Smart card’ streamlines care of pregnant women

Records available almost instantly

A pregnant woman walks into the emergency department complaining of bleeding. Triage staff ask what her blood type is, but she 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 patient’s medical records.

Washington University School of Medicine in St. Louis has begun a pilot study to see how effective the use of smart cards can be in the treatment of pregnant women. The 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 Dec. 1, 1998, and will involve 250 pregnant women by the time it is completed. Half of those 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" whose paper records will be accessed the traditional way. All patients will receive the same level of care at the facility.

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

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," he 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 development 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. 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, a data entry employee keys information into the system. "It’s put on paper first," Gross says. "In the future, maybe it won’t be."

To comply with 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."

Hospital staff are not waiting on the paper records when the patients are admitted, though. "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, people 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 timesavings when the system is used for patients leaving the hospital, as well.

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

Security measures built in

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

Each smart card has different levels of security. Gross can enter the system and make changes, whereas other staff 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 in the admissions process.

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

In the future, patients 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."