The HealthSmart Network Creating a Regional Health Network using Smart Cards

Paul Contino Vice President Information Technology Mount Sinai Medical Center

2006 Annual Conference October 5th, 2006 The Pulse of Healthcare

• High density urban population • Highly competitive healthcare marketplace • are in debit and losing money • NY has nations greatest income and health disparities between rich and poor • NY has some of the finest medical institutions in the US Mount Sinai Medical Center

• Founded in 1852, The Mount Sinai is one of the country's oldest and largest voluntary teaching hospitals. • Mount Sinai is internationally acclaimed for excellence in clinical care, education, and scientific research in nearly every aspect of medicine. • Mount Sinai's 1,171-bed tertiary-care teaching hospital with a medical staff of nearly 1,800 provides physicians who deliver the most advanced and compassionate inpatient and outpatient care. • Located at 98th Street and , The Mount Sinai Hospital serves 's Upper East Side and Mount Sinai – Affiliate Network

Affiliated Hospitals Physician Practices Veteran's Affairs Medical Center Mount Kisco Medical Group Cabrini Medical Center North Shore Medical Group Elmhurst Hospital Center Englewood Hospital and Medical Center LTC Facilities / Nursing Homes The Liberty HealthCare System, Inc. Arden Hill Life Care Center - Greenville Hospital Cabrini Center for Nursing & Rehab - Jersey City Medical Center Sarah R. Neuman Nursing Home - Meadowlands Hospital Medical Center The Jewish Home & Hospital Maimonides Medical Center The Mount Sinai Hospital of Strategic Alliances North General Hospital Saint Barnabas Health Care Network-NJ Phelps Memorial Hospital Center North Shore / LIJ Health System Queens Hospital Center St. Joseph's Hospital and Medical Center Our Vision ...

• Develop a Regional Health Network using smart cards • Leverage our large affiliate network • Easily and accurately identify patients at points of care • Allow providers the ability to track patients through a course of treatment that crosses multiple organizations and be able to access extensive medical record data • Share patient data between systems or between providers without server and network connections How we got started?

• Successful Smart Card pilot at Elmhurst Hospital in 2003 • Mount Sinai wanted to expand upon conceptual design • Mount Sinai and Elmhurst Hospital partnered with Siemens to develop the Personal Health Card system • Mount Sinai forms the HealthSmart Network Concept for a Regional Health Network

Mount Sinai and HHC both have a large network of facilities and affiliated health systems that can be linked together to form the “seed” for a regional health network.

The network would be open to all providers as long as card interoperability is maintained. The network concept can be easily replicated and could quickly expand to a multi-state and potentially a national level, in much the same way that ATM cash networks (Most, Cirrus, Plus, NYCE) grew in the late 1970’s and early 1980’s.

The patient with their smart card becomes the network The HealthSmart Network - Pilot

St. John’s Riverside Englewood

North General

Mount Settlement Health Sinai

Cabrini Jersey City Elmhurst

Mount Sinai Queens Queens What is the Personal Health Card?

• A secure smart card that contains your critical health care information: current medications, allergies, recent laboratory test results, EKG, blood type, recent medical encounters and insurance/demographic information • Allows medical providers the ability to track patients through a course of care that spans multiple organizations • Identifies and authenticates the patient and provides for improved registration and insurance processing • Provided the patient with control of their medical data • Delivers a scalable Portable Health Record Development of the Personal Health Card

The New System • Allows multiple healthcare providers to share patient information on the same card. • Allows an institution to easily interface its clinical and registration systems via HL7 standards • Has advanced security and identity management • Has image storage capability (EKG) • Can configure data as permanent or temporal • Configurable roll-off logic controls data retention • Data structure conforms to emerging CCR standard Local Benefits and Business Case

• Reduce medical errors and adverse events • Reduce medical records maintenance costs (duplicate/commingled) • Reduce registration time for patients • Accelerate clinical information availability in emergency care • Increase awareness of providers brand in and out of their service area. • Strengthen voluntary physician relationship Personal Health Card - features

64K MPU Memory Chip

Identification Bar Code Photo

FRONT Printed / Embossed Patient Information

Magnetic Stripe Corporate Logos / Sponsor Branding

BACK Personal Health Card – what’s on the chip

Patient Identification Recent Laboratory Results & Demographics Glucose 190 (70 – 110) mg/dL 4-2-2006 Name: Smith, John Glucose 150 (70 – 110) mg/dL 4-16-2006 Sex: Male Glucose 130 (70 – 110) mg/dL 4-20-2006 DOB: 11-18-1942 PSA 5 (0 – 4) ng/mL 1-23-2005 Address: 23 East 92nd Street New York, NY 10029 Home Tel: (212) 245-3455 Work Tel: (212) 826-1212 Ext 2332 Medical Summary Insurance: Oxford [Policy No. 2134323] & Problem List Emergency Contacts: Ellen Smith, Wife (212)-226-1232 Recent Healthcare Current Medications Encounters & Allergies Compressed EKG Image Medications: Coreg (12.5mg) 2xDaily Accupril (40mg) 1xDaily Pointers to Glucovance (500/5) 2xDaily Humulin 70/30 25-30 units as needed Remote / Allergies: Type: Penicillin Drug Off-Card Data Peanut (severe) Food Latex Environ Personal Health Card – how it works

Electronic Data Sources Smart Card Card Management System (CMS) Hospital Admitting System (ADT)

Clinical / Lab Systems Personalization: Photo, Printing, Electronic Medical Records Data Encoding Support for: Demographics, -HL7 Manual Data Entry MRN - Flat File (Batch) - Database Query

Card Viewer (CV) Card Editor (CE) Smart Card Database Data Import Repository of Engine incoming clinical data Important Considerations

• Health Card is not intended to be a complete EMR • Data model is focused on elements that would be valuable to critical care • No attempt was made to standardize data across institutions – “as is” presentation • Limited storage on the card (64K), roll-off logic for card data • Treat the Patient - Not the Card

• Interoperability by Design – if you use the PHC then you are part of the network There Are Benefits To All Stakeholders

Health Care Provider Patient • Instant patient identification - accurately links • Secure and portable health record patients to institutional medical records, and helps • Control of record access to eliiminate duplicate or commingled records • Easier and faster registration • Delivers quicker care for patients in • Improved and faster treatment and Emergency Care setting, rapid accessibility of medical care patient medical history • Positive identification of patient for • Potential to reduces adverse events and treatment and billing medical errors due to lack of patient information • May accelerates treatment in the • Delivers quick access to key medical record case of emergency data – without significant IT infrastructure investment • Tracks patients through a course of treatment Payor that crosses multiple organizations • Verifies eligibility and plan information • Reduces unnecessary / duplicate diagnostic • Reduce medical fraud tests or procedures by showing results from other • Reduce claim denials medical providers • Formulary compliance • Immediate adjudication at point of care • Can be used as eligibility/debit card for Personal Health Savings Accounts (HSA) Advantages of Smart Cards in Healthcare

• Provides a wide range of benefits across the spectrum of stakeholders (patient - provider - payor) • Proven technology solution (used as part of national health programs in Italy, France, Germany) • Provide a secure means of authenticating a patient and providing access to medical information • Can support multi-function/multi-application needs (health record, health benefit savings account, insurance verification all on one card) • Can provide a low-cost approach to achieving a regional and potentially a national health infrastructure • Can become the secure key into the national health infrastructure once it is developed. • Puts the patient in control of his/her medical information Extended Uses of Health Cards

Secure Electronic Prescriptions

First Responders: Emergency / Disaster Health Savings Situations Accounts (HSA)

Disease / Case Management Programs Nursing Homes / Long Term Care RHIOs Facilities National Health Infrastructure (NHIN) What about RHIOs and NHIN?

• See smart card technology as collaborative not competitive • Smart cards are available now • Proven, scalable technology • Costs of RHIO’s and NHIN are prohibitive • May provide solution to security and identity issues • Smart cards make initiatives more consumer-friendly The HealthSmart Network

Achieves the Vision . . . .

9 Improving Patient Care 9 Lowering Medical Costs 9 Empowering Patients The HealthSmart Network

Questions and Answers

Paul Contino Vice President, Information Technology Mount Sinai Medical Center New York, NY [email protected] (212) 659-1429