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

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 Information on HealthMeans Inc. is available at

SOURCE-Hospital Access Management