Giving patients more control over their own medical records is a complicated problem that various companies and governmental groups have been trying to crack for years. President Bush backs the idea of a Nationwide Health Information Network to reduce costs and improve care, through making records electronic and more easily shared among institutions. As part of that NHIN effort, various RHIOs (regional health information organizations) are working on ways to connect records and make systems interoperable between institutions.

Private industry sees big dollars to be made in organizing medical records: Google's expressed interest and Microsoft made news last week with its HealthVault service, an advertising-supported Web portal where consumers can collate their medical records. Contino believes Microsoft's model asks a bit too much work of consumers.

"The card is portable," he adds. "A Web site doesn’t have a security token that you can carry with you as you travel through institutions."

Contino advocates an arrangement where consumers use a smart card with a medical history snapshot, combined with a personal health portal run by a trusted third-party like a hospital or medical practice. The portal becomes important since the Web has unlimited space, whereas a 64K smart card doesn’t, says Contino, who also serves as co-chair of the Smart Card Alliance's healthcare council, helping the non-profit industry group share expertise and best practices.

The key for patients is control, Contino says. "The patient can see everything on the card," Contino says. "This gets rid of the fear factor that a lot of patients have." Today Mount Sinai patients can view card data using a kiosk at the hospital; in the future, Contino envisions consumer kits including card readers for home use. Mount Sinai has already learned some interesting technology and organizational lessons since rolling out the first 2000 or so health cards since February, and since forming a network of 10 New York area medical institutions to use the system.

Paper Problem, Portable Answer

Most people know all too well the reality of medical records today: The first thing you do upon arrival at a medical facility is present your driver's license and insurance card. Then you fill out an average of about 4 forms per visit. If you're visiting different departments within a hospital in one day, you may fill out a form-filled clipboard with the same information repeatedly. That information will not necessarily follow you to your primary care doctor or offsite specialists.

As Frank Avignone, VP of medical data firm Cocentrx, noted at the Smart Card Alliance's annual conference in Boston last week: “When was the last time you looked at anything other than a piece of paper for your healthcare information? The healthcare industry needs to catch up.” Everyone has their own paperwork-related snafu story. It's not surprising that patients, Contino says, want more control.