Giant health system in Pittsburgh plays the smart card

UPMC is taking the plastic data card out for an extended test drive as part of a multiyear, $500 million electronic records project.

By Tyler Chin, amednews staff. April 1, 2002.

UPMC Health System is expanding its test of smart cards after an initial run proved successful.

The Pittsburgh-based system, which has 16 hospitals and a group of 450 doctors, earlier this year installed a smart-card reader at one of its emergency departments. Soon, it is scheduled to test smart cards for adjudicating the claims of patients who have flexible spending accounts, a process that would be completed while those patients are in the office. That should speed up payment for physicians and spare patients the hassles of collecting and filing receipts for reimbursement, said Scott Gilstrap, UPMC's project director for technology solutions.

UPMC, which sees the cards as a small component of a five-year, $500 million electronic medical records initiative, also will issue smart cards to as many as 5,000 additional patients. It issued cards in August 2001 to 300 patients to help streamline the patient registration process. Patient demographics, allergies, medications and other encrypted data are stored on a chip embedded in the plastic cards, which are the size of credit cards.

Those data are decrypted when the cards are swiped through a card reader. Patients also can review and print their data at the doctor's office, using a kiosk and a personal identification number. UPMC is testing the cards only with members of its HMO and its employed doctors, though it eventually hopes to issue the cards to all patients and affiliated physicians.

So far, the pilot program has shown that the technology works and that patients accept it, said Francis Solano, MD, an internist at the seven-doctor group testing the cards and the president of the 450-physician group practice UPMC owns.

Dr. Solano said the cards have made the registration process easier for staff and patients, but neither he nor UPMC can quantify cost-savings because usage has been very low. "I think it's neat, but we need to have more people. Then, I think we will start seeing the value."

For example, as use of the cards grows, he expects they will provide an additional mechanism for reducing medication errors.

Several organizations have been using smart cards for health care purposes in the United States over the past several years. These include the Western Governors Assn., which has been conducting federally funded pilots since 1999 in Bismarck, N.D.; Cheyenne, Wyo.; and Reno, Nev.

Industry observers have predicted for years that this country would join Europe and Asia in widely adopting the cards.

But that prediction hasn't materialized because American telecommunications infrastructure is better and less costly than in Europe and Asia, and the credit fraud rate here is lower, said Donna Farmer, who recently resigned as CEO of Smart Card Alliance, an industry trade group, to launch a startup offering secure personal ID and authentication consulting and marketing services.

The cards also have flopped because most projects involving them haven't advanced past the pilot phase and have been too small or limited in scope, making it difficult to get a handle on cost savings.

Still, some think that the environment is right for smart cards to take flight as health care organizations and others wrestle with ways to protect the privacy and security of medical data. "Here in the States, I think the business driver will be privacy and security," Farmer said. "Smart cards afford so much of a range of flexibility to help ensure the security side but also help protect privacy."