ID card. Healthcare functions, currently dealt with in a limited way by the SIS social security card system, are likely to move to this new card over the next few years. The UK’s entitlement card system is as important as much about controlling access to state-provided services, such as the NHS, as it is about providing ID for national security purposes.
Smart card usage is not national or local in origin. The European Commission has taken an active step in promoting the use of smart cards in healthcare for many years. The commission has mandated that the existing paper E111 forms, giving access to emergency healthcare in other European member states, should migrate to cards, starting 2004. In the US health insurers are even considering adding commercial applications to health insurance cards. But in Europe, healthcare is still primarily viewed as a separate application especially with privacy and various organisational issues associated with running multi-application card schemes, adding health as an application to a multi-application card is unlikely to become a widespread trend. Some countries, such as Belgium and Italy are examining this option too.
The smart card technology or healthcard is here to stay, whether it be a sole medical data card or multi-application card. It is only a matter of time before others see the benefits of information technology and adopt them.
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