Give me your card

Technology allows quick access to records

A pregnant woman walks into the emergency department complaining of bleeding. Triage staff ask what her blood type is, but the patient doesn’t know. A nurse can take a blood sample — or she can ask for the patient’s smart card and immediately look up the women’s medical records.

Washington University School of Medicine in St. Louis recently began a pilot study to see how effective the use of smart cards can be in the treatment of pregnant women. The smart cards look like conventional credit cards and contain microchips that provide access to the medical information, which is stored on a Web server.

The study began last December and will involve 250 pregnant women. The project will end after all the women complete their pregnancies. Half of these women will receive a smart card that will be used to access their records during visits to the hospital’s obstetrics clinic. The other half will be "control subjects" and have their paper records accessed the traditional way. All patients will receive the same level of care at the facility.

The study aims to measure several things, says study leader Gilad A. Gross, MD, assistant professor of obstetrics and gynecology at Washington University School of Medicine and director of obstetrics at Barnes-Jewish Hospital in St. Louis.

"When the women come to the hospital, we measure time that they actually spend in the hospital — card vs. no card," he says. Staff also measure how much time it takes to develop a patient disposition, how much time it takes for patients to be admitted if necessary, and whether the cards are preventing redundant labs, X-rays, and ultrasound tests.

Patients are enthusiastic

The study is funded by a benefactor in St. Louis who is interested in card technology. "He wanted to know if we could apply it to the medical field," Gross says. "We felt that pregnant patients would be perfect for this because their charts grow every week, and different things are added and subtracted. We decided to try and make it work using the new technology over the Internet."

Since the study began, Gross and his staff have randomly approached 156 pregnant women who plan to deliver at Barnes-Jewish Hospital. "About everyone accepts enthusiastically," Gross says. "It’s a nice concept for them. We’ve only had two people say no for religious reasons."

The study uses two types of cards. The patient card contains vital data. "You put the card in the computer and a screen comes up with the information just related to the patient." The physician then puts in his or her card, and the system goes to a Web server over the Internet where the database is stored. The Web server is maintained by Site-C, an Internet developer company in St. Louis.

The database holds patient information such as medications, medical problems, insurance coverage, and lab results. Information about hundreds of thousands of patients can be kept there, Gross says.

"We wanted to be able to develop a good electronic chart," he explains. "Many now are limited by the amount of space and the speed in which you can access it. We felt that this technology was a way to cut through all those problems."

Each time a patient visits the clinic, information is keyed into the system by a data entry employee. "It’s put on paper first," Gross says. "In the future, maybe it won’t be."

To maintain standards of care, the hospital still uses the patient’s paper chart during the pilot study. "No one is being sent home until the paper chart is seen."

No more waiting for admissions

Hospital staff do not wait for the paper records, however, when the patients are admitted. "The time it takes to access the information in the [electronic] chart is seconds compared to the hours that are sometimes spent waiting for paper charts," he says.

"When patients are admitted, [staff] aren’t as afraid to not wait for the paper chart. They know people are still going to be in the facility." He anticipates tremendous time savings when the electronic system is used when the patients leave the hospital, too.

The electronic records also contain links to any diseases that are in the patient’s chart. Selecting the links will take physicians to information pages on the Web. "The chart is not only just a chart; it’s a tool, like a medical encyclopedia," Gross says.

Security always is a concern with medical records, but Gross and his staff built measures into the system to ensure security. "First, you need a card to get into the system," he explains. "Second, every card is password protected."

Each smart card has different levels of security. Gross can enter the system and make changes, whereas other people have read-access only. "You can’t go into the chart, make a change, or print anything without me or the systems operator knowing it," he says. "Everything is archived and tracked, and all changes are recorded."

So far, the pilot study has recorded 91 visits to the hospital and 12 deliveries. Preliminary data show that patients using the smart cards spend about an hour less being admitted.

The next step is for the study is to expand outside the pregnant patient group and into pediatrics and then female well-patients. "Then we can try to apply it to the entire patient population," Gross says.

In the future, patients also may be able to travel with their medical information on a card in their pocket. As the system is set up now, other providers must have a card reader and authorization to enter the system.

The study has generated a lot of interest, Gross says. "The minute I show the cards to someone, they’re sold. It’s such a wonderful record."

(Editor’s note: A survey conducted for the Smart Card Forum, a Washington, DC-based multi-industry trade group, found that three-quarters of respondents showed interest in the smart card concept. A significant number of respondents said they would want to use the cards for functions including bank access and ATM services, to carry a record of driver and health insurance information, and as credit cards. They would be willing to pay up to $50 for the card itself and a $25 annual fee.

In general, the survey showed that potential smart card users are younger, have higher incomes, and own a PC, the classic profile of the early technology adopter.)