Interestingly, this network of hospitals takes a few lessons from the old idea of sneakernet. The network avoids expensive new infrastructure or systems investments for the hospital IT groups. The cards themselves are the network link, Contino says. The network is open to all providers as long as they maintain interoperability of the cards. (For instance, all the cards in this project must use the same operating system.)

If Mount Sinai's biggest competitor wanted to use the cards, the hospital would agree, Contino says: "There's no competitive advantage to closing down the channel of information."

To use the cards, hospitals need only the readers ($20 gadgets) and freely downloadable viewer software. To add information to a patient's card, they buy editing software.

Another key point about the HealthSmart network approach: It doesn’t matter if all the institutions use differing systems and software. This decision was born of practicality: "The 10 institutions had very few of the same anything," Contino says.

The institutions range from Mount Sinai (which has 280 people in IT and a $47 million IT budget) to smaller hospitals and a community clinic. Some of these hospitals use fully electronic medical records, some don't. Mount Sinai's ER is paperless, others aren't. The smart card system doesn’t depend on any of these factors.

Plans call for the smart card system to be running at production level by the end of this year in most of the network hospitals, Contino says.

Making the Business Case for Smart Cards

What have the challenges been on the IT side so far? One of the biggest challenges for IT was making the initial business case to the CEO, CFO and board, says Contino (who reports to the CIO). "We had to prove out the argument of duplicate medical records."

Everyone felt there were valuable clinical benefits to exchanging patient data with other hospitals, but these benefits take time to prove out, Contino says. "We had to prove local value." The cost figures around duplicate records and claims denials were provable, and a key part of IT's pitch, he says.

A hospital can measure how much it's saving on prevention of medical records mistakes. It can measure how billing revenue measures up after registration errors are reduced. (And these are metrics Mount Sinai is certainly watching, though it's too early in their project to have ROI figures yet, Contino says.) It can be trickier to show financial payback for a hospital from the data-sharing from a RHIO (Regional Health Information Organization) network arrangement, Contino says. "RHIOs are typically sharing clinical data, not registration data," Contino says.