Smart Cards

[MichaelMHP]

Hello all... been awhile sine I posted, but I read up every day!

I'm interested in opinions regarding Smart Cards. I work for a health insurance company, and one of my projects is designing a process to pay providers faster. A secondary goal is to allow providers to have a summarized medical chart that the member can present.

I have also been asked to explore various technologies, including smart cards, biometrics, RFIDs, and other possible solutions. Smart cards are similar to a credit card, except they contain all of the major parts or a mini PC- RAM, ROM, processor, I/O, and everything necesary to carry around a startling volume of info. Biometrics can be used as an access key to special websites or secure networks containing personal data. RFIDs could do the same, allowing a key code and other limited info to be essentially broadcasted to a waiting Physician's PC- or anyone else's for that matter. Many more solutions are available, but they all have one thing in common- quick, easy, and accurate identification which could, in theory, be used also as a key to unlock a predetermined volume of data that has never commonly been collected in one place.

Similar, but more limited projects exist in France, Germany, and other EU states as well as military applications.

As I research these and develop my opinions, I am increasingly concerned for the "Human Factor". Obviously if this technology were implemented it would represent a significant leap forward in the ability to treat patients, reduce errors, and increase provider happiness. Conversely, it could also represent a significant blow to privacy, personal security, and control over one's own pocketbook.

In addition, I have heard some other, more disturbing theories regarding "marks of the beast" and "Big Brotherism". I myself have been reminded of Huxley's Brave New World. I don't consider myself particularly religious, nor am I easily taken by conspiracy theory, but these opinions and possibilities must be considered.

Where does Faith meet Sci-Fi? Is this technology something that would be beneficial, or does it signal something more sinister? Should Faith be a concern when implementing something for the good of all concerned?

I'm interested in all of your opinions. All opinions will be considered and I intend to include some in my presentation to my managers.

Thanks for all of your help!

[mjc]

The thing about this type of technology is that we humans are awfully damned nosy critters...we can't really be trusted to stop with just what we need to know, we want to know everything. All of these type of things start out small, but have a way of snowballing in a beast with a life of its own.

significant leap forward in the ability to treat patients, reduce errors, and increase provider happiness

That is going to be the most idiotic reason..because you can never completely satisfy, short of providing a running log of everything a person does ftom the day of conception until they kick off..the providers will always want more info.

Bla.....my biometrics chip is chirping about my blood pressure rising....the health cops will be here shortly....I'd better cut this one short...

[Steve]

I'm all for it. I don't see the point in putting up roadblocks to technology. If it can be done, it will be done. So we might as well put our energies into making these things beneficial. If ever I am carried into an emergency room unconscious or in such a state that I can't communicate effectively, it would be very nice to have my medical history availible to those trying to help me.

But...as these technologies come online, we have to identify the misuse to which they can be put and protect ourselves. I'm not going to stop using my computer just because someone can hack into it! I'd be glad to have a credit card sized computer that could help me out. The fact is, they are going to be here whether we like it or not. We might as well get to work preparing for them.

As for religion, I don't think we can stop technological progress because of religion. They will just have to get over it. Some religious folk refuse to have blood transfusions, and that is their right, but I would hate to think that I couldn't have one because of someone elses beliefs.

This might sound a little off the wall but I think we need to get rid of the profit motive in healthcare. The only reason that an insurance company wants anything is to make more money. I say eliminate any profit from healthcare, find the people who are in it for what I consider the "RIGHT" reasons and then bring on the technology.

[Fruss Tray Ted]

eliminate any profit from healthcare is ONE issue, but insurance is another entirely. what about the 'for profit' there? The rates for medical, homeowners, auto... go up up up up and now it isn't that a dog guards your property, it is now a liability. And for having one (that's never bitten ANYONE), you get denied! AARRGGHH! :mad:

BRB, I need a chill pill...

[Budfred]

The problem that I see with this type of technology is that they produce it without adequate concern for privacy and the effects of violating privacy in the first place. If I have a smartcard that contains my medical record and that I could update readily while trusting that NO one else can access it without my express permission, I would be delighted. If I could rely on still being able to get insurance in spite of having a condition that insurance companies don't like, I would be less worried about privacy in the first place. If I could rely on being able to get a job that I am otherwise qualified for in spite of a medical condition, I would be less worried about privacy.

I have seen people discriminated against for medical problems and, therefore, I will not trust any system that doesn't ensure me complete control over my records. Unfortunately, my primary clinic (and most clinics in the USA) are now computerizing records that can be accessed by anyone in the system with the correct password. Insurance companies have access to any data about me that they pay for (and probably a fair amount they don't pay for).

So it is true that we will not stop it happening and it is also true that it will be abused. If you can develop a system that can be trusted, I applaud you, but I don't believe you can....

[Steve]

Ted...did you get denied homeowners insurance because you have a dog??? :confused:

[Mark Miller]

There have been a number of posts on tech advances that most of us see as some form of an invasion of privacy. In a perfect world [U.S. circa 1850] these would all be valid arguments and we would all have choices to leave these "civilizied" advances behind us and move further into the wilderland. Unfortunatly the wilderland is gone and I think our choices of to accept or not has gone with it.
imho
Mark :(

[gracious]

I think that Big Brother already has ways of getting information about us even though we think that we have privacy. It almost seems like the government announces things to the public as if it were a new thing but I think there are things that they have been doing all along and have decided to let us in on it. I think we would go crazy if we really knew what they were really up to and how much information they already have.

As for insurance companies, I think with all the special interest groups and the lobbyists that we are at their mercy. The fact that the id# on my health insurance card is my SSN# is scary to me. I was watching a program and they were talking about health insurance costs and they were stating that one of the main reasons health insurance goes up is because they are using the premium money in the stock market and when they lose out we get increased rates. You would think that with the new technology we have at our disposal that they would be able to diagnose better and quicker and get people in and out so to speak..as far as the smart card, I don't think it matters because I think that they can get our info right now if they really wanted it.

[MichaelMHP]

Great responses so far! I really appreciate them- they are helping me to understand the mindset of the average patient, or at least, the wiser average patient.

I'd like to clarify a few things about my company, perhaps to help explain the purpose of the project.

- The goal is to improve security and access at the same time. We think it is reasonable with careful, guided steps.

- SSN's are no longer allowed as ID numbers by law as of 4-14-03 (HIPAA, 1993). We are in the process of moving members to a randomized number and removing personal data from cards to reduce the threat of identity "issues". The device, card or otherwise, is part of that initiative.

- My company is owned and operated by the Catholic church as a non-profit entity. Commercial clients (employers) are served to help fund our charity and Medicaid / Medicare based programs. We don't offer individual plans (except for Medicare / Medicaid recipients) because we accept all members from employers, regardless of health status. We also provide over $30 Million in free goods / services per year.

- We are a small company- one of the smallest in the country- 230,000 members.

- We are the first company to ever post both our profit / loss statements as well as claims data on the web (aggregateed, and without membership identification, of course). Members can look at our website to see how their MD compares to others in terms of charged price, paid price, member's happiness, and independent review results- all compared to national standards as well as possible alternative services (ex: c-section vs vaginal delivery costs) Transparency, we feel, is key to successful medical care and member happiness, and well as to build trust.

- We are an innovator in patient care- we moved away from a capitation based payment system and returned to fee for service in 2002-2003 because we realized that MD's should be paid for service, not lack thereof.

-We do not, nor have we ever, offered any kind of financial incentives or bonuses to providers outside of their payments for services rendered. They get the same ink pens, slinkys, and other baubles we give as promotional items, but that's it.

- Our CEO's goal is to provide patient care in such a situation that when they seek medical care they fail to consider their insurance altogether, because they don't need to.

As I read this over, I realize that I sound a bit like a cheerleader or corporate slime. The fact is, I may be. I have many years experience in the heath industry, and I was one of the people who started the company- as a phone rep earning barely over minimum wage. My company has paid for my education and continues to reward effort and loyalty for both the company and the members. I have seen the company grow in spite of its disregard for "traditional" insurance behavior, and I am proud of both who we are and how we got here. Our 94% retention rate in spite of being one of the most expensive plans available says soemthing to me- people believe in our vision too. They trust us.

We want to take it to the next step. We will do it. How is one of the things I'm trying to figure out. Please understand, I asked this question here because over the last year or so I've seen some pretty heavy philosophical discusions, and I've learned that in this forum, nobody screws around. I respect that. I just want to make sure that everyone understands I'm not selling anything, nor am I doing a PR thing. I really do value your opinions, and I understand feelings of mistrust. Our industry, in general, has failed in my opinion. Many people made gobs of money, and enemies of its members in the process. I hope to help fix that.

[gracious]

- SSN's are no longer allowed as ID numbers by law as of 4-14-03 (HIPAA, 1993

Well then somebody needs to let Aetna know because that is the id# they are using, my SSN.

I understand that we have the greatest medical field in the world and that in know way do I want to go to socialized medicine but...between the insurance companies and the ambulance chasers, making it hard for physicians and surgeons to perform their skills due to the high cost of mal-practice insurance,how are we the lay people suppose to know who to trust. For instance, what will you be getting out of this enterprise that you are proposing?

[MichaelMHP]

Good question!

For now, the proposed ROI measurements are based on the following:

-membership growth (how many new members can be attributed to the project)

-membership retention (how many do we keep because of the benefit)

-provider recruitment/retention (same as above)

-reduced penalties (we pay a contract based, self-imposed penalty if it takes longer than 30 or 90 days to pay a claim if it isn't contested. Some states also require similar penalties.)

-recognition and brand development

-"self-governance through pre-intervention" (by establishing our own guidelines more stringent than proposed ones as well as being the innovator, we have an opportunity to influence laws that will eventually pass to regulate the behavior / technology)

Gracious, you are correct in thinking that this has a profitability based motivation. In terms of money, there is a significant measurement. Some companies hire little white geese to promote them (AFLAC!). Others have recognition that goes back 100 years or more (BC/BS and their cross). For lack of a better term, innovation and transparency is our "gimmick". We want to offer something nobody else does. We can sell it to our clients- one that not only has the medical implications, but also financial ones, such as the ability to instantly pay claims, and not get letters about it months after you've forgotten the visit. Not having to spend weeks shuffling information that you could have provided immediately in person, etc.

By the way- Aetna should know, this is a huge law that impacts all of us. We all must be in compliance by mid-October, and many of us are tripping over ourselves to get it done. This one is not only huge, but also has teeth. Massive fines and mandatory prison sentences are big motivators.

[gracious]

By the way- Aetna should know, this is a huge law that impacts all of us. We all must be in compliance by mid-October, and many of us are tripping over ourselves to get it done. This one is not only huge, but also has teeth. Massive fines and mandatory prison sentences are big motivators.
what can I do to get them to change mine now?LOL:)

[Budfred]

Unfortunately in the current political climate, I doubt that big business of any kind, including big insurance companies will have to pay fines or do time if they don't meet the deadline. HIPAA is making a big difference in the medical world, but I suspect that the people who will be least effected are the insurance companies.

As for the transparency and other advantages of your company, it is nice to hear they are doing those things - depending on how well they actually execute the things they say they are going to do. However, it is a big leap from providing better service for clients to maintaining security with electronic data storage.

I work in a medical setting and we only recently got a system for shredding patient info that was not needed for charting. One of the people working at the desk was taking patient labels and simply throwing them in the garbage. This bothered me, but I was not in a position to do anything about it. With prompting from me and others, they got a shredding service and installed a box to collect documents. It required walking down the hall to dispose of the labels, so weeks after the box was available, this worker was continuing to throw the labels in the trash. I urged him to collect them and take them down the hall, but he ignored that until a supervisor spoke to him. They just put a second shredder collection box in his area today, so it probably won't be a problem anymore, but look at how long it took.

Human error and/or malice are what I worry about most. The worker I talked about may not be the brightest guy around, but he does a good job and is generally well intentioned. Give your smartcard to someone with malice and you are at even more risk. I would need some very good assurances of protection of data before I would be comfortable with putting my data on a smartcard. I recognize that I may eventually have no choice if I wish to receive medical care, but that lack of choice will simply lead to more animosity toward the entire medical field.

[goober]

I work in a medical setting and we only recently got a system for shredding patient info that was not needed for charting. One of the people working at the desk was taking patient labels and simply throwing them in the garbage.

Big round of applause to you, Budfred for doing something about it!! I never used to think about things like that at all, assuming there was no reason, then I worked at a Credit Union one summer and saw they threw all of their financial records..account#'s,SSN's,loan app.'s,ect. into a dumpster behind the bank with a loose chain to keep people out. You could literally go behind the building and see people's bank statements flying across the lot! Scarey world...

[FrankSG]

With the new privacy laws the just went into affect recently for the medical profession, you might have a problem making something like this a reality. I certainly believe in privacy, but I think the new laws are "over-kill". I doubt that something like this could be done unless the patient signed a zillion papers. Then I still think it would hit some snags.

[Budfred]

Actually one of the key words in the new privacy rules is "Portability"... The idea is that the records are supposed to be more portable than before and the smart card idea would help that along. In some ways, the new rules may make it easier for records to be transferred and more of them will be computerized, but they are supposed to be better protected at the same time.... We'll see...;) :p

[MichaelMHP]

Again, thank you all for your thoughts. The more "passive" phase of my research is coming to an end, and I thought that I'd pass on some interesting information I've learned.

Didja know...

... that there are 55 non-classified active smart card programs being studied by the US gov't at this time? Alone, this is unremarkable. When you add that roughtly 50% of them duplicate each other it becomes frustrating. The fact that all 55 are listed in the same document, and reviewed by the same Senate committee makes it infuriating. These programs include everything from military asset tracking systems to the exact program I am working to perfect. Except theirs is being done in Armenia establishing what one Senator has called a "New Medicare" demonstration.

... some smartcards are now powerful enough to hold not only images, but also video and sound.

... even the Vatican has taken some interest in the technology, for exactly the reson some have rejected the technology? They are "interested" in any possible biblical implications, but for right now are only passively watching. One related technology that has really piqued their interest is RFID tags. While the Vatican has no official position on them, many Cardinals in more developed nations are strongly opposed to them. On a related note, Wal-Mart is rumored to be planning to invest close to 30 Million in research and will offer to act as a test bed for the technology, under the condition that the tags are not set to expire. The semi-humorous joke is that they want to know how much of their stuff is brought back into the store while shopping, and how long it lasts.

... Sesem Vitae II, the French version of the card, was designed by a German company.

... the US Army is planning to replace all current paper ID cards with smart cards. These cards will act as paymaster, medical chart, asset tracker, and skill tracker. In addition, they are interested in integrating the card into the new "smart BDU" which will not only track position and activity, but also act as a digital "Key" to operate the weapons being designed. The goal is to prevent weapons lost on the battlefield from being used against us. Only a soldier with both the documented skill and authorization will be able to operate a weapon, without the card, the weapon disarms itself.

...credit card companies want to encourage smartcards in healthcare, partly because of a human nature based trend. One of the benefits to retail of accepting credit cards is that the average purchase is 20%-40% higher when the user is paying with credit rather than cash. Many people still do not equate credit with "real money" and therefore spend more, and more carelessly. The opinions I have read indicate the belief that because healthcare is such a big-ticket item, if they can get more people to use credit to pay for their care it will significantly increase thier revenue. Because of another inclination of the Baby Boomers- that of paying off a bill no matter how long it takes, they anticipate both extremely low charge-off rates as well as extremely long payment schedules. When you add in a predominantly established, non-transient population, the profit projections are staggering.


Some of it really is somewhat scary...