The HealthSmart NetworkCreating a Regional Health Network using Smart Cards
Paul ContinoVice PresidentInformation TechnologyMount Sinai Medical Center
2006 Annual ConferenceOctober 5th, 2006
The Pulse of New York City Healthcare
• High density urban population• Highly competitive healthcare marketplace• Hospitals are in debit and losing money• NY has nations greatest income and
health disparities between rich and poor• NY has some of the finest medical
institutions in the US
Mount Sinai Medical Center
• Founded in 1852, The Mount Sinai Hospital is one of the country's oldest and largest voluntary teaching hospitals.
• Mount Sinai is internationally acclaimed for excellence in clinical care, education, and scientific research in nearly every aspect of medicine.
• Mount Sinai's 1,171-bed tertiary-care teaching hospital with a medical staff of nearly 1,800 provides physicians who deliver the most advanced and compassionate inpatient and outpatient care.
• Located at 98th Street and Madison Avenue, The Mount Sinai Hospital serves Manhattan's Upper East Side and Harlem
Mount Sinai – Affiliate Network
Affiliated HospitalsThe Bronx Veteran's Affairs Medical CenterCabrini Medical CenterElmhurst Hospital CenterEnglewood Hospital and Medical CenterThe Liberty HealthCare System, Inc.- Greenville Hospital- Jersey City Medical Center- Meadowlands Hospital Medical CenterMaimonides Medical CenterThe Mount Sinai Hospital of Queens North General HospitalPhelps Memorial Hospital CenterQueens Hospital CenterSt. Joseph's Hospital and Medical Center
Physician PracticesMount Kisco Medical GroupNorth Shore Medical Group
LTC Facilities / Nursing HomesArden Hill Life Care CenterCabrini Center for Nursing & RehabSarah R. Neuman Nursing HomeThe Jewish Home & Hospital
Strategic AlliancesSaint Barnabas Health Care Network-NJNorth Shore / LIJ Health System
Our Vision ...
• Develop a Regional Health Network using smart cards
• Leverage our large affiliate network • Easily and accurately identify patients at
points of care• Allow providers the ability to track patients
through a course of treatment that crosses multiple organizations and be able to access extensive medical record data
• Share patient data between systems or between providers without server and network connections
How we got started?
• Successful Smart Card pilot at Elmhurst Hospital in 2003
• Mount Sinai wanted to expand upon conceptual design
• Mount Sinai and Elmhurst Hospital partnered with Siemens to develop the Personal Health Card system
• Mount Sinai forms the HealthSmartNetwork
Concept for a Regional Health Network
Mount Sinai and HHC both have a large network of facilities and affiliated health systems that can be linked together to form the “seed” for a regional health network.
The network would be open to all providers as long as card interoperability is maintained. The network concept can be easily replicated and could quickly expand to a multi-state and potentially a national level, in much the same way that ATM cash networks (Most, Cirrus, Plus, NYCE) grew in the late 1970’s and early 1980’s.
The patient with their smart card becomes the network
The HealthSmart Network - Pilot
EnglewoodSt. John’s Riverside
North General
Settlement Health
Elmhurst
QueensMount SinaiQueens
MountSinai
Jersey CityCabrini
What is the Personal Health Card?
• A secure smart card that contains your critical health care information: current medications, allergies, recent laboratory test results, EKG, blood type, recent medical encounters and insurance/demographic information
• Allows medical providers the ability to track patients through a course of care that spans multiple organizations
• Identifies and authenticates the patient and provides for improved registration and insurance processing
• Provided the patient with control of their medical data• Delivers a scalable Portable Health Record
Development of the Personal Health Card
The New System • Allows multiple healthcare providers to share
patient information on the same card.• Allows an institution to easily interface its clinical
and registration systems via HL7 standards• Has advanced security and identity management• Has image storage capability (EKG) • Can configure data as permanent or temporal• Configurable roll-off logic controls data retention• Data structure conforms to emerging CCR
standard
Local Benefits and Business Case
• Reduce medical errors and adverse events• Reduce medical records maintenance costs
(duplicate/commingled)• Reduce registration time for patients• Accelerate clinical information availability in
emergency care• Increase awareness of providers brand in and
out of their service area. • Strengthen voluntary physician relationship
Personal Health Card - features
Bar Code
Magnetic Stripe
IdentificationPhoto
Printed / EmbossedPatient Information
64K MPUMemory Chip
FRONT
Corporate Logos / Sponsor Branding
BACK
Personal Health Card – what’s on the chip
Compressed EKG Image
Patient Identification& Demographics
Name: Smith, JohnSex: MaleDOB: 11-18-1942Address: 23 East 92nd Street
New York, NY 10029Home Tel: (212) 245-3455Work Tel: (212) 826-1212 Ext 2332Insurance: Oxford [Policy No. 2134323]Emergency Contacts:Ellen Smith, Wife (212)-226-1232
Current Medications& Allergies
Medications:Coreg (12.5mg) 2xDailyAccupril (40mg) 1xDailyGlucovance (500/5) 2xDaily Humulin 70/30 25-30 units as needed
Allergies: Type:Penicillin DrugPeanut (severe) FoodLatex Environ
Recent Laboratory Results
Glucose 190 (70 – 110) mg/dL 4-2-2006Glucose 150 (70 – 110) mg/dL 4-16-2006Glucose 130 (70 – 110) mg/dL 4-20-2006PSA 5 (0 – 4) ng/mL 1-23-2005
Medical Summary & Problem List
Recent Healthcare Encounters
Pointers to Remote / Off-Card Data
Personal Health Card – how it works
Electronic Data SourcesSmart Card Card Management
System (CMS)
Personalization:Photo,Printing,Data Encoding
Support for:- HL7- Flat File (Batch)- Database Query
Clinical / Lab Systems
Electronic Medical Records
Hospital Admitting System (ADT)
Manual Data Entry Demographics,MRN
Card Viewer (CV) Card Editor (CE) Data ImportEngine
Smart Card Database Repository of incoming clinical data
Important Considerations
• Health Card is not intended to be a complete EMR• Data model is focused on elements that would be valuable
to critical care• No attempt was made to standardize data across
institutions – “as is” presentation• Limited storage on the card (64K), roll-off logic for card
data• Treat the Patient - Not the Card
• Interoperability by Design – if you use the PHC then you are part of the network
There Are Benefits To All Stakeholders
Patient• Secure and portable health record• Control of record access• Easier and faster registration• Improved and faster treatment and
medical care• Positive identification of patient for
treatment and billing• May accelerates treatment in the
case of emergency
Health Care Provider• Instant patient identification - accurately links
patients to institutional medical records, and helps to eliiminate duplicate or commingled records
• Delivers quicker care for patients in Emergency Care setting, rapid accessibility of patient medical history
• Potential to reduces adverse events and medical errors due to lack of patient information
• Delivers quick access to key medical record data – without significant IT infrastructure investment
• Tracks patients through a course of treatment that crosses multiple organizations
• Reduces unnecessary / duplicate diagnostic tests or procedures by showing results from other medical providers
Payor• Verifies eligibility and plan information• Reduce medical fraud• Reduce claim denials• Formulary compliance• Immediate adjudication at point of care• Can be used as eligibility/debit card for
Personal Health Savings Accounts (HSA)
Advantages of Smart Cards in Healthcare
• Provides a wide range of benefits across the spectrum of stakeholders (patient - provider - payor)
• Proven technology solution (used as part of national health programs in Italy, France, Germany)
• Provide a secure means of authenticating a patient and providing access to medical information
• Can support multi-function/multi-application needs (health record, health benefit savings account, insurance verification all on one card)
• Can provide a low-cost approach to achieving a regional and potentially a national health infrastructure
• Can become the secure key into the national health infrastructure once it is developed.
• Puts the patient in control of his/her medical information
Extended Uses of Health Cards
First Responders:Emergency / Disaster Situations
Secure ElectronicPrescriptions
Health SavingsAccounts (HSA)
Disease / Case ManagementPrograms
Nursing Homes /Long Term CareFacilities
RHIOsNational Health Infrastructure (NHIN)
What about RHIOs and NHIN?
• See smart card technology as collaborative not competitive
• Smart cards are available now• Proven, scalable technology• Costs of RHIO’s and NHIN are prohibitive• May provide solution to security and
identity issues• Smart cards make initiatives more
consumer-friendly
The HealthSmart Network
Achieves the Vision . . . .
Improving Patient CareLowering Medical CostsEmpowering Patients
Questions and Answers
Paul ContinoVice President, Information Technology
Mount Sinai Medical CenterNew York, NY
[email protected](212) 659-1429
The HealthSmart Network