Healthcare Applications

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Healthcare Applications

• Moderator - Daniel L. Maloney
• Director, Emerging Technologies
• Department of Veterans Affairs, VHA
• Silver Spring, MD., U.S.A.
• daniel.maloney_at_med.va.gov
• http//www.va.gov/
• http//www.va.gov/card/

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Card Technology in Healthcare

• Daniel L. Maloney
• Director, Emerging Technologies
• Department of Veterans Affairs, VHA
• Silver Spring, MD., U.S.A.
• daniel.maloney_at_med.va.gov
• http//www.va.gov/
• http//www.va.gov/card/

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Overview

• Major Events
• Future Vision
• What is the VA doing?

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Major Events

• French Patient Card
• French CPS Health Professional Card
• CardLink 9 Country Pilot Evaluation
• German Health Card
• Microsoft Expands Support for Smart Card Business
• Web Continues to Expand
• Security and Privacy are becoming a higher
  priority

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French Health Patient Card - Vitale

• Vitale 1 being distribute now
• 40 million family cards distributed as of 4/1999
• ID and Administrative data
• Smart card with operating system similar to M9
  used on French Bank card
• 5 million cards distributed per month from 4
  suppliers
• target of 42 million cards by May 1999

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The French Health Professional Card - Carte "CPS"

• 2 Pilots for CPS Health Professional Card
• CPS Health Professional Card with crypto chip to
  be distributed with a total of 300,000 cards
• Goals similar to patient card (simplicity,
  reliable information Confidentiality, limitation
  of frauds)
• Electronic Reimbursement
• Access key to the Healthcare Intranet
• Access key to the medical data set on the patient
  card

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The French Health Professional Card - Carte "CPS
(contd)

• 50,000 Health Professional Cards distributed as
  of 4/1999
• 10,000 distributed each month
• currently being distributed to physicians.
• identification of healthcare provider, RSA public
  /private keys, PIN protected
• distribution to nurses, pharmacists, and
  hospitals next
• negotiations ongoing with health professional
  organizations

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CARDLINK Project

• Portable Administrative, Emergency, Medical and
  Prescription Data - 100,000 cards
• User driven, supported by European Commission
• Interoperable European data set with language
  translation
• 10 sites in 9 countries include France Dublin,
  Ireland Germany Holland Spain Greece
  Portugal Italy Finland
• Demonstrate standards based card and reader
  interoperability with multiple manufacturers
• Measure usefulness in travel or emergency
  situations
• Begun in 9/1994, pilot to be completed in 1999
• Use of card is voluntary

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Germany

• Germany has completed a project distributing 80
  million cards to all citizens during 1994 and
  1995, along with the reader/printer
  infrastructure
• Memory chip cards used for insurance
  identification.
• Printing of Health Insurance forms
• Options for electronic submission to insurance
  fund, eliminating paper and reducing insurance
  processing costs

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Why Use Cards In Healthcare?

• Cards are a part of local or networked system
• Deliver Better Service and Benefits Faster
• Decrease Paper Work and Administrative Costs
• Decrease Date Entry Error
• Quicker and easier retrieval of Data (from a
  portable card or using card as key to data
  lookup)
• Increased Patient Convenience
• Decrease Fraud
• Secure Access to On-line Data
• Enable secure and private communications
• Support Digital Signatures
• Support Financial Transactions

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Major Concepts

• Card functions as part of the System
• Works with the networked data
• As the Network improves, the location of the data
  can change
• Network means Local and World Wide Network
  (Internet)
• Continuum with Essential data on card
• Many applications can be supported
• What critical Business Problem do YOU need to
  solve?

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Roles for a Card

• Multiple roles including
• Visual Identification
• Secure Portable Data Carrier or Pointers to Data
• Electronic identification (Keys and certificates)
  for logical access, digital signature and
  physical access
• Electronic Payment - insurance or e-cash
• Two Keys /Cards Required model - patient and
  doctor cards to access data located either on the
  card or on the network

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Major Trends

• The Web Changes Everything
• Customer Convenience /Humanize Interactions
• Electronic Service Delivery and EDI - saves time,
  money for corporation AND the customer
• Providers and patients interact from many
  locations
• Major obstacle - User authentication, Security
  and Privacy
• Major solution - Keys - Public /Private Key
  Infrastructure, encryption and Digital Signature
• Safely carry keys on smart card
• Multi-application cards reduce the cost per
  program
• User Opt In

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G-8 Healthcare Data Card Project

• Members are Canada, France, Germany, Italy,
  Japan, United States (United Kingdom, Russia.)
• Two pilot areas were initially identified for a
  global project approach
• an international emergency card with an
  international harmonized emergency and
  administrative data set (CardLink Project)
• an international professional card that will
  allow the secure identification of healthcare
  professionals when accessing medical data and
  network services (NetLink Project, PKI)
• http//www.sesam-vitale.fr/Projects/Netlink-G7-En/
  

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G-8 Healthcare Data Card Project

• Plans for Technical Interoperability - The
  functional goal is to allow data to be exchanged
  between different projects in multiple countries
  using equipment and cards from multiple vendors
• Multiple levels of standardization are required -
  Standard in areas of Nomenclature, Data Sets for
  emergency data, data sets for administrative
  data, and Standards related to various aspects of
  security
• More information and links at http//www.va.gov/ca
  rd/ and http//www.sesam-vitale.fr/Projects/Netlin
  k-G7-En/

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NetLink Project

• The NETLINK project aims at establishing
  recommendations and technical specifications for
  
• Health Professionals to access to Patient Data
  Cards (free or controlled access to data stored
  in Patient cards)
• Health Professionals to securely exchange
  documents (including digital signature and
  confidentiality services)
• Health Professionals secure access to on-line
  servers
• Involves smart cards (used by Health
  Professionals and Patients), computers (used by
  Health Professionals, Hospitals, Health Insurance
  Funds), large networks, and Security
  architectures including data encryption
• France, Germany, Italy and the Province of Québec

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Technology

• Cards with cryptographic capabilities
• 32 bit computer chips on cards
• Decreasing costs of biometrics fingerprint
  readers
• Combination cards with contact and contactless
  communications
• Reader Infrastructure
• Large software vendors like Microsoft are
  delivering software, APIs and now a card
  operating system to support smart cards

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Interoperability

• Interoperability will make it easier to deliver
  smart card solutions
• G-8 technical interoperability specification is
  being used in Healthcare (CardLink)
• Application - EMV, GSM, SET
• On the Workstation - PC/SC Specification and the
  OpenCard Framework
• On card - Java Card, MULTOS and Microsoft Card
  Operating System (6/99)
• Hardware level - ISO 7816

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What is the VA doing?
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The Department of Veterans Affairs

• 27 Million Veterans and 43 Million dependents
• Nearly one-third of the nations population are
  potentially eligible for VA benefits, includes
  dependents
• Second largest of the 14 Cabinet departments
• Facilities in all 50 states, Washington D.C.,
  Puerto Rico and the Philippines
• Nations largest medical system with 159
  hospitals, 129 nursing homes, 35 domiciliaries
  and 362 outpatient clinics
• 58 regional Benefit offices providing monetary,
  disability, pension, educational and vocational
  rehabilitation benefits
• 13 million home loans, and the nations largest
  insurance programs
• 114 national cemeteries

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Functions of VAs Public Domain Integrated
Hospital Information System (VistA / DHCP)

• Clinical and Administrative Support
• Clinical Results Reporting
• Order Processing
• Patients Medical Record
• Accounting and National Reporting
• Medical Care Cost Recovery
• Integrated Medical Images at pilot sites
• 60 Applications
• National Electronic Network for inter facility
  Communication

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Department of Veterans Affairs - Patient Card
Upgrade

• Rollout began in Dec 1996, finished in April
  1997, Planning began in Dec 1993
• Upgrade cards from simple plastic embossed card
• New cards have printed and embossed
  information, magnetic stripe, bar code, black and
  white picture
• Function as identifier and carrier of small
  amount of information
• Speeds patient look-up on medical information
  system, allows mini registration
• Personalized at facility, 2.5 million cards first
  year
• magnetic stripe - date of birth, period of
  service and service related disabilities
• Enhancements are planned

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The Veteran ID Card

• Photo Image
• SC Indicator
• Barcode
• Embossed Info
• Name
• SSN, DOB
• MAG Stripe
• 1-800 Number

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Department of Veterans Affairs - Home Health
Care Initiative- Design Stage

• Store commonly needed data on card to improve
  communications between different home health care
  providers
• Always available to home health care provider
• Also to be used at Emergency rooms and health
  care providers offices
• Use of portable devices to read and update
  patient card
• Begin Summer of 1999

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Department of Veterans Affairs - Lab Test of New
Technology

• Microsoft Windows Card Operating System (Beta
  now, projected release in June 1999)
• Workstation Development Tools
• ActiveX for Healthcare to transfer data
  bi-directionally between chip and VA VistA
  Medical Information System
• Shown at HIMSS in February 1999 in DataCard booth
  and CardTech 99 in May 1999 in DataCard and
  Microsoft booth

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Department of Veterans Affairs - Pilot of Secure
Access from Internet

• Strong Authentication with smart card to control
  access from Internet to selected VA networked
  Resources
• Levels of Control by person, by target resource
  (system, directory, file or URL), and by protocol
• Pilot began in May 1998
• 60 users for telnet and web access
• FTP and Exchange delayed
• Plans to migrate to system that uses PKI
• Support and coordination problems

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VA PKI Pilot

• Established VA wide project to investigate and
  implement VA PKI
• Steering Committee to advise project
• Participate on Federal PKI Steering Committee
• Drafting Decision documents and policy
• Initial Capabilities Demonstration
• Issuing VA Branded public keys / certificate
• testing secure electronic mail
• demonstration of PKI based access control
• demonstration of digitally signed forms and data
• supporting pilots

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VA Electronic Purse

• Department of Veterans Affairs,
• U.S. Treasury, Nations Bank and Visa began an
  electronic purse pilot with smart cards
• Announced Phase 1 on Oct 20, 1997 at the Bronx
  Veterans Affairs Medical Center located in New
  York City
• Announced Phase 2 on Nov 24, 1997 at the Tampa
  Florida Veterans Affairs Medical Center
• 25,000 cards will be issued at Bronx and 23,000
  in Tampa
• Used by staff and patients

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VA Electronic Purse

• Visa Cash in the hands of patients,
• physicians, visitors, volunteers and employees
• test numerous applications including
• combining identification badge and electronic
  purse
• vending machine acceptance
• integrated cash registers and terminals
• reloadable cards and
• cashless ATMs that transfer cash value onto
  reloadable cards, rather than distribute currency

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VA Electronic Purse

• At the Bronx site,
• up to 4,000 reloadable cards used as
  identification badges.
• Approximately 10,000 cards issued for meal
  tickets, and
• 1,000 for personal patient checking accounts.
• The Tampa pilot also has a special purpose card
  to be distributed by Veterans organizations for
  special events hosted at the medical center
  throughout the year

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Department of Veterans Affairs - VA / DoD
Multi-application Initiative- Planning Stage

• Reviewing Technical Interoperability Standards
• Reviewing Medical Emergency Data Standards
• Multi-application card
• Healthcare Functions - Identification of patient,
  data sharing and possibly electronic purse
• Select Site
• Select potential applications (registration,
  emergency, contract provider, access, finance)
• Select data fields (ID, Administration,
  Emergency, provider, treatment locations, keys
  and cash)
• Initiate Pilot in Summer or Fall of 1999

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Summary

• National patient projects in Europe Germany,
  France, with plans in Spain, Italy and Quebec
• National Initiative for Health Care Provider Card
  in France
• Opportunities in administrative simplification,
  data transfer, improved security/ privacy, data
  access
• Multiple Chip Cards pilots in US HPP, Secure
  Telemedicine, Oklahoma, DoD MARC
• The use of chip cards are gradually becoming more
  common in North America
• Secure access and communications - NETLINK
• Next - Patient uses keys of smart card to control
  access to their record

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G-8 Healthcare Data Card Panel- Overview of
their projects and how G-8 participation helps or
hurts their project- Questions

• Juergen Sembritzki - Germany
• Julie Kresge- USA
• Masuyoshi Yachida - Japan
• Jacque Sauret - France
• Ravi Raman - USA
• Denis Morency - Quebec
• Philippe Bedere - France
• Dan Maloney - USA