1. Information coming and going to the HIS, e.g., laboratory, pharmacy, orders, etc. 2. Information going to outpatient clinics for referring services, admissions to the hospital, or even to the patients physician at home. 3. In the emergency room, the utilization of an intensive care type of bedside terminal allowing data ollection, analysis and management, and also the ability to view clinical images in the ER. rom a consulting point of view, the whole electronic patient record, under an integrated diagnostic system,allows for any(department)consulting physician within or outside the hospital to review the case. Smart/Optical Card Smart/optical cards provide a wide range of applications in the medical field. The patient, the provider (e.g physician, dentist, etc. ) the hospital, and the insurer can all benefit from such a card. The card will eventually ontain all data forms-voice, text, graphics, clinical images, document images, signals, and data values collected from medical instrumentation. Besides patient identification/demographics, medical history, medications, aller- es, and insurance verification, the system could contain the patient's picture, fingerprint, digital signature, voice signature, and even genetic/blood information for security reasons The patient is admitted and treatment is provided more quickly, historical information is more accurate, and personal physicians and specialists can be consulted more quickly. Less testing may be a direct result, and faster diagnosis is accomplished. Since information needs to be entered only once, patients do not need to rely on their memory, particularly in emergency situations. The hospital identifies the patient and accesses all the medical records information from multiple departments more quickly. It needs fewer staff to find records from the hospital/clinics(even from other institutions), and this could reduce the length of stay The provider is better informed for a quicker diagnosis by getting all the available history at admission and can consult with the patients personal physician and specialist by having their respective phone numbers. All prior records from the same or a different set of institutions coexist in the card. It also can reduce exposure to malpractice The insurer reduces fraudulent claims, reduces costs for data entry, and has more complete and accurate claims data. Also, by eliminating redundant tests costs are reduced. Most of the cards can be classified into five groups by the type of technologies used: microfilm, magnetic trip, softstrip, chip, and laser/optical Microfilm is hard to change and can be damaged by both temperature and humidity. Magnetic strip contains little information, approximately 2K, and can be destroyed by electric and magnetic fields. The softstrip, because it is laser printed and optically read, is difficult to change information on. The chip card has only up to 10K of storage and is very expensive. Finally, the laser/optical card allows for approximately 1000 typed pages or approximately 4 Mb of memory and requires a read/write device Some of the complexities that are incorporated by using these types of technologies are associated with the access to the information. For someone to be able to either"read"and/or" write"in the card, it must possess technologies compatible with the ones where the information was created. It is a fundamental principle then that a set of international standards will be created so that any hospital that requires access to the card information can do so. Already the International Patient Cards Standards Council, the Health Industry Business Communications Council(HIBCC), and the Smart Card Applications and Technology(SCAT)have been created. These groups, among others, are working towards the goal of an international set of standards There is a large set of companies that are already marketing different types of card examples of proje Affiliated Healthcare in Princeton, New Jersey, which maintains a Health Summary Database with a Smart Card CentraHealth, a Florida hospital network with about 12K users Clinicard, a subscription service which provides a softstrip, 3K, PC DOS card that folds to a business Drexler Laser Card from Mountain View, California, which has 4 1-Mb card being tested by both British Telecom with a hospital group specializing in obstetric patients and Baylor College of Medicine in e 2000 by CRC Press LLC© 2000 by CRC Press LLC 1. Information coming and going to the HIS, e.g., laboratory, pharmacy, orders, etc. 2. Information going to outpatient clinics for referring services, admissions to the hospital, or even to the patient’s physician at home. 3. In the emergency room, the utilization of an intensive care type of bedside terminal allowing data collection, analysis and management, and also the ability to view clinical images in the ER. 4. From a consulting point of view, the whole electronic patient record, under an integrated diagnostic system, allows for any (department) consulting physician within or outside the hospital to review the case. Smart/Optical Cards Smart/optical cards provide a wide range of applications in the medical field. The patient, the provider (e.g., physician, dentist, etc.), the hospital, and the insurer can all benefit from such a card. The card will eventually contain all data forms—voice, text, graphics, clinical images, document images, signals, and data values collected from medical instrumentation. Besides patient identification/demographics, medical history, medications, aller￾gies, and insurance verification, the system could contain the patient’s picture, fingerprint, digital signature, voice signature, and even genetic/blood information for security reasons. The patient is admitted and treatment is provided more quickly, historical information is more accurate, and personal physicians and specialists can be consulted more quickly. Less testing may be a direct result, and faster diagnosis is accomplished. Since information needs to be entered only once, patients do not need to rely on their memory, particularly in emergency situations. The hospital identifies the patient and accesses all the medical records information from multiple departments more quickly. It needs fewer staff to find records from the hospital/clinics (even from other institutions), and this could reduce the length of stay. The provider is better informed for a quicker diagnosis by getting all the available history at admission and can consult with the patient’s personal physician and specialist by having their respective phone numbers. All prior records from the same or a different set of institutions coexist in the card. It also can reduce exposure to malpractice. The insurer reduces fraudulent claims, reduces costs for data entry, and has more complete and accurate claims data. Also, by eliminating redundant tests costs are reduced. Most of the cards can be classified into five groups by the type of technologies used: microfilm, magnetic strip, softstrip, chip, and laser/optical. Microfilm is hard to change and can be damaged by both temperature and humidity. Magnetic strip contains little information, approximately 2K, and can be destroyed by electric and magnetic fields. The softstrip, because it is laser printed and optically read, is difficult to change information on. The chip card has only up to 10K of storage and is very expensive. Finally, the laser/optical card allows for approximately 1000 typed pages or approximately 4 Mb of memory and requires a read/write device. Some of the complexities that are incorporated by using these types of technologies are associated with the access to the information. For someone to be able to either “read” and/or “write” in the card, it must possess technologies compatible with the ones where the information was created. It is a fundamental principle then that a set of international standards will be created so that any hospital that requires access to the card information can do so. Already the International Patient Cards Standards Council, the Health Industry Business Communications Council (HIBCC), and the Smart Card Applications and Technology (SCAT) have been created. These groups, among others, are working towards the goal of an international set of standards. There is a large set of companies that are already marketing different types of card technologies. Some examples of projects and/or vendors include: • Affiliated Healthcare in Princeton, New Jersey, which maintains a Health Summary Database with a Smart Card. • CentraHealth, a Florida hospital network with about 12K users. • Clinicard, a subscription service which provides a softstrip, 3K, PC DOS card that folds to a business card size. • Drexler LaserCard from Mountain View, California, which has 4.1-Mb card being tested by both British Telecom with a hospital group specializing in obstetric patients and Baylor College of Medicine in Houston, Texas