Monday, April 8, 2013

Smart Cards for Your Health Care

Pierre arrives at the construction site, has his morning coffee and croissant, then ascends the scaffold to begin his work.  He felt a little woozy this morning but ignored it.  Becoming more dizzy, he loses his balance and falls two stories fracturing his femur and pelvis.  On arrival the paramedics find his health smart card in his wallet, scan it, and instantly have his medical records including medications, allergies and importantly prior EKG's.  He's found to have a new rapid irregular heart rate and given appropriate medical treatment on the way to the ER.  Pierre is lucky he lives in France where smart card technology is widely applied.

Billy has severe COPD and is on multiple medications.  Going out to pick up the morning paper, he trips, falls, becomes confused and can't respond logically to questions from a bystander.  911 is called and arrives.  No family members are present.  No medical information is available.  He's transported to the hospital where it takes 3 hours to track down a partial medical history and an advance directive.  There is a delay in recognizing internal bleeding until it's discovered that warfarin is one of his medications.  Billy is unfortunate he lives in a state not using smart card technology.

The smart card has been around for a few decades and is in wide use in Germany, France, Taiwan and several other countries.  Biometrics and other security measures have been developed to comply with patient privacy regulations.  The VA hospitals are using a smart card system successfully.  Other health smart card companies are competing for this potentially large market.

There are state wide and even nation wide efforts to have registries for advance directives and POLST forms in order to make them available on an emergent basis.  But we are a mobile society. Individual state registries can become redundant, expensive, and hard to maintain.  Oregon has the most advanced state registry for POLST forms but that is just one state.  Smart cards will allow each one of us to carry around our own health care information in our wallet or purse.  Privacy can be protected with use of a thumbprint.  Secure readers can be portable.

The lack of wide use of smart cards in the US health care delivery is one more symptom of a broken and dysfunctional non-system.

1 comment:

  1. Dear Dr. deMaine,
    I am a San Diego attorney interested in end-of-life issues, giving presentations whenever I can. I focus on the need for conversations over the need for advance directives -- hard for an attorney to admit. But directives are important.
    San Diego Hospice was going to print my unique advance heath care directive when it went BK! I'm now thinking of turning it lose on-line, probably via a blog. It focuses on the quality of life one wants at the the end of life. Would you be interested in looking at it? It is designed for California but that is very easy to fix. I see you haven't linked any advance directive.
    Never heard of smart cards, and am investigating. I have a lot to learn.