Contino's vision of the future for personal health records, using smart cards and a consumer health portal, also varies from the original RHIO vision in several ways. To date, RHIOs haven't offered a sustainable business model for medical institutions, because they depend on grant money that can disappear. A RHIO also involves added infrastructure and operating costs, Contino says. Among the various RHIO arrangements being tried, there's no common technical framework, so scalability is a question. Finally, RHIOs don’t actively engage patients with regard to records, Contino says.

For reasons including these, some early RHIOs, such as the Santa Barbara County Care Data Exchange in California, have already thrown in the towel, as Computerworld reported recently.

A smart card solution along the lines of what Mount Sinai is using could let hospitals in a RHIO or in an informal network get more payback from data sharing, Contino believes. "Smart cards [with registration data] allow the institution to gain some value and ROI from the data exchange," he says.

What's Next for Mount Sinai’s Smart Card Program

Ultimately, one of the biggest issues around Mount Sinai's vision may be who issues the smart cards to consumers, and who bears the costs. The card issuer could be a hospital, an insurer, and employer, or a related entity. Mount Sinai's pilot is being funded by smart card vendor Siemens, as it prepares to develop future products, and the first 100,000 cards have been paid for by Siemens. The hospital will bear the cost of the cards after that. Contino believes that in the long term, the entity that consumers will trust the most is a hospital or medical group.

On the technology side, Contino notes one potentially significant hurdle looms. "One thing we have to overcome is incompatibility," he says. Given the way data is encoded on the chip on any smart card, the OS acts as a wrapper around that data. Different smart card vendors favor different operating systems. "There will continue to be several OSes," in the world at large, being used on smart card applications as varied as security and public transit, Contino says. "Ultimately, we'll need an interoperability layer." This would let developers use API-like functionality to access data on the card no matter the OS, he notes.

As far as advice to other IT leaders working on smart card rollouts, Contino says the Mount Sinai team followed classic IT strategy in one key regard. "Think focused, on an area where you can get immediate improvement, then think about aggregating services on the card."