Subject: Get Ready for `Smart Cards' in Health Care Date: Published: 5/3/93 (120 lines) Source: Wall Street Journal. Copyright Dow Jones & Co. Inc. Technology -- Information Age: Get Ready for `Smart Cards' in Health Care ---- By William M. Bulkeley Michael Kaye, a surgeon in Stillwater, Minn., used to go crazy trying to assemble complete records on his heart and lung transplant patients. But six months ago, he started equipping patients with free optical cards that hold their entire medical histories, including angiograms. Now, when a patient sees Dr. Kaye for a follow-up, "individuals can generate their own charts. A great deal of time and money can be saved by avoiding the duplication of tests," says Dr. Kaye, who helped develop the system with Summit Medical Systems that used equipment donated by Canon Inc. Dr. Kaye's system may presage the key role "smart cards" will play under the national health care system envisioned by the Clinton administration. During the campaign, candidate Clinton said, "Everyone will carry a smart card, encoded with his or her personal medical information." Such a card could authorize payments and hold medical histories, contributing to fairness, efficiency and quality in health care. But to some people, this vision of the future looks like a nightmare: a national identification card that holds your key personal information. Moreover, cardholders might not want any medical staffer to see all of their medical history. An AIDS patient might fear that a dental assistant who saw the record might refuse to help in oral surgery. An emergency patient mightn't want an admissions clerk in a Catholic hospital to see that she had had three abortions. Privacy advocates worry that medical data also could be obtained by employers, insurers, government workers and marketers. Privacy expert Mary Culnan, associate professor at Georgetown University's business school, is especially concerned that if the card is tied to the individual's social security number, "the question is, can all the medical information be merged with other stuff?" Groups including Computer Professionals for Social Responsibility and the American Civil Liberties Union have written to Hillary Rodham Clinton urging that privacy restrictions be designed for cards. Proponents claim protections can be built in to ensure privacy. Right now, health planners around the world are considering two different types of cards, smart and optical cards. Smart cards with a microprocessor and memory chips currently hold the equivalent of 30 pages of data -- not enough for an X-ray, for example. The cards cost $10 to $50; they can be secured so that a user has to give a password, a fingerprint or voice print to open up the contents; and the reader that displays the contents on a screen costs just $100. Optical cards use the same type of technology as a compact disk for music or data, but look like silvery credit cards. An optical card now holds about 2,000 pages of data. There's enough space to hold a number of digital images, such as ultrasound pictures of a fetus, electrocardiograms or even a low-resolution chest X-ray. The cards cost about $5 to $20 each, but the systems that display the information and record new data added by a doctor or druggist cost $3,000 -- a big expense when spread through the medical system. Still, because they can cram so much information into so little space, optical cards may be attractive to consumers. Donald Specht, president of Argenta Systems Inc., which is installing optical library-card systems in Ontario, predicts that many patrons will pay $15 to store a lot of personal information on their library cards, such as images of birth certificates, insurance policies and other documents. The most popular card technology in the U. S. is that used on most credit cards, a magnetic stripe that holds just half a page of data. It costs less than $1 and the reader costs about $400. America has been slow to embrace smart cards because of the installed base of magnetic stripe readers and an abundance of phone lines for retailers to use to check on cards. In many countries where phone lines are scarce, merchants prefer smart cards, because they carry their own spending limits and can be shown to be valid when the owner keys in a personal ID number. Stephan Seidman, editor of Smart Card Monthly, a newsletter based in Montara, Calif., doesn't worry about unwanted readers looking at data on a chip-based card, because "nobody has ever penetrated a smart card." Optical-card advocates say that optical data could be encrypted or a chip could be added to the card to control access. In France, where the smart card was invented and is used for pay phones and bank cards, medical insurers are experimenting with a number of different smart cards for patients. The government is starting to distribute practitioners' cards to 1.3 million doctors, medical technicians and pharmacists that would allow each to read any patient's medical cardbut only sections applicable to the professionals, says Elsbeth Monod of the French Ministere des Affaires Sociales, who recently spoke at the CardTech industry show in Arlington, Va. Pharmacists, for example, could see current prescriptions but not diagnoses. Congress's Office of Technology Assessment is currently studying the French system. One way to balance efficiency and privacy is to require people to carry a smart card with administrative information. Patients could then volunteer to carry a more comprehensive optical card, especially if they have medical conditions such as pregnancy or organ transplants where follow-up reporting is valuable. Recently, Germany launched a national health card program with administrative data only. In the future, a second card with health information will be added. American Telephone & Telegraph Co. 's smart card unit is demonstrating a multipurpose card that could be used for various functions, including automatically filling in medical insurance forms. "The plan is for it to be a records locator" that could speed-dial insurance carriers or other doctors to authorize procedures, says Diane R. Wetherington, president of AT&T's Smart Cards Systems and Solutions division. "You should always be able to see everything that's in your card, and nobody should be forced to carry information he doesn't want to," adds Ms. Wetherington. The Pentagon also is looking at the benefits of putting extensive records on smart cards as a replacement for the traditional dog tags. Besides medical information, they could include service and family data. But that poses risks. Michael Noll, of the office of the secretary of defense, says, "To send something like that with a pilot who may have to bail out over Baghdad would be a mistake." [This article is made available here by Dow Jones Co. for the personal and non-commercial use of callers to this bbs, in the hope that it will be of some help to those who are suffering from the disease and others who are seeking to help them.]