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What happened to the medical smart card?

For several years now, we’ve been hearing about the imminent deployment of a portable, multifunctional, accurate, read/write credit card-shaped personal medical record. Using chip and web technologies, the card can authenticate users, enable better clinical decisions, accelerate workflows and transactions, collapse the receivables cycle, features multimedia storage capabilities, and, most important, is cheap to produce and operate on a broadcast basis. Smart card technology has been trumpeted as a natural fit with healthcare, particularly as card features continue to expand and the technology matures. This includes sophisticated security features such as digital tokens, biometric identification, and public key infrastructure encryption, which meet HIPAA standards for data security and patient privacy. Multi-application cards can, it is claimed, capture, store, and retrieve sensitive patient information, patient demographics, and insurance information, and can support multiple transactions, including insurance verification and claims submission. A complete, up-to-date patient medical record can be accessed from any web-enabled location by using the digital “key” feature of the card. Sounds great, as long as it’s easy to implement, easy to maintain — and somebody else is going to pay for it. And there’s the rub. As a value add, the medical smart card holds undeniable appeal. The card is an effective branding device, patients love it, and it can accelerate transactions and workflows. But most players in the commercial healthcare market — the MCOs, hospitals, and physicians have shown tepid interest in the card. That’s understandable, because, to date, the economic rationality of the card is still unproven, and a compelling ROI remains elusive. Several pilots in both the public and commercial sectors have been well received, but most have quietly expired without striking sparks. The direct-to-consumer marketing angle is even more uncertain — witness the American Express track record with its Blue card — millions of dollars in advertising, giveaways, and incentives spent to prime the pump of consumer demand, and still the card is struggling to gain acceptance.