A common exchange in a physician’s office:

“Mr, Smith, how do you feel?”

“Lousy, Dr. Jones,”

“What’s wrong with you?”

“That’s why I’m here to see you, so you can tell me what’s wrong.”

“Well, I need to get your medical history and your current complaint.”

“I feel lousy.”

“Yes, well, what brought you here?”

“A Yellow taxi cab.”

This scene, frustrating for both doctor and patient, is a dreaded one played out many times during a typical physician’s career. Physicians must extract a lifetime’s medical history, often relying on a patient’s memory, which may or may not be accurate. In the case of an emergency, or a debilitating condition such as Alzheimer’s or a stroke, a patient may not be able to relate important information that a doctor will need to know before providing care to that patient.

To eliminate these problems, and to inject efficiency and accuracy into the process, Dr. Gary T. Ryan has developed a concept which he has successfully launched in Culberson County, which encompasses Van Horn, TX, and the surrounding area. The Health Smart Card, similar in appearance to a credit card, contains an individual’s entire medical history on an embedded microcomputer chip. A medical history can be printed in less than one minute and made a part of a medical record, allowing health care providers an accurate, comprehensive history.

When Dr. Ryan successfully implements the program in El Paso, it will be the second area in the country to use the system, placing Van Horn and El Paso on what he calls the “bleeding edge” of this technology and light years ahead of the rest of the nation in terms of personal medical information storage and retrieval. He explains, “This is my home, and this is where I’m going to try to make the business work. This is a very positive step forward for the members of this community.

“This application of microcomputer chip technology was first used in Germany,” he reports, “where the government uses it to track the bureaucracy of socialized medicine for about 80 million people, but is not using it to maintain personal health records. I realized how much better the system is than a simple Med-Alert bracelet, which contains only limited information, and felt that this was the most proactive method of using this type of media in the field of medicine.”

Once he developed his idea of using the cards to store medical information, Dr. Ryan hired a programmer, and has secured an inventory of smart card readers and cards. When presenting the idea to health care facilities, he realized that he had a chicken-and-egg equation on his hands. He says, “Many people said they would commit to having a card reader on their premises once a large portion of the population had received cards, but the readers have to come first. The cards are of value only when the readers are in place. Many groups across the city are interested in having Health Smart Cards, and are simply waiting for providers to install readers.”

The readers are obviously ideal for emergency rooms and ambulances, but also will be of significant value to doctors’ offices, dentists, chiropractors, pharmacies and ancillary facilities. “Two hospitals have already agreed to place a reader in their emergency rooms and a school district is also very interested in having the readers to streamline checking for up-to-date immunization,” he says. When nursing homes send a resident to an ancillary facility for care, they can send a printout, shrinking the 45-minute medical history process to less than one minute and shaving time off of the patient’s visit. This is more efficient for the health care provider, as well as the patient.

Dr. Ryan explains that this technology has proven useful in many markets, such as in banking and retail. For instance, when attending a White Sox baseball game, a fan may purchase a card with a $20 value. When used to purchase food at a concession stand, the cost of items purchased is deducted from the value on the card. He explains, “There is no exchange of money, so you can’t receive the wrong change, there is no potential for employee theft, and the concessionaire or vendor has an automatic and accurate running inventory.”

The Health Smart Card system works in this way: An individual, with the assistance of family members if necessary, completes an application that requests an abundance of information – blood type, diagnoses, allergies, last hospital admission, surgical procedures, medications, their health care providers’ names, the existence of a living will, who to reach in case of an emergency, and insurance particulars. Updates may be made to the card as necessary, when procedures are performed, when new medicines are prescribed, or when insurance information changes.

Along with the card, two stickers are supplied to the cardbearer: one for the light switch just inside the front door of the person’s home, and an electrostatic sticker for their car windshield. These stickers alert emergency medical personnel to the existence of the card, which is to be carried next to the driver’s license.

When the Health Smart Card is needed, whether in a participating ambulance or emergency room or for a routine physician’s office visit or a trip to the pharmacy, the card is inserted in a reader which connects to a computer via a serial port. The data is displayed on the computer screen and then easily printed for inclusion in a medical record. The reader is about the size of a deck of cards and costs a mere $150. The software needed to read, display and print the information is free of charge.

Patient confidentiality is maintained with this advanced method of record keeping. “The individual who carries the smart card decides who reads the information,” Dr. Ryan asserts. The patient gives the card to the care givers who generate a printout which becomes part of the patient’s medical record. These records are already bound by the laws, rules and regulations concerning patient records confidentiality, and there is no mechanism for uploading the data to a mainframe computer from the card.

As a further safeguard, the informational application completed to generate the card allows an individual to omit facts they do not wish to divulge, and the printed report will indicate, “For other confidential information, please ask patient.” It is up to the patient to relay that information, further allowing the person to maintain control.

“The Health Smart Card is of significant benefit to patients and providers alike,” Dr, Ryan says. The University of Texas at El Paso’s business college conducted a study of this technology, and concluded that this high-tech tool is a valuable asset to a provider when considering the consequences that can stem from inaccurate medical information and the time involved in extracting information that may be incomplete or impossible to obtain.

(From M.D. News South East Edition)