Use of Smart Card Technology Puts Texas System on the Cutting Edge

Project's flexible approach fits needs of rural facilities

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."