By Jeffrey E. Barnhart, ICMA

Imagine you become ill in a foreign country and have to be taken to a hospital. Typically, the hospital administrators will have to contact your doctor, insurance company or government provider, and next-of-kin to find out about your medical history - and if you are seriously injured and unconscious, precious minutes may be ticking by. Furthermore, barriers of time zones and language can make quick contact difficult at a critical time.

Now suppose all of your health history could be carried with you on a credit card-sized microchip smart card - your physician and insurance contacts, all illnesses and operations, blood type, vital signs, medical history, current medications, allergies and more, in a password protected format available only to you and medical providers. Such a system could literally mean the difference between life and death.

This is not as futuristic as it may seem. The country of China is currently initiating a National ID Smart Card that will carry the health history of its 1.5 billion citizens - and other countries and health systems are following suit in Taiwan, Macao, Germany, Austria and more. By using smart cards, patient data can be accessed much more quickly than paper file and document records. But in order to be viable, some issues regarding standards must be addressed.

According to the ISO (the International Organization for Standardization of which ICMA is a member and maintains representation)* Working Group (WG) 5 on Health Cards of ISO/TC 215, Health Informatics was drawn up in 1999, and now, four work items have been officially approved and are well advanced - while others are in different stages of development. In order to understand the standard issues, first let's define a health card.

ISO defines a health card as a card that contains computer-readable data that is issued to a patient or healthcare professional to facilitate the provision of healthcare. The different technologies to store these data include barcodes, magnetic stripes, IC memory cards, IC smart cards and optical memory cards. Applications include administrative functions, emergency health cards, records of specialty-specific care, prescriptions used, and general patient-held records.

An important issue for implementation is interoperability, or the ability of one health card system to read, use and/or update another health card system. Since the benefits of health cards come from their portability across geographic regions, it is important to develop interoperable health card systems. Currently within ISO/TC 215, Health informatics, WG 5, Health cards, experts from 18 nations are working on harmonization of these systems. The physical characteristics of these cards derive from the more familiar card standard ISO/IEC 7810, Identification cards - Physical Characteristics. Standards for health cards are being developed principally based on the content of the cards intended to convey healthcare data not immediately usable by other means, but WG 5 is only considering credit-card sized health cards that conform to ISO/IEC 7810, Identification cards - Physical Characteristics.

Standards are evolving from different sets of documents and precedents already in place in diverse countries for health care information delivery. These have led to a new draft standard (i.e. work in progress) ISO/DIS 21549, Health informatics - Patient health card data, in which data is placed on a voluntary basis with the patient's informed consent. It includes electronic prescription information and linkage information and is now an eight-part work item incorporating portable information systems and storage and access devices to them.

These patient health card data includes four subsets: device data (identifying the device(s) and functions); identification data (unique ID of the device holder and related parties); administrative data (funding relationships, insurance carriers, public or private healthcare providers); and clinical data (information about the cardholder's health, events, appraisal and labeling by a healthcare professional, and related actions planned or performed). Obviously, some of these data are shared across the subsets, such as names, ID numbers, provider information, etc.

The goal is an easy-to-access, portable, interoperable card that can be read by patients and healthcare professionals across different computers and software. The benefits of a smart card come via its ability to store large amounts of data in a password-protected manner, so
that confidential health data is not compromised - and to be carried in a portable manner and principally controlled by the cardholder. The smart cards are capable of carrying biometric identifiers such as fingerprint or iris scan data to authenticate the cardholder, the main bearer of their data. They can then be used routinely in special readers in doctors' offices, ambulances and hospitals throughout the world, once standards are finalized.

These smart cards will lower administrative costs, refine and pinpoint patient information, and, most importantly, serve patients' general and critical healthcare needs - whether they've run out of a prescription drug on a trip or are in transit to a hospital emergency room. Certainly, this will make navigating this increasingly shrinking world much safer and easier in the future.

*Source: "Your Medical History on a Smart Card;" By Juergen Sembritzki, Convener, ISO/TC 215 Health Informatics, Working Group WG 5, Health cards; ISO Bulletin, June 2003.