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

paul.contino@mountsinai.org(212) 659-1429

The HealthSmart Network