Smart Card Health Role in Rational Use of Medicines

The objective of this study is to examine the role of smart cared in health and their role in the rational use of medicines. Smart cards are very small and very secure and serve to protect patient privacy. Smart cards contain digital logs with location, date, time, and the individual’s stamp to record every transaction. Smart cards also may contain digital prescriptions therefore mistakes made with prescriptions that are handwritten are eliminated and specifically as to the “quantity or quality of medications.” (HealthOne, 2011)

How the Smart Card Works

The smart card uses technology that stores a patient’s personal health information on a microprocessor chip embedded in the card that is the size of a credit card but that has a “small metal contact plate on the front which is how the reader accesses the medical information stored on the chip” and this is accomplished only with the permission of the patient who enters a PIN code. (Gemalto, 2011) The patient’s PIN code is set by the patient at the time the smart card is issued. (Gemalto, 2011, paraphrased) The establishment of accurate patient identification who is receiving healthcare services is key in improvements to healthcare service delivery.

II. Smart Health Card Provisions

The work of Hsu, Li, and Liu entitled “ADRs and Smart Health Cards” reports that the use of “computerized physician order entry and online alerts to reduce medication errors are common elements of medication safety policy.” (2006) Hus, Li and Liu report the implementation of an automated alert system for drug-drug interactions in Taipei Municipal Wanfang Hospital, a hospital managed by Taipei Medical University and reports that the system “alerts the clinician in real time is a drug-drug interaction is detected for prescriptions” given at the hospital. (Hsu, Li, and Liu, 2006) Reports state that the system has the capability of detecting drug-drug interactions for prescriptions given from different hospitals by checking the electronic prescription records on the patient’s National Health Insurance (NHI) integrated circuit (IC) card.” (Hsu, Li, and Liu, 2006) Four types of information are reported to be stored on the NHI IC card including:

(1) Personal information;

(2) NHI-related information;

(3) Medical service information (including drug allergies, long-term care prescriptions, ambulatory care prescriptions and certain medical treatments); and (4) Public health information (including immunization records and willingness to donate organs) (Hsu, Li, and Liu, 2006)

III. Detection of Duplicate Medications

The work of Hsu, et al. (2011) entitled “Online detection of potential duplicate medications and changes of physician behavior for outpatients visiting multiple hospitals using national health insurance smart cards in Taiwan” reports on doctor shopping or “hospital shopping which means changing doctors or hospitals without professional referral for the same or similar illness conditions” and states that this practice is common in Hong Kong, Taiwan and Japan.” Because there is a lack of infrastructure for health information and medication history sharing among hospitals and doctors, “doctor-shopping patients are more likely to receive duplicate medications and suffer adverse drug reactions.” (Hsu, et al., 2011)

The study reported utilized a computerized physician order entry (CPOE) system that alerts physicians when potential duplication medications are detected at the time the doctor prescribes the medication. The system is reported to have identified 2.36% prescriptions that contained at least one duplicate medication and the rate of potential duplicate medication alerts for the hospital’s pediatric department is reported at 2.78%. The rate of physicians that reviewed and revised their prescriptions based on the system alerts is stated at 29.25%. (Hsu et al., 2011, paraphrased) The findings in this study emphasize the key role that the smart health card plays in reducing duplicate medications being prescribed to patients. In a separate study reported by Runciman, et al. (2003) it is stated that 2-4% of all hospital admissions, up to 30% of patients more than 75 years of age are medication related, and up to 75% of these could be prevented and were due to medication errors. The study reports “Errors occur in 15-20% of drug administration when ward stock systems are used and 5-8% when individual patient systems are used. Previous allergic reactions to drugs may not be recorded more than 75% of the time.” (Runciman, et al., 2003)

Summary and Conclusion

The health smart card offers a method to prevent prescribing of duplicate medications when patients visit multiple doctors, clinics, or hospitals and as well makes provision of a method of recording allergies to specific medications when patients have adverse reactions to those medications. As noted in the studies reviewed nearly 75% of adverse or allergic reactions to medications are never reported however, with the use of the health smart card, the treating physician, clinic or hospital can readily and easily record such adverse reactions to medications and through use of the health smart card duplicate medication prescriptions are easily avoided as well.

Bibliography

Benjamin, DM (2003) Reducing Medication Errors and Increasing Patient Safety: Case Studies in Clinical Pharmacology. J Clin Pharmacol 2003 Jul;43(7):768-83.

Hsu, MH (2011) Online detection of potential duplicate medications and changes of physician behavior for outpatients visiting multiple hospitals using national health insurance smart cards in Taiwan. Int J. Med Inform. 2011 Mar;80(3):181-9. Epub 2010 Dec 22.

Hsu, MH, Li, YC, and Liu, CT (2006) ADRs and Smart Health Cards. CMAJ Aug 15, 2006 Vol. 175 No. 4. Retrieved from: http://www.cmaj.ca/content/175/4/385.1.full

Runciman, WB et al. (2003) Adverse Drug Events and Medication Errors in Australia. Int J. Qual Health Care 2003, Dec;15 Suppl 1:i49-59.

Securing Healthcare: Smart Health Identification (2011) Gemalto. Retrieved from: http://www.gemalto.com/brochures/download/securing_health.pdf

Smart Card Software Custom Solutions (2011) HealthOne. Retrieved from: http://www.smartcardsource.com/health.html