Patient Healthcare Smart Card System: A Unified Medical .

2016 Proceedings of the Conference on Information Systems Applied ResearchLas Vegas, Nevada USAISSN: 2167-1508v9 n4275In 1998, a study involving an electronic chipcard was carried out where 5000 chronically illpatients throughout Hungary received a smartcard that had entire patients’ medical historystored in it (Naszlady & Naszlady 1998). Thegoal was to achieve complete patientinformation and also to support the growingneed for an integrated healthcare deliverymodel.Currently, there is no national health caresmartcard system in place in the US. However,in some European countries such as Britainand France, pilot programs had beenestablished over a decade ago. These pilotprograms have proved to be highly useful andeasilyimplementable(Neame,1997;Marschollek & Demirbilek 2006; Liu, Yang,Yeh, & Wang. 2006). Today’s, healthsmartcards in France have served the purposeof carrying information related to healthinsurance, and some ongoing health recordsand basic emergency health information.Furthermore, strengthening the evidence oftheir usefulness, the Exeter Care Card (ECC)pilot program that was funded by Britain'sDepartment of Health and carried out byExeter University (Hopkins, 1990), showedtremendous advantages of having such asmart card system in the health care industry.The advantages of the ECC pilot were thereduction in the cost of prescribing; reducedcost of carrying out investigations; reduction inrisk of iatrogenic cases of illness; reducedtimes taken for data communication; readyaccess to necessary medical records (Neame,1997). A valuable addition to the result of thestudy was that it also showed high patientsatisfaction levels.In 2006, another study illustrated to the UShealthcare industry the possibility of solvingone of the major hurdles to llek & Demirbilek, 2006). Sincehealthcare organizations do not use the samehealth information system software, there aremultiple sets of ways to code for the sameinformation based on the type of software thatis being used. These challenges can easily beovercome using standardized software withmultiplehealthcareinformation systems, such as used in theGermanHealthCardpilotprogram(Marschollek & Demirbilek, 2006).Another study conducted by Wei Chen et al(2012), proposed to establish a portableelectronic medical record system that appliedstreaming media technology to access medicalimages and transmit them via the Internet.This is an example of a distributed informationmanagement systems in healthcare. Figureone shows a graphical representation of thestructure of the portable electronic medicalrecord (EMR) system. The study proposed asystem that is composed of the EMR querysystem, data exchanging, and the EMRstreaming media system. The proposedarchitecture provided local hospital users theability to acquire EMR text files from aprevious hospital. It also helped accessmedical images as reference for clinicalmanagement. The proposed architectureshown in figure one provides a diagrammaticillustration of what a distributed informationsystem could look like (Wei Chen, 2010). Onemajor limitation to the system shown in thestudy is the system’s dependency on theinternet for its data transfer functionality.However, the concept proposed in this paperdoes not require the internet for its operabilityand functionality.The factors that have been referenced from allthe various studies described provides acompellingargumenttoimplementacomprehensive, consolidated and securemodel for healthcare information system thatcan be easily and quickly made available andaccessible to healthcare providers. Addingportability to the electronic medical recordsystem in the form of the UMRAA cardmaximizes efficiency and streamlines thewhole patient-doctor experience at a nationallevel.4. UNIFIED MEDICAL RECORD ACCESSAND ANALYTICS (UMRAA) DISTRIBUTEDINFORMATION SYSTEMThe work presented here proposes atheoretical approach to building a distributedinformation management system in the formof a Unified Medical Record Access andAnalytics (UMRAA) card. The UMRAA systemwill not only store patient's entire medicalhistory, but it will also update, synchronizeand store all information at every point of apatient’s encounter with healthcare (i.e.Hospital, Family Doctor, etc.). This systemenables any doctor in the US to view apatient’s entire medical history therebyincreasing overall efficiency and reducing thepossibility of potential medical errors or malltreatments.Historically, smart cards have supported animpressive variety of applications, and thisvariety will expand as the cards have becomesmaller, cheaper, and more powerful (Shelfer& Procaccino, 2002). With this innovativeoutlookandcompellingneedfora 2016 ISCAP (Information Systems & Computing Academic Professionals)http://iscap.infoPage 3

2016 Proceedings of the Conference on Information Systems Applied ResearchLas Vegas, Nevada USAISSN: 2167-1508v9 n4275comprehensive, consolidated and securemodel for healthcare information system, thisresearch describes a patient informationsystem, where the data is captured on all therespective information systems redundantly. Akey player in implementing the UMRAA Cardsystem is the federal government.The United States has one of the highest percapita health care spending among all thedeveloped countries (Anderson, Frogner, Johns& Reinhardt, 2006), yet healthcare remainscomplicated and expensive. Highest per capitahealthcare spending has not translated intomore resources; the problem here is that theUS health care system does not have theproper allocation of funds. The German HealthCard (Marschollek & Demirbilek, 2006), theTaiwanese national health insurance card –which also had medical records (Liu, C et al.,2006) - and the Exeter Care Card (Hopkins,1990) all have one thing in common. Theyhave government funding. Out of the threeaforementioned programs, the ECC andGerman Health Card were both well acceptedby the patients and healthcare providers.These studies suggest that such a programcan be implemented in the US and that theUMRAA card system will be well received bythe general population.However, it is worth mentioning that there areother proposals for integrating health caresuch as cloud based, block chain and personalhealth records. The characteristics of each ofthem are presented in table one.5. PROPOSED SYSTEMAlthough the use of information systemsincreased the quality of health care services, itstill faces numerous challenges (Shekelle,Morton, & Keeler, 2006). The existence ofmultiple information systems in varioushealthcare facilities can make it a realchallenge to compile and report the data fordifferent purposes (Heathfield, Pitty, &Hanka,1998). Historically, a number of data modelingtechniques have evolved from recent researchto improve reporting, analytics and quality ofhealth care. In a recent study (McGregor,2012), Patient Journey Modeling architecture(PaJMa) was used as a modelling technique fordata representation. PaJMa was an approachused for process flow modeling that wasdesigned specifically to understand thenuances of patient journeys during a patientprovider encounter.UMRAA is a portable unified medical recordsystem which is a part of a distributedhealthcare information system. It maintains acontinuously-growing list of data records thateach patient encounters. Each encounterrefers to a previous encounter on the smartcard and is thus the patient data on the smartcard is comprehensive and hardened againsttampering and revision by unauthorized users.The diagrammatic representation of theproposed system is represented in Figure 2which shows the data flow in the proposeddistributed information system. To phase inthe system to the current US population, thefirst point of patient's data entry will bedetermined by the circumstances of eachindividual patient. Current patients can begiven their UMRAA card on their next doctor orER visit, while new-borns can be registered inconjunction with the issuance of their socialsecurity card and/or birth certificate. Theproposed system could work very similarly to aCarFax (Barnett 1991) report that consumerscan obtain for knowing the complete history ofa car based on its vehicle identificationnumber.CarFax is a database search and reportingprogram where used car consumers enter avehicle identification number (VIN). A CarFaxapplication searches a database, and providesa report for a small fee. The business modelfor Carfax is as follows: used car consumerswant to know if an automobile has a tarnishedhistory, and CarFax provides an instantanswer. CarFax is able to provide an answerbecause they have compiled a huge databaseof more than 1 billion vehicle registrationrecords. By searching the database it canquickly provide detailed information on justabout any vehicle sold in the US. The systemproposed in the paper can be thought of as a“CarFax for patients."Similar to a CarFax report, a healthcareprovider such as a physician or nursepractitioner in any part of the United Statesmay have access to a patient's entire medicalhistory, regardless of which part of the countryand what type of service the patient receives.For instance, a family doctor’s reports fromAnchorage, Alaska and free clinic reports fromAtlanta, Georgia can all be accessible to anurse practitioner in Amelia, Ohio). TheUMRAA Card will synchronize (i.e. Downloadnew data and upload previous data or evenjust allow access to the information stored) allinformation every time it is accessed at ahealthcare facility.Even after the Affordable Care Act (ACA),private healthcare organizations have thetendency to work in silos. Therefore the idea ofhaving a Unified medical record would not be 2016 ISCAP (Information Systems & Computing Academic Professionals)http://iscap.infoPage 4

2016 Proceedings of the Conference on Information Systems Applied ResearchLas Vegas, Nevada USAISSN: 2167-1508v9 n4275well accepted in the US. For the US healthcaresystem to adopt the proposed plan nationwide,it is important that the federal governmentpush this agenda as an addition to the ACAwhich would help further the cause of movingfrom fee based performance to value basedsystem. Individual health organizations wouldnot be willing to adopt such a system as theyfear that it would lead to patient poaching bytheir competitors. The data available in thesmart card could be available to competitors ifpatients come in contact with competitors.Therefore, in order to implement and reap thebenefits of the proposed plan, it needs to beadopted by the federal government which canmake it a mandate as they did it in case of theACA.In addition, the adoption of the proposed planwould require the development of a commonvocabulary. A champion from the highestechelon of government will be required toencourage adoption of such a system byhealthcare providers, patients and insuranceproviders. High system adoption and systemsuccess through a strong champion from uppermanagement is well recognized in large ITimplementations in organizations (Cresswell,Bates, & Sheikh, 2013). Such a championwouldencourageallstakeholdersandconsumers to adopt and share a commonvocabulary/taxonomy. These stakeholders andconsumers will be able to reap the benefitsonly if they are willing to talk the samelanguage and if they are willing to do adopt acommon taxonomy. In other words, achampionfromthe ead adoption of a shared taxonomy isessential to implementing the proposed plan.The implementation of the UMRAA Cardsystem can be straight forward. Figure threeshows the step by step illustration of theUMRAA process. Patient registration istriggered on the very first visit of a patient toany health care facilities or at birth. Theproposed system requires patients to registerat a point of interest in any possible routessuch as primary care practice, hospital facility,social services or emergency room. Inemergency cases, healthcare takes precedenceover recording patient information and in somecases the formalities are relaxed in anemergency situation. The prioritization ofregistration and healthcare support is ce.Therefore,thepatientregistration can take place before or after thetreatment for first-time visitors.The UMRAA record for each patient is createdin a database and stored on a portableelectronic card. The next step of the processwould be to encrypt the UMRAA card with asecure password. Now the UMRAA card isready to be carried by the individual patientand presented at all health care facilities fordata synchronization on each visit. After theessential clinical and health care activities, thepatient data is recorded in the informationsystem and transferred over to the health carecard. If the patient paid a visit to anotherhealth care facility and the card is holding newdata, it is transferred over to the primary careinformationsystem.Thiswillensurecompleteness of patient data in all health carefacilities. The process is visually presented inFigure 4.However, the patient may also choose only tohave new reports downloaded and have theirprevious history be only viewable to thehealthcare provider they are seeing. Thismethod will prevent possible privacy leaks andalso prevent a littering of data in healthcaredatabases throughout the country where thepatient was only visiting and had neededunplanned emergency care.6. POTENTIAL BENEFITSThe UMRAA card would have a number ofpotential benefits with regards to manydifferent stakeholders in the continuum ofcare. From a patient's perspective, the patienthas complete and comprehensive informationabout his/her health status. This wouldimmensely help in terms of patient complianceand satisfaction. Furthermore, most of thebenefits that have been outlined for otherstakeholders seem also to apply to individualpatients as well.Fromtheproviders’perspective,thehealthcare provider will have completeknowledge and information that would berequired to deliver a complete managementplan. This vital information would also help inavoiding duplication of health services and atthe same time avoid redundancies. The majorbenefit from the UMRAA card would be in theevent of an emergency at a healthcare facilitythat never had any prior encounter with thepatient seeking emergency medical care. Theinformation on the card would be critical inmaking life and death decisions that wouldimpact the health of the patient. Anothersignificant benefit would be the reduction inreadmission rates with the help of the dataavailable from UMRAA to the first clinical pointof contact which would potentially help thehealthcare provider to take necessary steps to 2016 ISCAP (Information Systems & Computing Academic Professionals)http://iscap.infoPage 5

2016 Proceedings of the Conference on Information Systems Applied ResearchLas Vegas, Nevada USAISSN: 2167-1508v9 oking from a payer’s perspective, UMRAAcould lead to care coordination and reductionin over utilization leading to cost savings.Lesser administrative burden to processclaims. Customization of health plans todetermine the best combination of benefits forcovered lives.To put things in perspective, US healthcaresystem is one of the biggest spenders incomparisontoitsotherdevelopedcounterparts worldwide. In spite of havingextraordinary expenditure geared towardshealthcare, outcomes do not match theexpenditure or are less than some of thecountries that spend far less than the US onhealthcare. In view of these unfavorabletrends in US healthcare, politicians and lawmaker have systematically steered healthcarefrom volume to value based service with theaid of various policies and reforms over theyears (Mayes, R. 2011). Moving forward,having such new unexplored territories in thearea of population health and value basedcare, would be detrimental for organizationswith limited access to needed data. Havingaccess to information that would help themcontrol cost as well as provide quality care inorder to be in alignment with the policies andreforms, is crucial for success. The kind oftimely analytical information that can bederived from the data on UMRAA can be theparamount factor providing competitive edgeto healthcare providers seeking growth inbusiness and increased market share.UMRAAcanprovideinstantpredictiveinformation to healthcare personnel withregards to impending acute health episodebased on the trend in the chronic condition ofa patient. It can potentially reduce theemergency department visits as well as thethirty day readmission post discharge from ahealthcare facility (Amarasingham, R., et al,2010). As the US healthcare system is pacingtowards a shift from volume to value basedcare as well as reimbursement; much of thefinancial gains are going to come from keepingpatients out of emergency departments as wellas preventing 30 day readmissions. Integratedsystems like UMRAA are going to greatlyimpact such areas with reliable and accuratepredictive information. This will enable payersand providers to act in time and steer towardsdesirable health outcomes that are in line withthe requirements of the centers for Medicareand Medicaid services (CMS).Healthcareorganizationshavingaccess,disease, outcomes and analytics data, derivedfromUMRAA,canbetremendouslyinstrumental to organizations. They can betteralign with the requirements of the CMS, as aresult. CMS is the largest healthcare payer inthe US., An organization’s ability to align withCMS’s requirements with the help of predictiveanalytics coming from UMRAA can greatlyimpact the financial viability of organizations.With enhanced reimbursements, rmore, with regards to BI benefits fromUMRAA, avoiding duplication and reduction inredundancies can potentially give rise toeconomies of scale in relation to the use ofsupplies and cost of care. Additionally, havingmass quantities of information coming frompatient encounters across the continuum ofcare can facilitate the development ofbenchmark and best practices.In addition to the above, CMS and healthcarein general are slowly steering towardspopulation health and bundled payments.Historically, healthcare organizations, and thedifferent entities within have worked in silos.This kind of operational silos in terms ofproviding and managing care will makepredicting risk for bundled payments verydifficult. UMRAA can be helpful in assessingtime and costs in terms of episodes of care.This will help organizations be more costeffective in terms of predicting costs based onhistorical expenditures. Having the advantageof data and information in terms of cost of thecare during the continuum can help thempredict ball park risk. This will help us betternegotiate payer contracts as well as deliverefficient and timely care leading to increasedfinancial returns.The vast amount of information and data thatwould be gathered from a complete andcomprehensive healthcare history of patients’would help in running clinical and non-clinicalhealthcare analytics that would greatly help inresearch and development of clinical as well ashealthcare management protocols. The vastamount of data and knowledge that would begenerated from the advanced analytics ofpatient data will improve the efficiency ofhealthcare management and reduce healthcarecosts, both, to the individual patient as well asthe US healthcare system in general(Raghupathi, Raghupathi 2014). This kind ofbusiness and clinical intelligence frameworkcan lead to a major breakthrough in healthcareand can give rise to a completely newapproach to the way the US delivershealthcare in the future (Foshay, & Kuziemsky,2014). 2016 ISCAP (Information Systems & Computing Academic Professionals)http://iscap.infoPage 6

2016 Proceedings of the Conference on Information Systems Applied ResearchLas Vegas, Nevada USAISSN: 2167-1508v9 n42757. CHALLENGESWhile there are a number of advantages ofUMRAA, there are some challenges to theproposed approach. The UMRAA card systemwill incur costs of hardware, portable electronichealth care cards, and software. In addition tothenumerouscostsassociatedwithhealthcare, the added costs of this system willbe a burden that can be felt across the board,ranging from increasing insurance premiumsto increasing tax rates.The costs associated with the initiation,implementation, and maintenance of thissystem will have to be shared between thegovernments (i.e. City, State & Federal),insurance companies and local healthcaresystems. As mentioned earlier, the costsassociated with the initiation of this programwill have to be funded via a federal ion, the program can be startedstate wise, with the least economically weakstates implementing the program first.Furthermore, the maintenance costs of thisprogram will have to be shared in someproportion by all parties responsible for thehealthcare needs of a US resident, namely, thegovernmentsatalllevels,insurancecompanies, and even the individual hospitalsystem or primary practice at a local level.This ensures that there are checks andbalances across the board, and everyone isheld accountable.The system requires a compatible system ateach patient healthcare touch point. Words onany online material can be recognized bysoftware as text that can be editable.Similarly, the UMRAA database will have to beable to recognize all the data associated withmedical records across various health carecheck points and be able to store that data inan effective way for daily access as well asdecision support analytics.The damaged, lost or stolen cards can occurand bring about additional costs. Such cardsmay also raise privacy and security concerns.These costs will, to a certain extent, be theresponsibility of the patients. Just as socialsecurity cards and expensive jewellery areprotected, the UMRAA card will also become anindispensable part of an individual. Providing asecure way of accessing the

and basic emergency health information. Furthermore, strengthening the evidence of their usefulness, the Exeter Care Card (ECC) pilot program that was funded by Britain's Department of Health and carried out by Exeter University (Hopk