Card Technology in Healthcare in U.S.A.

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Card Technology in Healthcare in U.S.A.

• 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

• Overview of Healthcare Card Projects in the US
• What is the VA doing?
• Major Influencing Events
• Future Vision

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Western Governors Association Health Passport
Project

• Objectives Improve Delivery of Benefits
• Lower Administrative Barriers to Care, and
• Improve Data sharing Between Programs
• RFP for system with 25,000 cards awarded in June
  97
• Phased launch began in May 1999
• Locations - Nevada, North Dakota, Wyoming
• Preventative Health Care Programs
• Womens Infant and Children (WIC)
• Medicaid Eligibility (EPSDT)
• Immunizations
• Head Start
• Maternal and Child Health
• URL http//www.westgov.org/hpp

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Secure Collaborative Telemedicine Over Public
Networks

• West Virginia University in Morgantown, West
  Virginia under NLM Grant
• Secure and private Telemedicine involves policy,
  administration, regulation and technology systems
• Building on standards including G-8 1996
• Health professional cards are required for use of
  secure Telemedicine applications
• Includes role-based information access to data on
  patient cards
• Emergency room physicians will have web based
  access to their patients electronic medical
  records
• Authentication based on Digital Certificates
  (PKI)
• URL http//www.cerc.wvu.edu/nlm/telemedicine.html

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Department of Defense

• Navy deploying smart cards
• DoD decision to convert ID card to smart card
  with PKI as a function (Nov 10 1999 memo)
• MARC
• Multifunction and Multitechnology card
• Testing in Hawaii and used for deployment
• 50,000 cards in use
• Smart Card, bar code, magnetic stripe, picture,
  signature block and embossed characters
• Non Medical Functions include manifesting and
  deployment, food services and security
• Medical Information includes Identification,
  Emergency Data, Blood Type, Immunizations,
  Allergies and Registration
• DoD defining applications and planning the next
  generation of MARC
• Highly successful program

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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 Healthcare
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 in late 1999

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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, web access, FTP, Exchange
  mail, pcAnywhere, Citrix
• Some users from other government agencies and
  business partners
• Plans to migrate to system that uses PKI

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

• Lab prototype of G-8 /Netlink compatible card
• Reviewing Technical Interoperability Standards
• Reviewing Medical Emergency Data Standards
• Building interoperability prototype
• Campus style multi-application card
• Healthcare Functions - Identification of patient,
  data sharing and possibly electronic cash
• Site Selected is Hawaii
• Select potential applications (registration,
  emergency, contract provider, access, finance)
• Select data fields (ID, Administration,
  Emergency, provider, treatment locations, keys
  and cash)
• Initiate Pilot in of 2000

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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 certificate based access control
• demonstration of digitally signed forms and data
• supporting pilots

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Influencing Events

• The Web
• HIPAA Act
• Microsoft support of smart cards
• American Express Blue Card - the first nationally
  available credit card with a computer chip
• Washington Metro rechargeable chip card

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Influencing Events

• Health Insurance Portability and Accountability
  Act of 1996 (PL 104-191) - HIPAA (URL
  http//aspe.os.dhhs.gov/admnsimp/)
• HHS responsible for identifying or developing
  EDI, privacy and security standards
• Standards Groups have accelerated activities
• Privacy Guidelines - HHS published new Heath
  Information Privacy Regulation as mandated by
  HIPAA. The industry has 60 days in which to
  comment.
• Health Care Financing Administration - HCFA
  Internet Policy (URL http//www.hcfa.gov/ )
• National Research Council report For the Record
  Protecting Electronic Health Information - March
  5, 1997
• password or PIN in conjunction with a token
• U.S. General Services Administration (GSA)
  Government wide contract for cards and card
  Services from the GSA Smartcard technology
  program (URL http//smart.gov/ )

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Influencing Events

• Digital Signature
• Government Paperwork Elimination Act (GPEA) (URL
  http//www.whitehouse.gov/OMB/fedreg/gpea.html )
• electronic business transactions
• electronic signature
• State digital signature legislation

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Influencing Events

• PKI
• Federal PKI Steering Committee (URL
  http//www.gits-sec.treas.gov/oofpkisteer.htm )
• Tunitas Groups Healthcare PKI Project - (URL
  http//www.tunitas.com/pages/PKI/pki.htm )
• Connecticut Hospital Association - CHA (URL
  http//www.chime.org/ )
• American Society for Testing and Materials (ASTM)
  E31.20 Healthcare PKI (URL http//www.astm.org/)
• E31.17 Privacy, Confidentiality and Access
• E31.20 Data and System Security for Health
  Information
• GSA ACES contract (URL http//www.gsa.gov/aces/ )

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