Feds, states pilot smart health cards

In a project that could have implications for how the government delivers public benefits in the future, federal and state agencies next month will kick off a multistate pilot project to deliver a variety of public health programs on a single smart card.

The Health Passport Project will provide smart cards to about 25,000 people made up of pregnant women, mothers and children who are eligible for public health programs such as Medicaid and the Women, Infants and Children program, which provides supplemental food and counseling to families. The cards will store basic health-related information, such as immunization records. The program also will make it possible to electronically store in a single database the information that comes from different agencies in charge of human services programs.

The vision for the project, said Chris McKinnon, program manager at the Western Governors Association, "grew out of a desire to combine a number of different health care benefits and health care services for women and children. The idea was to cut down on costs for health care and provide the best care when and where it is needed."

In addition, the project aims to give patients more control over their health care information. Information on the smart card, which includes among other things a patient's name, weight, height, immunization records, vision exams, WIC benefits, and government program participation and referral information, can only be accessed or updated using the patient's personal identification number. A card holder will swipe the card through a reader at a doctor's office, for example, and then enter a PIN. All health care providers also will have PINs that determine what data on the patient's card they can access.

"Clients control that information," McKinnon said. "The long-range idea is that a client could take this card and travel to emergency-care facilities or other places and with them have a card containing health records and secured identification data." The card will prevent the need to fill out the same paperwork for different programs over and over.

The 18-month pilot project, which begins next month in Bismark, N.D., and Cheyenne, Wyo.

"My expectation and my dream with the Health Passport program is that we could make things not so difficult for clients who now have to wade through paperwork at several different agencies," said Bertie Bishop, North Dakota's Health Passport Project manager. "I truly see this as something that could work in a lot of areas, not just in public health but extending to the entire population base."

Recipients in Reno, Nev., will begin using the smart cards in the fall. If the pilot is successful, program officials may roll out the program nationwide.

Federal officials plan to apply lessons learned from the project to other federal programs that could benefit from multi-application smart cards, said Larry Carnes, who works in the General Services Administration's Office of Electronic Commerce, which is providing technical assistance to the project. "We will be able to compile a report of lessons learned to help federal agencies develop multi-application smart cards for health care services," Carnes said.

Katie Hirning, deputy director for information technology at the National Partnership for Reinventing Government, said the project is part of a trend toward electronically delivering services to citizens. "There's no question that we need to move ahead on delivering transaction services," she said. "Smart cards are one type of technology to do this and a good type for this [project]. They are not necessarily the end-all answer for everything."

Different services will require different levels of security and privacy controls, such as a public-key infrastructure, she added.

Reno was selected to participate in the project in part because the city represents a diverse population of beneficiaries. The city, which will begin the pilot in mid-September, is the only site that has no existing electronic benefits transfer infrastructure, which is necessary to deliver WIC benefits, said Marty Brown, a consultant hired by the Western Governors Association to oversee Reno's participation.

Cheyenne has an EBT infrastructure that will be updated during the pilot, and North Dakota plans to add EBT capability later but will initially limit its use of the system to within WIC offices.

Sandy Kaufman, director of state government affairs at Pasteur-Merieux Connaught, a company that produces vaccines and helped fund the project, said the project should raise immunization rates by keeping data accurate and centralized. "What appealed to us about the Health Passport Project is that it's a platform that, if it should prove successful, could be utilized in more than one state," he said.

The Agriculture Department's Food and Nutrition Service is folding its smart card-based WIC benefits program in Wyoming into the Health Passport Project. The project "automates the whole process and helps us reconcile our records with retail vendors that provide food services," said a spokesman at the Food and Nutrition Service. "It will make clear [to clients] what they can get, how much they have gotten and what they have left. It's a way to electronically keep track of WIC benefits."

Siemens Information and Communications Networks is the prime contractor for the Health Passport Project. The company is providing all technology, infrastructure, support and training for the project, which is the largest health care smart card project in the country, said Mike Irvine, the project's program leader at Siemens.