HealthMeans eNvision Smart Card Solutions

See HealthMeans featured in the February 2006 issue of Health Data Management!

Texas Considers Health Insurance Smart Cards - 05/01/07 Statesman

Will 2007 be "Year of the smart card?" - 01/03/07 Healthcare Finance News

Best Practices: Rural Health Care Communities Connect with Smart Card - 11/06 - 12/06 Texas Hospitals

Use of smart card technology puts Texas system on the cutting edge - 09/06 Hospital Acces Management

Smart Cards may Combat Health Care Problems - 02/09/06

Are Cards Finally a Good Bet? - 02/09/06 Health Data Management

Smart Card Applications in the U.S. Healthcare Industry - 02/06 Smart Card Alliance

Danbury Hospital Optimizes Technology Investments with IBM Diagnostic Study

From Emergency First Responders to Healthcare Professionals, Smart Cards Establish Trust, Secure IT Systems and Increase Efficiency - 10/13/2005 Market Wire

Card Sharks - 04/2005 Health Executive

Clinton, Frist Tout Medical Records Bill - 06/16/2005 Associated Press

Smart Card Alliance Forms Healthcare Council to Address Rising Use of Smart Cards in Health Industries - 06/29/2005 Smart Card Alliance

Hospitals Looks To Smart Cards, Prox Cards And Biometrics For HIPAA - 04/16/2003 ID Newswire

Texas Considers Health Insurance Smart Cards - 05/01/07 Statesman

By Corrie MacLaggan, American-Statesman Staff

Bill Would Start Pilot Program

Figuring out what a health insurance plan covers can be tricky even for the kind of patients who like to read fine print. For some, it's not until the bill arrives that they get an answer to what was — or was not — covered.

That's why Texas is considering requiring health insurance companies to electronically embed coverage information into insurance cards. With the swipe of the card at a doctor's office or hospital, the health care provider and patient would get real-time information such as what the co-payment is, whether the deductible has been met, which providers are in network and which procedures are covered.

"I'm a physician. I can't even tell you what my own insurance covers," Corpus Christi ophthalmologist Jerry Hunsaker told a House committee considering the so-called smart card legislation last month.

The House last week overwhelmingly approved a bill by Rep. Beverly Woolley, R-Houston, which would establish a pilot program in a to-be-determined part of the state. The measure now goes to the Senate.

Austinite Jeannie Rollo said the proposal sounds like a good idea. While in Lampasas in December, she fell and broke her leg. She had no idea whether the doctors treating her at the hospital there were in her network.

"At that moment, I was in no condition to pick up my phone and call the insurance company about what kind of coverage I had," said Rollo, executive director of the Lawyer Referral Service of Central Texas.

The insurance company ended up paying the bill, she said.

Others aren't so lucky, said Susan Strate, a Wichita Falls pathologist who is also chairmanof the Texas Medical Association's council on socioeconomics.

Sometimes, she said, "the procedure is finished, the care has already been given, and the patient is thinking that their out-of-pocket expenses are X. But it turns out to actually be X plus Y."

Strate said that having clear information in advance would help doctors better counsel patients on the most affordable and effective treatments available to them.

Woolley said her bill would cut down on administrative costs and reduce errors.

She said she got the idea from a constituent who pointed out that health insurance cards could have embedded information much like Texas driver's licenses do.

Some health plans already embed patient information into insurance cards. They are not required to do so in Texas.

The Texas Association of Health Plans supports the bill, executive director Jared Wolfe said. He said having the information up front could help prevent payment disagreements between health plans and health providers after a procedure.

Woolley's bill does not specify the technology that would be used to put the information in the cards.

Will 2007 be "Year of the smart card?" - 01/03/07 Healthcare Finance News

By Jack Beaudoin, Editorial Director

( GREENWOOD VILLAGE , CO ) If 2006 was the year consumer directed health plans began to pick up steam, 2007 may be the year that all-in-one "smart" cards, designed to automate the payment process, grab the public spotlight.

Such cards promise to eliminate the revenue cycle management woes of healthcare providers, eliminate much of the manual claims verification for payers and simplify the medical financial management for consumers.

"The use of smart cards in healthcare is gaining momentum," said Randy Vanderhoof, executive director of the SmartCard Alliance, upon the release of a 2006 white paper on the topic. "In the long run, the data carried by smart health cards can not only save lives, but can also save the healthcare industry billions of dollars."

But to make good on those promises, these cards will have to bevery smart. One example: Given the burgeoning popularity of flexible savings accounts, health reimbursement accounts, medical spending accounts and health savings accounts, new consumer directed healthcare plans and the multiplicity of benefits attached to standard products, conforming to IRS autosubstantiation rules will be complex.

Cards will also have to facilitate eligibility verification, conformity with a range of benefit levels, oftentimes among multiple payers, and actually draw down from HSAs or other consumer accounts.

Those in the industry maintain that most of the technical hurdles have already been solved.

"Payment at the point of care," says Robyn Bartlett, president of First Data's healthcare services, "is not a problem of technology, but a problem of [current] healthcare markets and change management."

Industry analysts agree. Keith Campbell, speaking on behalf of First Consulting Group (no relation to First Data), said thanks to empowered consumers, "providers must adjust their methods of working with health plans and patients, change management techniques in accounts receivable, and pay closer attention to what competing providers are doing to attract new patients and keep current patients satisfied."

Bartlett says the company's expertise in other vertical markets - First Data has been providing payment processing services for more than three decades - has positioned it to bring new automation to healthcare. But healthcare's admittedly quirky third-party payer structure and regulatory environment have so far limited its application.

"Since consumer directed health plans are at the beginning of the growth curve, there's not a lot of adoption - yet," Bartlett said. But as CDHP enrollment rises, consumers and providers will begin to clamor for real-time eligibility verification, claims adjudication and debit accounts.

"This is going to happen one step at a time," Bartlett predicts.

A recent report from DiamondCluster gave a hint of the market forces that may drive demand for healthcare financial smartcards. It found that over the last two years, HSA custodians have opened more than 1 million accounts, and the number is increasing by more than 50,000 accounts each month.

"By 2010, we expect 15-25 million HSA accounts holding $75 billion in assets," the report concludes.

Empowering millions of patients to participate in a payment system that is already criticized for long delays and complex rules will require consumer-friendly automation, Bartlett said, which is why First Data is investing heavily in healthcare.

Best Practices: Rural Health Care Communities Connect with Smart Card - 11/06 - 12/06 Texas Hospitals

By Melissa Gaskill

Electronic or smart cards have made many of today's transactions simpler and faster.Use a quick swipe of a card to pay for everything from gas to groceries, open doors to secure areas, reserve seats at a concert, check a bank balance, and more.

The same technology makes it possible for health care facilities to gather and share data, providing a means to measure and improve outcomes. It can make the admissions process more efficient, eliminating delays, reducing paperwork errors and providing instant access to accurate patient data.

The Southeast Texas Hospital System has launched a smart card project to connect its six rural hospitals, associated referring physicians, clinics and ancillary providers into a virtually integrated Regional Health Information Organization.

“Originally the focus of this project was to raise the level of technology in the region,” says Shannon S. Calhoun, executive director of STHS. “We wanted the ability to have collective data specifically for rural hospitals, because true evidence-based medicine requires volume, and any one site is not sufficient.” STHS worked for several years acquiring grants and private funding and now is implementing the eNvision Smart Card system from HealthMeans, Inc.

The project includes installation of patient registration and check-in kiosks and distribution of smart cards to patients in the region. This allows for automated registration at each participating facility with a central data center. Physician practices in the STHS network will have access to patient health records and registration web portals.

Four of the hospitals already have implemented automated registration. “A big benefit is that the registration process is much quicker for returning patients,” says Jamie Jacoby, chief financial officer at Memorial Medical Center in Port Lavaca. “Eventually, we should be able to do things like move physician orders from the hospital to the clinic, with drug allergies, medications taken and that sort of thing on the card, too.”

By year end, STHS plans to have seven hospitals and their physicians connected, says Calhoun. Each facility has software and hardware for 5,000 cards. The project eventually will connect 12 rural hospitals to the STHS smart card data center.

It is a large project, says Jacoby, but “the way it was done, a little at a time rather than one big bite, was intelligent. It will work well for us in the long term.”

As Vicki Judd, director of marketing for HMI, points out, “This will be the second largest live health care smart card project in the country to date. It is the first live RHIO relying completely on smart card technology as its backbone.”

The challenge now is interoperability in the industry, something that the Secretary of Health and Human Services and the National Coordinator of Health Information Technology have highlighted as fundamental to the future of the health care system. “Interoperability is having the ability to exchange information, actually getting the information on a card in one place that can be used in another place,” says Calhoun. “It is a huge national issue, and we've worked diligently to address it. The smart card interfaces are specific to each and every site. It is a very customized program.”

Each site still is addressing patient demographics and registration information and interfaces, and is not at a point of sharing clinical information, she adds. “It is important to address the point of issue. There are more than seven hospitals participating, but also physicians and ancillary places like lab and X-ray. Our next step is to connect the physicians and to raise the level of the point of issue and the meaningfulness of the card.”

Another challenge is moving information from existing systems onto the cards. It is done uniquely at each site, Calhoun says, either manually or through an interface. Because people go to their physician more regularly than they go to the hospital, critical mass for the project will occur when the physicians are on board.

“The end value is when we have large numbers of patients carrying the card, and it is trusted both to and from referring providers, and in emergency situations,” Calhoun says. “That gives us the ability to recognize that person's demographics, family history, allergies, medications and so forth. That will be a huge return. Trusted information exchange is good. It eventually will be a requirement.

“The opportunity is here for us to define the parameters of a RHIO for rural facilities and for Texas . It is kind of scary but also fun.”

For more information about the Smart Card and HMI's other services, contact Vicki Judd at 972/488-6633 or visit www.healthmeans.com. HMI is endorsed by HealthShare/THA.

Use of smart card technology puts Texas system on the cutting edge - 09/06 Hospital Access Management

Use of smart card technology puts Texas system on the cutting edge

Project's flexible approach fits needs of rural facilities

Interoperability — how to get one system to talk to another — is one of the hottest topics in health care today, and a challenge that every hospital and health system must face in some fashion, says Shannon Calhoun, executive director for the Southeast Texas Hospital System (STHS), a Goliad-based organization.

An organization's needs and priorities, she adds, will determine exactly how it approaches that challenge. In the case of STHS — which is made up of eight independent hospitals, five of which are rural — the goal is “to create economy of scale and scope, while allowing our hospitals to maintain autonomy,” Calhoun says. “This is not a system that owns a bunch of hospitals, but a group of hospitals that owns a system.”

In rural communities, there typically is not enough patient volume to support the infrastructure required for cutting-edge technology projects, she points out, which is one of the reasons for such collaborations.

“If we can do it better together, then why not?” Calhoun adds. “It doesn't change how each of [the hospitals] operates.”

STHS received a Healthy Communities Access Program (HCAP) grant from the federal Health Resources and Services Administration (HRSA) in late September 2005, she says, which provided an infusion of funding for endeavors that “create through efficiency, quality or access, services for the uninsured and under-insured.”

“It's generally a three-year grant, but we were at the end of the program, so we only got two years,” Calhoun explains. “Then the federal funding didn't pass, so we only got the first-year funding.

“We consolidated and refocused our efforts, and started in January 2006, with an Aug. 31 deadline,” she adds. “So we had eight months to spend [the grant money].”

Among several other HCAP projects, an STHS technology team had looked at creating an electronic medical record (EMR), a smart card, and a data repository, Calhoun says, but time constraints led to the elimination of the EMR project.

“We focused on establishing the foundation of the data repository and initiating and moving forward as much as possible with the smart card project,” she says.

By the end of the funding period, STHS was set to have five hospitals connected through software to a central data repository, to “allow patients to carry a card with a microprocessor chip that will have their personal health summary,” Calhoun says.

“It is a wonderful approach to a win-win for patients, providers, and stakeholders,” she says.

“It's a different win for each, but in all it means better quality and better access.”

The STHS initiative is “the first live RHIO [regional health information organization] completely relying on smart card technology as the RHIO backbone,” notes Vicky Judd, director of marketing for HealthMeans Inc., the vendor that worked with the health care system. “It will be the second-largest live health care smart card project in the country to date.”

The STHS smart card

While there are “a host of things” a smart card can provide — from creating customer loyalty to achieving efficiencies in the registration process — STHS's approach is probably different than that of most organizations, Calhoun says. “Our focus has been that we wanted regional, portable access to patient information.

“We want to have it across multiple hospitals, with a regional community logo that is like a watermark,” she explains. “Our hospitals have a choice of how to interface, how they want it to flow in their process. It's not rigid. It's about automating what you're doing well, and there is also the opportunity to improve through automation what is not working well.”

Each of the STHS hospitals has addressed the question of interoperability differently, Calhoun points out. “There are commercial health information systems and there are proprietary health information systems. One hospital has a programmer in-house who is writing an HL7 interface.”

Another facility is larger and is connected with a national hospital chain, which means it is more difficult to make changes, she notes. “Getting approval for change is a whole lot different for a small hospital that doesn't connect with anybody else. It allows for more flexibility.”

The five hospitals currently participating in the smart card project have health information systems from four different vendors; but even when systems are the same, Calhoun says, “the way they work it in the network is different. Every time is customized, and to interact with a customized program is intensive work.”

The STHS project, she adds, is not about imposing change inside the information technology world of each hospital, but rather allowing each facility the flexibility to maintain its current IT culture, with the type of interface that best serves the automation of the workflow process.

While the STHS smart card will streamline the registration process and automate physician orders and notes, among other improvements, it also has a value outside the four walls of the hospital, Calhoun says. “We have also created a community card that supports a regional data center. It's a community benefit, a regional benefit.”

The card has a watermark — miRHIO — which combines the acronym for regional health information organization with the Spanish word for “my,” she explains, which seemed an appropriate designation for southeastern Texas.

“Because the concept is relatively new,” Calhoun says, “we made the decision to get good proof of concept and build champions before we implement a large marketing campaign.”

Putting it to the test

STHS decided to limit the project to a relatively small number of patients — an initial total of 35,000 cards will be issued among the eight facilities — until “a good comfort level” is attained, she explains. “We're working out interface complications so the hospitals are really comfortable.”

Those 35,000 cards should all be distributed before the end of the year, Calhoun estimates, noting that personnel at the member hospitals are eager to expand that number. “They're asking, ‘What if we want to issue more?'”

Each medical community makes the decision as to whether the cards are issued through physicians, a community clinic, or the hospital, she adds. Some have decided that cards will be distributed after patients walk up to a kiosk in the hospital lobby and sign in, and then are called into a registrar's cubicle to work through getting their information in the card, Calhoun says.

One of those hospitals will start out with cards containing only the patient's demographic and payer information, while at other facilities allergy and medication information also will be included in the initial card.

After that first time, patients checking in at the kiosk will be asked if they need to make any changes to the information, and if the answer is yes, there will be a red flag alerting the registrar to make that change. “The kiosk can be connected to appointment queues or schedulers,” she says.

Typically with that method the patient won't have to fill out any paperwork on subsequent visits, Calhoun adds. At the hospital that decided to put data on the card incrementally, however, the person will need to work on adding allergy and medication information on the second visit.

In the case in which smart cards are being issued through the community clinic, the decision was made to preload patient information already on record onto the card rather than starting with an empty form, Calhoun notes. “We are using IT to do as much of the initial work as possible.”

Associated with that clinic, she says, are about 4,000 patients who are frequent users of the facility.

If a person never goes to a physician or a hospital, there might be a question as to the benefit of having a card, she adds. If that individual has a chronic illness, however, just having that information readily available is a huge plus, Calhoun points out.

“It's a value card,” she says, “The lay people [at the various hospitals] are saying, ‘When do we get our card?'”

Disaster preparedness payoff

STHS hospitals cover seven counties along the Gulf Coast and are surrounded by four major metropolitan areas, Calhoun notes. “If [an STHS] patient goes somewhere and wants a provider outside the system to be able to see the information [on the card], the person can use the card as a key to authenticate access.”

Patients also will have the ability to go on-line and print the information to carry with them if, for instance, they are going to a large hospital to have a treatment or procedure, she says. The person will not be able to touch the clinical information, however, nor will a provider outside the miRHIO system, Calhoun adds.

Issuing smart cards to residents of the hurricane-prone Gulf Coast so their health information could be accessed during an emergency would have a huge potential benefit, she points out. “We're building on that piece. It's hard to limit our focus in order to manage the growth.”

One of the most gratifying things about the smart card project, Calhoun says, has been the opportunity for a group of small, rural hospitals to be on the vanguard of technology with such far-reaching implications.

“Usually, rurals have to find a way to fit into technology that has been created,” she adds. “This way, we can customize it to fit us.”

(Editor's note: Look for more information on how STHS handled the challenges involved in implementing its smart card project in a future issue of Hospital Access Management. Shannon Calhoun can be reached at scalhoun@goliad.net. Information on HealthMeans Inc. is available at www.healthmeans.com.)

OP flow coordinator has unexpected benefits

Patients get closer attention

Adding a coordinator to help regulate the flow of patients to registrars in the outpatient registration area has played an integral role in slashing wait times at the University of Pennsylvania Medical Center-Presbyterian in Philadelphia, says Raina Harrell, CHAM, director, patient access and business operations.

The flow coordinator position — one of seven parts of an action plan aimed at reducing patient wait time — has led to improved communication between registrars and ancillary departments, virtually eliminated lines at the reception desk, and improved the outpatient operation in ways that were not even anticipated, Harrell adds.

“We identified that patients who were in the wrong area or needed to be directed to another area were presenting to the outpatient receptionist,” she explains. “There were others who weren't prepared — who didn't have a referral, didn't have a [physician order], and were not even sure what test they were having performed.”

The access management team determined that a flow coordinator was needed to address those problems and that the position didn't need to be full-time, but should cover the area's busiest times, which are 9 a.m. to 1 p.m. Monday through Friday, Harrell says.

Because the position was filled by an existing registrar — who returns to his registrar duties after 1 p.m. — there was no increase in full-time equivalents (FTEs), she notes.

“We bought a podium so that paperwork wasn't visible to patients, and gave that person the schedules for the day and a ‘zone phone' [for interhospital communications],” Harrell says. “We informed the physician practices and ancillary areas that we had this person, and gave that zone phone number as the point of contact.”

The stated purpose for the new position, she says, was to facilitate communication between central registration and the physician practices so that patients could arrive at their ancillary appointments in a timely fashion.

“Our initial target was to reduce wait time,” Harrell continues. “Instead of a sign saying, ‘Have your referral and your insurance card ready,' there is now a person saying, ‘Do you have your insurance card, your identification, and your [order] for the test you're having? Please have that ready for the registrar.'”

The flow coordinator is able to prescreen patients before they reach the receptionist desk and find out, for example, that a patient is covered by a payer that requires a referral for outpatient tests, and the person does not have the referral in hand, she says.

“If the patient doesn't have a [physician order],” Harrell adds, “the flow coordinator can get on the phone and see if it can be faxed over before the patient sits down with a registrar so there is no delay.”

The receptionist signs in patients and lets registrars know they have arrived, but can't do any investigative work, she notes. That means that before, the first time registrars realized something was missing was when the patient sat down to be registered, Harrell says.

The new position has been of particular help to the high-volume radiology department, she points out. If staff there are looking for a patient who is late, they can call the flow coordinator and ask if the person is in the lobby.

“This became a tremendous benefit for us,” Harrell adds. “If Patient X arrived late and Patient Y was early, we can have a proactive conversation about sending [the one who's ready] to the department.

“In the past, they would have called registration and a registrar would have had to stop registering another patient and answer the phone and figure out if the patient they're asking about is there,” she says.

‘The waiting room was clear'

The registrar, who serves as flow coordinator, happens to be a man, and by his own choice wears a suit to work, which, Harrell says, adds a certain aesthetic quality. “There is a man in a suit out in the lobby, walking around greeting patients.”

After the flow coordinator began doing his job, Harrell discovered an unexpected benefit.

“All of a sudden the waiting room was clear,” she notes. “I didn't know why, but the staff did. Patients used to just sit back down [after registration], rather than going on to their appointments.”

While in some cases these patients might have been waiting for someone to tell them to report to the ancillary department, Harrell says, in other instances it had to do with the penchant many elderly patients have for arriving as much as two hours early for their appointments.

“If they arrive at 7 a.m. for a 9 a.m. appointment, then they do need to sit back down,” she adds. “Then they might forget the time and end up being late.”

Now the flow coordinator is on hand to notice that someone has been sitting too long, and to ask if there is a problem, Harrell says. “The coordinator can also let patients know about delays, and if someone needs a wheelchair, go and get it.”

If a registrar determines that the person he or she has just registered needs an escort to his or her appointment, the flow coordinator also can take a few moments to provide that service, Harrell notes.

The flow coordinator position, which was established in February, was one piece of the initiative aimed at reducing outpatient registration wait time, Harrell explains. That effort, which took place within the fiscal year that ended June 30, also included the following improvements:
• Benchmark wait times of 20 minutes for non-scheduled patients and 15 minutes for scheduled patients were established.
• A “red flag” process was created, whereby someone alerted the rest of the staff if a patient's wait time went over 30 minutes.

In such cases, Harrell notes, additional staff were called in from other areas to assist in registration.
• The target was established of having 100% of scheduled patients preregistered at least 24 hours before their appointment.
• The access department worked with orthopedics — one of the major ancillary areas — to establish proactive communication of insurance information.

Within that patient population, Harrell explains, there is a large number of workers' compensation and automobile accident cases. Delays had resulted, she says, because the only way to verify those kinds of insurance is by telephone.

To prevent those delays, Harrell adds, orthopedic staff now send over the insurance verification information — which they already obtain anyway — along with the referral and physician order.
• A point-of-service registration area for scheduled services was established for radiology.

Because of the high patient volume in that area — due to MRI and CAT services — a registrar is stationed there, she notes.

Patients are told during preregistration to report directly to radiology, Harrell says, and if there is any confusion, the flow coordinator provides assistance.
• A weekly report regarding wait time and high-risk (any patient who waits more than 30 minutes) cases is created on a weekly basis.

The outpatient registration supervisor, the access manager, and assistant director, along with Harrell, meet each week and evaluate the report.

“Before the meeting, the manager [writes an explanation] of why each patient waited — for example, because it was a high volume time, they were awaiting a referral or there was an issue with insurance verification,” Harrell continues. “We look at each case and determine what to do so that it won't happen again.”

By the end of June, she says, average wait time had been reduced from more than 30 minutes to 10.5 minutes for non-scheduled patients and 8.6 minutes for scheduled patients.

Harrell attributes the project's success to the identification of a target and “outside the box” thinking on the part of each member of the access management team. “We all worked together to make it happen, and we exceeded our expectations.”

[Editor's note: Raina Harrell can be reached at (215) 662-9295 or raina.harrell@uphs.upenn.edu.]

A patient pleaser, ‘Team Triage' cuts ED wait times

Physician does triage at peak hours

A new process for streamlining patient care in the emergency department (ED) at Vanderbilt University Medical Center has cut length of stay (LOS) by 52% and reduced the number of patients who leave without being seen from 5% to less than 1%, says Brent Lemonds , MS, RN, administrative director of emergency and inpatient medicine.

“Team Triage” — a system that places a physician at ED triage during the peak hours of 10 a.m. to 10 p.m. — essentially follows the theory that if patients don't need to be in a bed, there is no need to have them sit in the waiting room until a bed is available, Lemonds explains.

LOS for Team Triage patients is down to an average of 130 minutes, he says, while the overall figure for those not going through that process was 272 minutes.

“We still have a triage nurse, who sees the patients and then immediately refers them to the physician,” Lemonds explains. That replaces the typical linear process of the patient being seen by the nurse and then directed to the waiting room, where nothing happens until a bed is available and care begins, he adds.

With Team Triage, Lemonds continues, a few patients are treated and released almost immediately. For the majority, however, the workup by the physician is started very early, he says.

“The physician is able to determine the appropriate tests and go ahead and get those ordered,” Lemonds adds. “He can tell whether or not the patient will need to be in an ED bed for further workup.

“We have some patients who never make it to an ED bed,” he says. “They are seen by the physician, he might order an X-ray or a lab test, and they go back to the waiting room until the results come in. Then they are [released].”

In the past, the hospital experimented unsuccessfully with having nurses use protocols to order patient tests upfront, Lemonds notes. “But they can't use a physician's clinical judgment to know exactly what will be needed.”

Experience also has shown that it is more effective to put a seasoned attending physician, rather than a resident or a nurse practitioner, at the point of triage, he points out. “The attending physicians typically order fewer tests and don't need to have someone check behind them.”

To facilitate the Team Triage process, the hospital redesigned the triage area so that it could accommodate three patients instead of just one, Lemonds says. “That allows the physician to move back and forth between patients.”

Another change has been the addition of a technician to assist the physician, he adds. “Blood has to be drawn and patients have to be moved. We're moving some of the back end processes up to the front end.”

Registrars, meanwhile, “have to make sure they catch the patients before they get out the door” in order to complete the registration and collect payment, Lemonds says. Aiding that process, he notes, is a discharge station that was already in place. (See related story in the July 2006 issue of Hospital Access Management , p. 76 . )

“We have a two-step registration process that is driven by the Emergency Medical Treatment and Labor Act [EMTALA],” says Laura Roberts, assistant manager of admitting. “Patients come to the front desk and we get eight pieces of data — the bare bones of information — to get [the account] into the computer.”

After treatment has begun, or after the patient has had testing done and is back in the waiting room, registrars do a follow-up interview to get billing and insurance information, she adds.

With the faster turnaround provided by the Team Triage process, Roberts says, “the time available to get in and do that interview is greatly reduced. [Registrars] have to work quickly.”

Step two of the registration is conducted at the bedside in the ED treatment room, she says, unless the patient's treatment doesn't require a bed. If the patient is waiting for test results, for example, registrars take the person to a cubicle and complete the registration.

“It's a lot of hustling, but it's a good process,” Roberts says. “It has improved our patient satisfaction scores.”

‘It's not cheap'

Team Triage is an expensive option; “It's not cheap to add physicians — but feedback from patients has been good,” Lemonds adds. “Most of the patients are tickled not to have to spend a lot of time in the ED.”

There have been a few complaints, however, from patients who don't understand why they received an ED bill when they never got to a bed, he notes. “They think it's a room charge.”

As for the effect of Team Triage, which was started in July 2005, on the overall cost of providing care, Lemonds says, “We can't tell if it has impacted the financial picture. We don't have great data on those results.”

Access career ladder targets burnout, turnove

‘I want to promote from within'

Demonstrating leadership ability, obtaining a professional certification, and meeting collection goals are among the key requirements of a comprehensive access career ladder being implemented at The Children's Hospital in Denver .

“The biggest thing our staff would need to do to go to Level II is to pass the CHAA exam,” says Stephanie Benintendi, CHAM, director of patient access.

Staff who work the day shift typically are cross-trained in other access areas, she notes, so that requirement is accomplished pretty quickly. Another requirement for Admissions Representative Level II is to participate in a departmental quality initiative.

That could be, for example, a customer service program now under way aimed at raising the hospital's Press Ganey scores, Benintendi says.

All 21 admission representatives, by virtue of qualifying for the job, are at Level I of the ladder, she adds, which equates to 15.52 full-time equivalents, including part-time and PRN employees.

The organization's focus on upfront collections is reflected in all three levels of the career ladder. Level I status requires that the employee maintain the collection goal set in the annual evaluation; and to qualify for Level II, the access representative must exceed the Level I figure by at least 10%. To achieve Level III, employees must consistently meet a goal that must be at least 15% higher than that for Level II.

To assist staff in collection of copays, Benintendi explains, there is an established path for them to follow.

“When a person is scheduled for inpatient or ambulatory surgery, our team calls and gets their benefits and other insurance information and loads that in the record,” she says. “If the patient is checking in, [the registrar] says, ‘I see that part of your benefit is a $250 copay. How do you want to take care of that?'”

If the patient is being preregistered over the phone, Benintendi adds, staff will try to direct the family member to look at the insurance card to see if there is a specific copay, and then say, “We will anticipate collecting that amount when you check in.”

The hospital uses a registration system from Madison, WI-based EPIC that allows money taken from a patient to be automatically posted to that account, she notes. Reports can be pulled showing collection totals, which are tracked on a weekly basis.

“We can get down to the representative level, even to the individual account detail,” she says. “We can see that, for example, someone collected 17 copays this month. We're not good at [determining], ‘You collected 17, but should have collected 50.'”

During a weekly quality review process, an admissions supervisor pulls five random cases to check for collection effectiveness, Benintendi notes. “If the copay is listed on the insurance card and the screen and the admissions representative didn't collect, she has to document why she didn't collect.”

If there is not a good reason, she adds, that is reflected in the person's score.

The quality review score also plays into the career ladder requirements. Level I reps must maintain an accuracy rate of 2.7 (out of 3) and meet productivity standards, while Level II reps must maintain the same accuracy rate and consistently exceed productivity standards. Level III reps must consistently exceed the 2.7 accuracy standard.

To reach the top of the admissions representative career ladder — Level III — employees also must pass the CHAM exam, demonstrate a working knowledge of spreadsheets and data collection, and initiate at least one performance improvement project for the department annually that results in a change of process, among other requirements.

NAHAM forum sparked interest

Benintendi says she decided to pursue the development of a career ladder after participating in an access forum sponsored by the National Association of Healthcare Access Management (NAHAM), which created and administers both the CHAA and the CHAM designations.

“I learned about another [hospital] that had done something similar that seemed pretty successful,” she adds. “I thought, ‘If they can do it, I'll see if I can.'”

After designing the career ladder in October 2003, she brought it to the hospital's human resources department in 2004 and began working to get approval for the program, Benintendi says. She finally received that OK in the first quarter of 2006.

While she had the career ladder virtually completed before bringing it to human resources, in retrospect, she notes, she would have involved the department “early and often,” which is her advice to those working on a similar project.

“Typically, without HR understanding from the beginning why you're doing [a career ladder], your intent, and how you will manage and communicate it, it takes a lot of time to get them up to speed,” Benintendi says. “I've spent a lot of time going back and forth with them, with them asking, ‘Now, why do you want to do this, and how are you going to do it?'

“It's been two and a half years since my initial submission,” she adds, noting that if she had the process to do over she would have contacted HR for input as she was designing the ladder.

At least two staff members already have expressed interest in working to complete the requirements for Level II, Benintendi says, and she anticipates that interest will grow as the first few employees are successful in their efforts.

“I expect about a third of the staff will be interested in moving forward, and the other two thirds will be a little hesitant at first,” she adds.

“In an ideal world, if all of the staff were at Level III, they would need little supervision, which is the intent we had in mind,” Benintendi notes. “We want to improve training and education and increase retention.”

Employee burnout, resulting in extremely high staff turnover, was an issue when she became director, she says, noting that stress levels have been particularly high among staff working in the emergency department.

“We don't have a central admissions area for inpatients,” Benintendi says. “They now go through the ED and have to be screened by an attending physician if they are direct admits.”

Children's Hospital is a level one trauma facility, she adds, and 2.5 admissions FTEs are designated for the trauma area, where they stay 20 hours a day waiting to register those patients. There are about 40,000 visits a year to the hospital's ED, Benintendi adds.

The career ladder, she suggests, will lead tomore job satisfaction, and will help admissions employees have a greater sense of ownership in the department. Another goal is to groom staff to become supervisors or to move up to the management level, she adds. “If one of our managers leaves, I want to be able to promote from within.”

An access representative could progress from Level III to supervisor, and from there to business analyst or departmental trainer, Benintendi says.

“We want [employees] to know that if you're good at the job you do, and there is more you want to do, you don't necessarily have to leave us.”

[Editor's note: Stephanie Benintendi can be reached at (303) 764-8021 or by e-mail at Benintendi. Stephanie@tchden.org.]

HIPAA, quality specialist warns against complacency

‘People have to be reminded'

If ensuring compliance with the privacy and security rules of the Health Insurance Portability and Accountability Act (HIPAA) has moved way down on your list of priorities, you mightwant to reconsider, suggests Barbara Disher, JD, president of Chicago-based LogiSpan, a company that specializes in risk management and quality control software.

“People have to be reminded,” Disher says. “If you don't constantly remind, it gets off the topic list until something negative happens.” Those who are complacent, she adds, “will be unpleasantly surprised.”

Giving weight to her assertion is a recent survey by the American Health Information Management Association (AHIMA). The percentage of respondents who said they believed their institution was more than 85% compliant with HIPAA dropped to 85% in 2006 from 91% in 2005.

Lack of resources and competing priorities have led some hospital and health system staff to slack off regarding all aspects of the privacy rule, according to the survey report. It went on to say that privacy officers particularly need support for education and training of new staff.

Disher will address HIPAA concerns this month at a seminar in Brookfield , IL , sponsored by the Association of Illinois Patient Access Management and the First Illinois Chapter of the Healthcare Financial Management Association.

HIPAA provisions call for periodic training, Disher points out, noting that attending seminars can serve as a means of fulfilling that requirement. Those receiving the training can, for example, write a synopsis of the material for the staff newsletter.

In working with clients or doing a presentation on HIPAA, Disher says, she usually focuses on a few of the most important parts of the rule — what to remember while registering a patient, for example.

Apply common sense test

She emphasizes the importance of applying the “common sense” test when looking at a situation to which HIPAA may apply.

“For example, when the security rule first came out,” Disher says, “the security officer at a large health system we were working with had gone to a seminar and gotten the idea that you had to verify who you were talking to before you could release information.”

That meant that, per his instructions, when someone from a physician's office called the registration desk, following up on whether a patient had made an appointment to get a CAT scan, registrars had to hang up and call the office back to see if that was in fact where the call had come from.

When one considers extending that policy throughout a huge medical center, to nursing and laboratory and diagnostic imaging, among other areas, Disher adds, the logistical challenge is obvious.

It's also one that doesn't need to be battled, she points out, noting that a closer reading of the rule indicates that simply asking the person on the phone to confirm that they are calling from a particular physician's office is sufficient.

Another situation that has caused providers to jump to unnecessary conclusions, Disher says, came out of the fact that many individuals leave their primary residence for certain parts of the year. While away, she adds, they may want to follow up on an upcoming appointment.

“What a lot of folks would like to do is [make arrangements by] e-mail, but the danger of e-mail is that it is an extremely open universe,” Disher says. The provider's initial reaction, she says, was, “We can't do this.”

What she suggests, instead, is to consider that communicating by e-mail can be a benefit for both parties, and to ask the patient to sign off on it.

A recent query came from a client associated with a hospital that has a long-term care facility attached, Disher notes.

“One of the biggest [privacy] issues in longterm care is that pictures of the patients are often put on the door of their rooms, which helps them find their home,” she adds. “If the facility has more than one hallway, [residents] can get lost, and if they are on another unit, staff members there may not know them.”

There is a book of resident photos, Disher says, so that employees can identify these wandering patients and get them back to their rooms.

The client had been in a seminar where participants were cautioned about using photographs in hospital nurseries and during surgery, and so had asked about the appropriateness of the photos in the long-term care facility, she says. “He said, ‘Do we have to eliminate this, because it is difficult to get permission from these patients?'”

In that case, Disher says, she highlighted a HIPAA provision that allows such practices when there is a legitimate reason behind them, but that the provider should explain the photos in its privacy notice.

“The biggest thing to remember about HIPAA is that it is like a living regulation,” she points out. “It's not a regulation that tells you to create a form and put it in place, and then there is a limited set of people who fill out the form and send it in. It applies to every single person who works in health care — every situation where there is any interaction with a patient, a visitor or protected health information.”

Adding to the challenge, Disher notes, is that the Department of Health and Human Services seems constantly to be tweaking the rules.

While HIPAA doesn't require providers to be perfect, she says, it does require them to do the best job they can at being perfect.

“If you have processes in place to protect [patient privacy] and you demonstrate that you try to do your best to follow them, and if there is a misstep, you appropriately follow up so it doesn't happen again,” she continues, “then you have not violated HIPAA. But if you ignore [that misstep], then you are violating it, even if it's an accident.”

(Barbara Disher can be reached at bdisher@logispaninc.com. The company's web site is www.logispaninc.com.)

Medicaid enrollees get DRA exemption

Medicaid enrollees and applicants who receive Medicare or Supplemental Security Income benefits have been exempted from a Deficit Reduction Act provision requiring Medicaid beneficiaries to prove they are U.S. citizens.

The exemption, which affects roughly 8 million of the nation's 55 million Medicaid enrollees, is one of several changes to earlier guidelines that were announced by the Centers for Medicare and Medicaid Services (CMS) in an interim final rule.

Among other changes, the rule allows states to accept database matches with state records for individuals whose citizenship was put on file when they applied for other services, such as food stamps or a driver's license, which could exempt more people, according to CMS.

The American Hospital Association and other groups have expressed concern that the earlier guidelines would place an unreasonable burden on elderly, mentally impaired, and other vulnerable patients who would have difficulty documenting their citizenship.

Settlement reached in sign language suit

The Department of Justice (DOJ) recently announced that a settlement had been reached in a lawsuit alleging that Laurel (MD) Regional Hospital did not appropriately respond on several occasions to requests to provide sign language interpreters or other aids for deaf or hearing-impaired patients or their companions.

Under the consent degree, the hospital agreed to assess the communication needs of individuals with speech or hearing impairments on arrival or when an appointment is scheduled; provide qualified interpreters as soon as possible when necessary for effective communication; provide auxiliary aids to patients and companions when needed; and meet certain standards for video interpreting services.

A Laurel spokeswoman told AHANews Now, an on-line news service, that the hospital has implemented a new system for the hearing impaired and is making an effort to ensure that employees understand the needs and rights of the hearing impaired.

More workers in plans with hospital copays

The percentage of workers enrolled in employer-sponsored health plans that required a copayment for hospital care increased by more than 60% between 1999 and 2003, to 54.7%, the Agency for Healthcare Research and Quality reports.

According to the agency's Medical Expenditure Panel Survey of private-sector employers, the share of workers whose plans required hospital copayments ranging from $150 to $400 doubled, to 21%, while those whose plans did not require hospital copayments fell by nearly a third, to 45.3%.

States move toward eHealth data exchange

Twenty-eight states are developing plans for electronic health information exchange and seven states have begun to implement such plans, according to early results from the latest annual survey by eHealth Initiative.

As part of its 2006 Third Annual Survey of Health Information Exchange Initiatives and Organizations, the eHealth Initiative took a special look at health information technology and health information exchange planning and implementation activities at the state level — building on its experiences supporting 21 states across the nation with technical assistance. The full survey report will be released Sept. 25.

In most cases, the governor's office or state health department is leading the state's health information technology (HIT) efforts. About half of U.S. states have an executive order or legislative mandate designed to stimulate the use of HIT, and 17 states are providing funds to support regional and local efforts, the organization said.

Increasingly, state leaders are recognizing that information technology can help address many health care challenges, such as rising costs, decreasing Medicaid reimbursement, and concerns about quality and safety, the survey indicates.

Eighty-eight percent of state leaders cite concerns about quality in health care as a significant driver, and 86% cite concerns about patient safety as a significant driver.

Smart Cards may Combat Health Care Problems - 02/09/06

Smart cards are tailor made to fix many problems in the health care industry, according to a report released Feb. 9 from the Princeton Junction, N.J.-based Smart Card Alliance. The credit card size devices feature a microprocessor chip capable of encrypting and storing information. The report states that the cards can:

support privacy and security requirements mandated by the Health Insurance Portability and Accountability Act,
provide a secure carrier for portable medical records,
support processes that can reduce administrative costs,
reduce health care fraud,
provide secure access to emergency medical information,
and provide support for patient loyalty programs.

A primary obstacle to smart card adoption in health care is the size and cost of the projects, says Randy Vanderhoof, executive director at the Smart Card Alliance. "Health care systems are not small, confined projects but usually involve tens of thousand of people," he says.

Vanderhoof also says that health technologies are not always integrated and typically move at a slower pace than others. "The I.T. industry in health care is not uniform so it's difficult to get systems to talk to one another."

The report details seven different smart card health care programs that are either in the works or operational. For instance, the University of Pittsburg Medical Center has issued 2,000 of its "Healthcare Passports" to patients. Patients store some medical information on the cards and access the data through kiosks at the centers or by using smart card readers at home. To access the information on the card, patients or physicians must enter a personal identification number. The benefit for the patient includes speeding through the check in process during office visits. Houston-based St. Luke's Episcopal Health System uses smart cards for personnel to access electronic medical records. The system was installed to resolve problems with physicians and nurses remembering numerous passwords. Now personnel insert the card into a reader, type a four-digit PIN and are logged on. For more information, visit smartcardalliance.org.

Are Cards Finally a Good Bet? - 02/09/06 Health Data Management

There's no consensus on whether smart cards have a role to play in an increasingly connected industry.

By Bill Briggs, Senior Editor

In 2003, executives at Queens (N.Y.) Health Network rolled out an initiative to use smart cards to fill in the information gaps at its two emergency departments.

The cards are "smart" by virtue of embedded microprocessors that can store 64 kilobytes of data, more than enough storage room to house patient identity, insurance and basic health information. To date, Queens Health has distributed more than 14,000 cards.

The smart cards have helped improve patient safety and treatment; user acceptance has been steady but slow, says Al Marino, CIO.

An unanticipated benefit, however, is how the initiative is helping open a dialogue with other New York-based provider organizations as they all explore the regional health information organization concept, the forerunner to the federal government's vision of national health information infrastructure. Smart cards may be the vehicle to link patients to data in disparate information systems as well as act as a portable data safety net in an emergency.

"The big focus now is RHIOs and information sharing," Marino notes. "Smart card technology is a basis to begin discussion about how to share data and build the infrastructure to do so."

Queens Health is a member of a small fraternity of health care organizations that have pursued smart card technology. For years the technology has been touted as an ideal solution to the challenge of making health information portable, but it has chronically been hampered by high costs, technological limits and lack of user acceptance.

Smart cards have occupied a very small corner in health care I.T., and it remains to be seen if the technology will ever be anything but a niche solution. But costs have dropped dramatically, and some organizations are finding the cards are an effective way to quickly link to patient information stored in electronic records and other information systems. As a result, some organizations are rolling out or planning large-scale smart card programs.

Reliability, portability questions

But even as organizations move forward with big smart card projects, some experts question whether the cards are the best delivery mechanism for data at the point of care, which has been a chief selling point for the technology. "Are we going be able to rely on information on a smart card, or will we be looking at data from an online database?" asks John Quinn, a senior executive in New York-based Accenture's health and life sciences consulting practice.

Potential pitfalls

Other drawbacks arise when comparing smart cards with Internet-based technology. Smart cards must be accessed by specialized readers deployed everywhere a patient might show up for care in a delivery system or a community. In addition, the issuer-not the patient- typically updates data stored on a smart card's microprocessor. "What is the source of data and how does it get to the card?" Quinn adds. "When you get down to it, the only way it will get updated is when the patient visits a provider."

Those obstacles, combined with high costs, have scared off many potential smart card users. However, the cost of smart cards has dramatically declined over the past few years. At one time, cards cost up to $15 each. Today, bulk purchases can push per-card cost under a dollar.

Lower costs make smart card technology competitive with traditional magnetic stripe cards, which can store less data, typically just an ID number.

The falling cost of technology and the potential to reduce operating expenses are key reasons why HealthOne Alliance, a Calhoun, Ga.-based regional PPO network and health plan, is exploring smart cards for its 100,000 members, says Jeff Myers, president and CEO.

Myers sees smart cards as a way to improve efficiency and reduce operating costs. "There is an enormous amount of redundant work that occurs in the patient admitting process between physician offices, hospitals and ancillary providers."

HealthOne Alliance has not deployed smart card technology yet, but it's in the 2006 budget. The organization is working with HealthMeans Inc., Irving, Texas, to supply software, cards and readers to replace conventional plastic member ID cards. Data on ID cards is confined to plan type and telephone numbers.

Using smart cards would enable the health plan to load information such as the amount left on a patient's annual deductible, or automatically initiate a transaction, Myers says.

"The idea is that members using a smart card would go into a physician's office and when the card is swiped, it links to our third-party administrator via the Web to get precertification, verify eligibility, get a current balance on deductible, and basic health information, such as medications that might be prescribed by other physicians, and allergies," Myers says. "That will bring efficiency and better information to physician office staff and to clinicians."

Smart card technology can help payers and providers reduce the cost of patient payment and insurance reimbursement-related transactions, says Frank Avignone, vice president at HealthMeans Inc., a smart card technology vendor. He also is co-chair of The Smart Card Alliance's Healthcare Council, a segment created last summer by the Princeton Junction, N.J-based alliance.

The Healthcare Council was established to help drive collaboration among health care industry players, with a goal of spreading smart card adoption. The Smart Card Alliance advocates the technology's use across multiple industries.

An advocate

Avignone champions smart card technology from two vantage points. He notes that, along with health data, the cards can carry transaction data, such as whether there are funds in flexible spending or health savings accounts.

"That can reduce the cost of a transaction between a physician and an insurer from $1.40 to 40 to 50 cents," he says. "And it can pay the doctor faster-close to real time."

Smart cards also can document whether payments have been made to providers, such as office visit copays, or if deductibles have been met.

Avignone has been in the smart card business for eight years and is expecting growth to accelerate. Myers, the HealthOne president, has been aware of the technology for some time, tracking it closely for nearly three years. He believes the time is right to invest because costs are more manageable and technology is sophisticated enough to eventually integrate patient data from multiple sources.

"It's all evolving, but certainly as electronic health records systems expand, linking the data from cards to electronic records and practice management systems is critical," he says. Such links also could open the door to standardization of medical forms. "If we can move to more standardization, with electronic signature capability, we could gain an enormous amount of efficiency."

Patient safety

Smart card technology showed some potential to remove costs at Queens Health Network, but the underlying motive was patient safety, says Marino, the CIO. "It had the potential for improving patient care. Also, for our population it was significant in terms of communicating with providers. A large percentage of our patients don't speak English, so it helps both sides."

Queens Health's patient base is about 40% Medicaid-insured, and the rest includes a combination of those enrolled in Medicaid managed care and Medicare. Cards are distributed to patients seen in primary care settings at the hospitals.

The cards feature a patient's photograph, demographics, and a summary of the patient's health data including a problem list, allergies, active medications and lab results. That information is downloaded onto the cards from Queens Health Network's electronic health records system, from Misys Healthcare Systems, Raleigh, N.C.

New York-based Data Industries Ltd. developed the smart card application and cards and readers are from Gemplus International SA, Luxembourg.

Queens Health has invested between $200,000 and $250,000 in smart card technology, Marino says, reflecting the organization's commitment to I.T. "Cost certainly is a consideration," he explains. "The organization already has made a significant investment in an electronic health record, so the add-on was not a significant amount."

Just the same, Queens Health grant writers are exploring a state funding program to help enhance the use of I.T. in health care and get more organizations to issue smart cards, Marino adds.

Patient registration

Executives at Northeast Health System in Beverly, Mass., plan to get patient health data onto the smart card system it implemented more than two years ago. But until the organization has the resources to devote to keeping such data up to date, the cards will continue to store just the name and medical record number of more than 150,000 patients, says Cheryl Akre Teal, director of access services.

Northeast Health System includes three community-based hospitals and two outpatient clinics just north of Boston. The organization bought software, readers and cards from Health Card Technologies Inc., Oklahoma City.

The cards require only a patient's enterprise medical record number to enable patient registration staff and clinicians to access data residing in an electronic medical records system from Medical Information Technology, Westwood, Mass.

Benefits from the technology skew to patient safety. "We have one universal medical record number, so only one number comes up on a computer screen anywhere in the health system," Teal says. "That's a huge patient safety factor because there are no duplicate medical records floating around."

The smart cards are distributed to new patients and can be issued during registration. In addition to the medical record number, the cards include the patient's name, which is encrypted on the back to ensure the cardholder is the right person.

A good history lesson

Teal and other smart card technology proponents note that the cards are most effective as sources of medical history when a patient arrives at an emergency room unconscious or otherwise incommunicative. "A drivers license can produce the patient's name, but if a patient has one of our hospital cards it's a direct hit on our electronic records," Teal says.

Teal declined to discuss the costs of smart card technology. The beauty of a smart card investment is that it's not necessarily a recurring budget item, she adds, noting that there was no funding earmarked for the technology in 2005.

Northeast Health System is upgrading its card readers, which incorporate a computer mouse pad. Prosisa International LLC, New York, makes the devices, called SmartEPads. They feature a pad with 20 buttons that can be programmed to access a specific Web site with one touch.

Patient registration staff can program their most common insurance carriers' Web sites, for example, for ready access as soon as a card has been read.

About half of 250 new readers have been installed, but they won't be implemented until Health Card Technologies engineers adjust the devices to scan their cards, Teal adds.

Meeting challenges

The biggest challenge to getting the system rolling, Teal says, was user acceptance among hospital, outpatient clinics and physician offices. Patient registration staff at Northeast Health System locations, which report to Teal, were not eager when the card system rolled out. "But now it's part of the day-to-day process," she says.

Educating both administrative and clinical staff as well as patients is commonly noted as one of the key steps to getting smart card technology in play. "The main challenge for us is ongoing staff and patient education," Marino says. "We found through interviews and patient surveys that we need to do more regarding patient education. Patients need to understand what information is on the card and how it can be used."

Educating office staff and PPO members on smart card capabilities is one of the top tasks that HealthOne Alliance faced, Myers says. That's because the technology is unknown to its providers, which includes about 2,000 physicians in some 400 locations.

An earlier challenge for HealthOne Alliance was getting the right amount of data onto the cards. "Vendors' original focus was rapid patient registration that would include some of the patient's medical history," Myers explains. "But the technology a few years ago didn't seem to have the sophistication to incorporate the insurance component. Vendors did not understand the insurance side of the equation."

Chip capacity and technological progress have resolved those issues, he adds.

In the future

Myers hopes to see the day when smart cards can be read anywhere, much like Visa and MasterCard cards for personal credit. Danger, however, lies ahead if each payer and provider creates their own proprietary card that works only with their constituents.

HealthOne Alliance's health plan employer customers have been "very receptive" to the smart card plan, Myers adds. "They are having issues with members passing ID cards to folks who are not covered by the plan." They see smart cards as a means to tighten user authentication, he adds.

Sidebar

Smart Cards' Future: Dim or Bright?

Assessing the potential of information technology in health care depends on whom you ask.

Some see smart card technology as an important tool for attaching health and insurance information to patients. Its proponents expect great things to come. However, provider and payer organizations using smart cards are hard to find. And some industry observers believe that tells all there is to know about the technology to date.

The promise behind smart cards is that patient health information, which can include medical history, allergies, recent test results and current medications taken, will be available at the point of care. However, the advent of other electronic means to access patient data, such as Internet portals and virtual private networks, have gone smart cards one better, some experts say.

The amount of data available on a smart card's microprocessor, which has continually increased, is not the obstacle it once was, says John Quinn, a senior executive in New York-based Accenture's health and life sciences consulting practice.

The key tests are human behavior-whether card users and caregivers are willing to change the way they do things to accommodate this medium-and how much money providers can spend on the technology.

"The farther you go down the path the harder it is to understand the role smart cards play," Quinn says. "They do fit for portability, capacity and capability. But we haven't seen a business driver, in other words, people saying we can do this faster by using smart cards."

Despite that shortcoming, proponents believe smart cards have a place in health care. Some, like Al Marino, CIO at Queens (N.Y.) Health Network, feel that smart cards can function as a part of the electronic data flow pipeline that includes Web-based applications and Internet portal technology.

"The card itself can be a bridge until a more complete structure can be built," Marino says. "It also helps in terms of identity management and could possibly help with security."

Two-way communication

Smart cards can provide access to patient information where Internet access is not available, he adds. Marino and Queens Health executives recognize that smart cards are a one-way means of communication, where the public health provider loads data onto a card for providers to read. There are solutions to that problem, however.

Queens Health is part of an initiative announced in December that will enable providers to update patient information stored on smart cards. Nine hospitals in the New York City metropolitan region will offer 100,000 smart cards to their patients. The hospitals are working with Siemens Communications Inc. of Boca Raton, Fla.

The cards will be owned by the patients and loaded with demographic data and information on allergies, current medications, chronic illnesses, medical history, and laboratory tests.

Participating facilities will have smart card readers integrated with various information systems to access data and update the cards. Patients will unlock the information on the card by entering a personal identification number.

Portable data

The need for health and insurance data portability will determine the value of smart card technology, says Robert Williams, M.D., director at Deloitte Consulting LLP, New York. So far, he says, the case for smart cards has not been made convincingly.

The greatest potential is in emergency care, when communication between patient and caregiver isn't possible. But using smart cards to any appreciable degree in that setting hasn't happened yet, Williams says.

Future alternatives, based on existing technology, include formation of an Internet-based clearinghouse where personal health data resides for all providers to access, he says. One current option for portable data storage is flash drives with enough memory to carry digital images and then plugs into any computer with a USB port.

In the next two to three years, Williams expects relatively slow growth for smart card technology, "but it could accelerate around sharing health information, such as among members of a regional health information network."

For Northeast Health System, smart cards are filling an important need now and they eventually will play a bigger role in health care, says Cheryl Akre Teal, director of access services. The Beverly, Mass., delivery system has been using the cards since November 2003 to store patient identification and a universal medical record number that makes patient data available anywhere in the organization.

Teal is hoping to spread the word on the technology in a seminar at the 2006 national conference of the National Association of Healthcare Access Managers in May. "It seems smart cards come up every year," she says. "Maybe I'll be able to talk about it this year."

Smart Card Applications in the U.S. Healthcare Industry - 02/06 Smart Card Alliance

Executive Summary

John Taylor walks into the cancer clinic with his 7-year-old daughter for what he hopes will be the last time. After almost 18 months of treatment, Rebecca seems to be in full remission. John is relieved—in fact, almost everyone involved is relieved. During Rebecca's ordeal, various family members have filled out the same forms 73 times and been asked the same questions during all 116 visits to the different participating members of Rebecca's care team. Rebecca has received the wrong medication three times (once with dire effect) and been subjected to duplicate lab tests and radiology studies because previous test results were not available. Rebecca's reward for having experienced all this and survived? Expenses of about $18,000 dollars above and beyond what was necessary for her treatment.

Although this story may sound like fiction, it is true. Healthcare systems in the United States are burdened with paperwork, prone to errors, and in some cases, hazardous to one's health. On top of these issues, the industry faces high costs, increased fraud and government-mandated requirements to put in place processes and systems that protect the privacy of patients' personal information.

Healthcare organizations are now investigating and deploying new information technology that is designed not only to solve the significant challenges that the industry is facing, but that also provide new functionality that improves patient care and the efficiency of healthcare delivery. Smart card technology is being incorporated into many of these new healthcare systems as an instrumental component that protects and enables convenient access to patient data and that supports new applications that deliver both clinical and administrative benefits.

Smart cards are used worldwide for many applications, including healthcare, financial, transit, telecommunications, and secure identification. Defined at the highest level, a smart card is a device (e.g., a plastic card) that includes an embedded integrated circuit (IC) chip. Applications that use smart cards take advantage of the technology's ability to provide secure, portable storage of data, enable authenticated access to information (either on the card or within the application system), and support secure transactions between the card and the system. Also important in many applications is the familiar form factor – a plastic card – that is convenient to use.

Smart card technology provides a feature-rich, flexible platform for healthcare organizations to implement applications that address key industry issues. This white paper provides an overview of how smart cards are used in a variety of these applications, including:

Supporting privacy and security requirements mandated by HIPAA
Providing the secure carrier for portable medical records
Supporting new processes that can reduce administrative costs
Reducing healthcare fraud
Providing secure access to emergency medical information
Providing support for patient loyalty programs
Enabling compliance with government initiatives and mandates

The white paper discusses some of the daunting challenges facing the U.S. healthcare industry today and has identified clear opportunities for the employment of smart card technology to address and resolve these issues. In recent years, there has been a pronounced effort to establish and refine standards for maintaining and moving healthcare data. With continued advances in smart card technology and the increased awareness of its practical solutions, healthcare organization use of that technology is gathering momentum. This paper has cited some examples of smart card use, and has suggested additional applications for consideration. Of course, there are a plethora of new healthcare applications waiting for discovery and implementation.

About this White Paper

This white paper was developed by the Smart Card Alliance Healthcare Council to describe the value that smart cards deliver in a variety of U.S. healthcare applications. Developed as an educational overview for executives and senior managers in healthcare provider organizations, it reviews key challenges that the U.S. healthcare provider industry faces and examines the key drivers for implementing smart card-based systems to address these challenges.
The white paper concludes with profiles of a number of organizations who are implementing smart cards, including the Queens Health Network, University of Pittsburgh Medical Center, St. Luke's Episcopal Health System, Florida eLife-Card, Texas Medicaid, and the French and German health cards. These implementations illustrate the diversity of applications that are enabled by smart card technology and the business benefits that the technology delivers to healthcare organizations.

About the Healthcare Council

The Healthcare Council is one of several Smart Card Alliance Technology and Industry Councils, a new type of focused group within the overall structure of the Alliance. These councils have been created to foster increased industry collaboration within a particular industry or market segment and produce tangible results, speeding smart card adoption and industry growth.

The Smart Card Alliance Healthcare Council brings together payers, providers, and technologists to promote the adoption of smart cards in U.S. healthcare organizations. The Healthcare Council provides a forum where all stakeholders can collaborate to educate the market on the how smart cards can be used and to work on issues inhibiting the industry.

Healthcare Council participation is open to any Smart Card Alliance member who wishes to contribute to the Council projects.

Danbury Hospital Optimizes Technology Investments with IBM Diagnostic Study

Danbury Hospital optimizes technology investments with IBM diagnostic study

BM Healthcare and Life Sciences delivers diagnostic study for Danbury Hospital using Safe and Lean Methodology

Customer: Danbury Hospital

The Challenge

· Non-profit hospital wanted to improve patient care and safety in its emergency department
The Solution

· A detailed diagnostic study with recommendations for achieving the desired emergency department improvements
The Benefits

· Avoided costly and time-consuming changes by confirming the impact of technological changes prior to implementation
· Justification for the value of emergency room process changes and the value of a new emergency department information system (EDIS)
· Broader understanding of clinical business processes across multiple areas
Danbury Hospital is a 371-bed community-based, non-profit teaching hospital serving approximately 360,000 residents in western Connecticut and eastern New York State. It has several specialized facilities, including a Level II Trauma Center within the Emergency Department (ED) that serves approximately 65,000 patients annually.

The hospital is committed to advancing the health and well-being of patients by anticipating and responding to new developments in the healthcare system and integrating these in a cost-effective manner. They sought to reduce patient waiting times and enhance care in the ED but were unsure of the process changes necessary to achieve the objective. To that end, they turned to IBM Healthcare and Life Sciences to determine opportunities for workforce transformation, error and cost reduction and readiness for a new emergency department information system (EDIS).

IBM diagnostic processes

IBM Healthcare and Life Sciences embarked on an eight-week engagement to analyze and model business processes by following the patient experience from time of arrival in the ED until discharge or admittance as an inpatient. This involved observing existing processes and collecting data to develop a baseline process model as well as identifying process bottlenecks and technology gaps to reveal opportunities for improvement.

IBM focused on key drivers, including doctor, physician assistant and nurse staffing; change in bed mix; annual increases in patient volume and the application of technology, such as an EDIS and bedside registration. Based on the data collected, the IBM team ran four simulation scenarios to identify impacts to throughput, staff utilization and length of staff results. The team modeled patient-centric ED processes to test process changes using “what if” process model scenarios.

Throughout the engagement, IBM Business Consulting Services relied on the following methodologies:

· Modeling and Simulation—generating reliable data and integrating the results with new or revised processes and technology changes
· Lean Sigma—a rigorous, statistical approach to decreasing variables, reducing process or product errors and enhancing quality
· Workforce Transformation—a carefully aligned set of activities, including strategy building, organizational design, competency re-mix, learning and knowledge management and readiness assessment, that takes into consideration cultural, organizational and human concerns involved with redesigning processes and technologies
· Technology Fusion—the joining of process management with technology for sustainable change
· Financial Modeling—activity-based assessment balancing the costs and impact of particular business practices and processes
Through its unique mix of modeling and simulation, combined with its healthcare expertise, IBM was able to solve the highly complex issues within the ED space.

For example, as part of its Technology Fusion analysis, IBM demonstrated areas where technology could impact 160 different aspects in the process model, identifying key efficiency and clinical impacts. For example, order entry involved multiple handoffs among physicians, nurses and unit secretaries. Through Technology Fusion analysis, IBM demonstrated that implementing a computerized physician order entry system had the potential to reduce the number of handoffs, significantly increase patient safety and increase inpatient throughput from 5.8 percent to 8.1 percent. At the end of the engagement, the IBM team presented a business case with associated recommendations for long- and short-term projects to achieve the desired ED improvements.

Proof of concept

IBM uncovered opportunities for improvement, demonstrating that the proper implementation of EDIS and bedside registration could result in the ability to increase patient volume from 64,000 to 72,000 visits annually, without augmenting existing staff or beds. Further, IBM estimated that the hospital could implement bedside registration within four months, yielding an estimated 10 percent reduction in patients' length of stay without adding resources or physical space.

The team also demonstrated that use of Multilingual Automatic Speech-to-Speech Translator (MASTOR) devices could aid caregivers in faster and more effective communication with non-English speaking patients. Designed by IBM to help people communicate using natural spoken languages, MASTOR is the first translation system to combine speech recognition, machine translation and speech output.

The next phase

Once they were able to confirm the value of implementing a new EDIS, IBM Business Consulting Services developed critical-to-quality specifications to identify customer functional/process requirements for the new system. In addition, the team provided workforce transformation analysis to guide the hospital in revamping its processes and operations for sustained growth.

Poised for success

With the completion of the diagnostic study, Danbury Hospital gained an understanding of the true impacts of a new workflow delivery model—before investing considerable time and money implementing changes. For example, one proposed scenario was to change the bed mix. However, the IBM team discovered that this change would not bring about the desired results. Thus, the hospital was able to avoid costly and ineffective process changes.

The hospital now has an implementation plan with a business case justifying both the value of the ED process changes and the value of an EDIS. With this independent analysis, Danbury has gained a broader perspective on its clinical business processes across multiple areas, including patient registration, patient accounting and medical records. The detailed diagnostic study from IBM serves as a decision-making tool, giving the hospital a tremendous opportunity to optimize technology investments.

About IBM

The goal of IBM Healthcare and Life Sciences is to rapidly bring IT technology to customers and IBM Business Partners in the fields of pharmaceutical research, biotechnology, genomics, health and other life science industries. IBM is a proven leader in data integration, supercomputing, high performance storage, e-business and information technology services.

Long-term projects at IBM Research Centers and the IBM Deep Computing Institute foster collaboration with life science companies — bringing domain expertise and innovative technologies to the development of life science solutions.

From Emergency First Responders to Healthcare Professionals, Smart Cards Establish Trust, Secure IT Systems and Increase Efficiency - 10/13/2005 Market Wire

Highlights From Smart Card Alliance Conference Second Day

MIAMI, FL -- (MARKET WIRE) -- 10/13/2005 -- Smart Card Alliance Fall Annual Conference -- From identifying 15 million federal agency employees to responding to emergencies like Katrina to more efficient healthcare administration, smart cards bring trust and privacy to identity management and credentialing, a gathering of executives told attendees on the second day of the 13th annual Alliance conference.

Highlights

Craig Wilson, speaking on behalf of the Department of Homeland Security's First Responder Program gave some real life examples of emergency response scenarios where trained personnel were hindered due to a lack of a common identity trust between federal, state, and local authorities. The common trusted identity smart card currently being implemented across the U.S. federal government directly addresses this issue. The DHS First Responder Program plans to issue credentials to first responders so that the identity card they use in their daily routine can become their crisis identity card when needed. The ID credentials will be consistent with the new federal government standards that call for smart card technology.

Mauricio Coehlo, director for the Public Key Infrastructure of Information Technology National Institute -- a federal agency linked to the Presidency of the Republic of Brazil -- shared details on one of the largest electronic government digital credential programs using smart cards and tokens in Latin America. This national program will provide digital identity credentials to individuals and corporations in order to file electronically signed documents. A new law sets standards for digital signatures recognized by the Brazilian government. The goal of the program is to address the Brazilian government's problems of handling millions of paper forms using Internet-based services. Coehlo said one of the main challenges for implementing such a broad system is interoperability.

Michael Butler, director, Access Card Office, Department of Defense and chairman of the Interagency Advisory Board, seconded that opinion. Speaking on the Federal Issuer's Experience panel, Butler expressed the government's need to ensure interoperability of identity credentials, and described the DOD's conformance testing program to ensure that all cards work with all readers at DOD facilities.

Tony Cieri, a consultant on HSPD 12 to the IAB, appealed to the industry to speak out about the need to continue moving forward in the implementation of government smart cards, despite some uncertainty on the final end point standards. "The card is only a minor part of the total system," said Cieri. "It is the system that uses the cards where the greatest challenge exists -- yet we are stuck on focusing on the card." Cieri expressed concern that by waiting until 2006 to issue cards, it could be another two years for the authentication system behind the card to evolve before fully realizing the benefits of HSPD 12.

Frank Avignone, vice president business development for Healthmeans, Inc and co-chair of the Alliance's Healthcare Industry Council, raised awareness of the uses of smart cards in healthcare. He cited examples of efficiencies that can be gained in the processing of patient records and insurance claims using smart cards. One example: A doctor who implemented a smart card system reduced the number of separate patient processing steps for office visit medical records from 40 separate steps to 7, saving countless hours of paperwork handling and reducing potential errors.

Membership growth in the Alliance was more than 40% over the last 14 months, Smart Card Alliance Executive Director Randy Vanderhoof told attendees in his annual report to the members. He cited interest in the Alliance's new industry councils and expansion into Latin America as factors fueling that growth. Cathy Medich, task force chair, reported that over 200 individuals from more than 100 member organizations have been involved in recent task force and council activities. Linda Santucci, international trade specialist for the Department of Commerce, Commercial Services organization, explained the many programs offered by the U.S. commercial services organization to assist U.S. organizations in marketing products and services to Latin America.

Mary Mitchell, deputy associate administrator, General Service Administration (GSA) Office of Governmentwide Policy, described the GSA's efforts to help agencies move to FIPS 201 compliance on the mandated timelines. The Alliance presented the GSA Office of Governmentwide Policy with an Innovation Award for being at the center of the government smart card procurement services, its work through its Federal Smart Card Project Managers Group, and being a supporter of forming alliances between government and the smart card industry.

The Transportation Council, Contactless Payments Council and Physical Access Council of the Alliance met in separate sessions to discuss current projects and plan new activities.

About the Smart Card Alliance

The Smart Card Alliance is a not-for-profit, multi-industry association working to accelerate the acceptance of smart card technology.

Through specific projects such as education programs, market research, advocacy, industry relations and open forums, the Alliance keeps its members connected to industry leaders and innovative thought. The Alliance is the single industry voice for smart cards, leading industry discussion on the impact and value of smart cards in the U.S. and Latin America. For more information, please visit http://www.smartcardalliance.org .

Media Contact: Deb Montner Montner & Associates 203-226-9290 Email Contact SOURCE: The Smart Card Alliance

Card Sharks -4/2005 Health Executive

Agreement is nearly unanimous that smart card technology in the health 1care sector could yield great efficiencies, reduce medical errors, and save lives. Patients wouldn't have to complete the same medical history forms at different providers. Information about patient allergies, medical records, medical tests, and insurance limits could be accessed from secure, central databases. Healthcare could become truly portable, one of the pillars of the Health Insurance Portability and Accountability Act of 1996.

President Bush created a national health information technology coordinator position last year and vowed to restore $50 million cut by Congress last fall for the office. But despite Bush's declaration that modernizing America's healthcare system with information technology is a priority, don't hold your breath that sweeping reforms will show up soon because $50 million represents a small fraction of the cost involved in bringing this technology into commonplace use. And then there's the nagging question of
interoperability.

Smart card technology may become latest in a series of technological battles that have been waged in the marketplace. VHS or Beta? Mac or PC? Still, many Americans are accustomed to carrying smart cards and storing value on cards used at toll booths or on public transportation systems.

Each smart card provider has it's own system to store and access smart card information. Although readers are becoming more affordable and increasingly can be found integrated into computers, the communication issues still need to be worked out.

As always, the greatest divide between great idea and indispensable technology is money. Should the insurance company pay for the cards? The health system? The patients? Healthcare providers continue to be squeezed by rising costs and decreased reimbursements, hardly the right atmosphere to launch technology that's not critical to patient care. However, the heightened use of electronic medical records may bring this technology to the forefront.

One common platform
Numerous closed-system tests of mainly hospital systems are under way in the US, and the early results look promising. But until a common platform of information exchange is agreed on and until the price of cards drops, expect to keep filling out those medical forms.

“Selling the technology first is not a good strategy,” said Randy Vanderhoof, executive director of the Smart Card Alliance, based in Princeton Junction, NJ. “It is the closed systems that will figure it out and develop program accessories to serve customers in a unique way over competitors.”

Vanderhoof says it's hard to predict when the technology will find wide acceptance, noting that new technology generally takes five years to do so. “There's no telling what will happen to force the timetable faster,” he said.

The healthcare field often lags other industries in adopting new technology, noted Zack Martin, editor at IDNewswire, but vendors say this could be the breakout year for the technology.

“The focus today is on giving providers cards to securely log onto networks,” Martin said. Giving cards to patients is a goal. It's being used overseas in Europe and Asia, but it's not seen much in the US outside of pilot projects, he added.

Steven Rimpici, vice president of sales and marketing for Competech SmartCard Solutions, calls interoperability the $64,000 question. The Moonachie, NJ-based company concentrates its sales efforts on large, closed systems such as insurance companies, health centers, and statewide agencies. After extensive beta testing, the company planned to roll out its product last month.

Smart card reader technology is fast becoming commonplace on laptops and keyboards, but the software to drive it is not standard. However, if a patient with a card visits a hospital or physician who doesn't have compatible technology, a 24/7 call center can e-mail or fax medical information with proper authorization, Rimpici said.

“The biggest challenge is interoperability,” Rimpici said. “From a doctor's standpoint, there are hundreds of practice management systems and hundreds of EMR systems.”

Another challenge is the myriad laws governing privacy and information release, said Rimpici, citing a New Jersey law that a pregnant minor is automatically an emancipated adult with a right to privacy that supercedes parental access to her records.

High adoption rate
HealthMeans, based in Dallas, also markets to such closed groups as hospitals, physician groups, and insurance companies, said Vicki Judd, director of marketing. But as the cards become more common, others are brought into the network, including pharmacies and laboratories.

After five years of research and development, the product was launched in August, with adoption rates beyond company projections, said Frank Avignone, vice president of business development.

“Smart cards can do a lot,” Avignone said. “They're focused and specific. Our challenge is to create a market.” He added that the HealthMeans product abides by HIPPA standards and is Web-driven, with access to information restricted by the user. For example, the information an optometrist could access differs from what a physician or a mental health professional could obtain.

With socialized medicine the norm in many European countries, it's no wonder that smart card technology has made great inroads there. Germany, France, Italy's Lombardy and Veneto regions, Finland, Austria, Greece, and the Czech and Slovakian republics are working on a common Netcard platform that requires both patients and physicians to have a card