Health Passport

When Bismarck, N.D., held focus groups earlier this year to gauge how disadvantaged mothers and pregnant women would react to using a smart card that gives them access to Medicaid, Head Start and food subsidy programs, their concerns about privacy and technology were almost nil.

Instead, recipients of the Health Passport card were much more concerned with the immediate challenges of raising healthy children.

"My expectation and my dream all along with Health Passport is that we could make things not so difficult for clients, who have had to wade through paperwork at several different agencies," said social worker Bertie Bishop. "That can be an overwhelming task for someone, especially for someone who is in the difficult position of having to seek help in purchasing food for their family."

Bismarck, along with Cheyenne, Wyo., and later this summer, Reno, Nev., are the launch points for the Health Passport project, which is the first combined federal/multistate pilot to deliver a variety of benefits on a single smart card. Using Health Passport, an individual would be able to access Medicaid accounts and collect food benefits such as milk and cereal and other products under the federal government's Women, Infants and Children (WIC) program.

Coordinated by the Western Governors Association, Health Passport wraps together the efforts of many agencies at all levels of government. "The vision for the project 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," said Chris McKinnon, a WGA program manager.

The cards will store basic health-related information, such as immunization records. In part to allay concerns about confidentiality, the card contains no income-related data nor detailed health history information, such as a person's HIV status. The card also holds benefits information from different agency human services programs, but the data is segregated and can only be accessed by the appropriate agency.

In addition, the project aims to give clients more control over health care and benefits data and more responsibility for managing their own families' use of those programs. "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 eliminate the need to do the same paperwork for different programs over and over.

Information on the smart card, including a client's name, weight, height, immunization records, vision exams, WIC benefits, and program and referral information, can only be accessed or updated using the client's personal identification number. A card holder would swipe the card through a card reader at a doctor's office, for example, and then enter a PIN. Health care providers also would have PINs that determine what data on the patient's card they can access.

Those precautions seemed to satisfy some of the 5,000 Bismarck users, Bishop said. "We did some focus groups with clients of the North Dakota WIC and Head Start programs and some other families that will be involved," she said. "People today are very savvy in terms of electronics. They know how to use [automated teller machine] cards, and they know all about how giving out your PIN...will jeopardize secure information."

Siemens Information and Communications Networks is the prime contractor for the Health Passport proj-ect. 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, according to Mike Irvine, the project's program leader at Siemens.

The Urban Institute, a policy consulting firm, also is involved with the pilot, charged with evaluating aspects of the program on the client side. "We've been asking some questions about privacy, how they feel about sharing certain kinds of information," said senior research associate Nancy Pindus. "It's kind of early to tell. But using the small focus groups as a baseline, I would say that overall clients are very accepting. They really are technically sophisticated. They are younger, and the younger you are, the more exposure you've had to technology."

Colleen O'Hara is a senior reporter for Federal Computer Week. She can be reached at ohara@fcw.com.