Academic journal article Australian Health Review

Health Smart Cards: Differing Perceptions of Emergency Department Patients and Staff

Academic journal article Australian Health Review

Health Smart Cards: Differing Perceptions of Emergency Department Patients and Staff

Article excerpt


An analytical, cross-sectional survey of 270 emergency department patients and 92 staff undertaken in three tertiary referral hospital emergency departments was completed to compare the perceptions of patients and staff regarding the use of health smart cards containing patient medical records. The study recorded data on a range of health smart card issues including awareness, privacy, confidentiality, security, advantages and disadvantages, and willingness to use. A significantly higher proportion of staff had heard of the card. The perceived disadvantages reported by patients and staff were, overall, significantly different, with the staff reporting more disadvantages. A significantly higher proportion of patients believed that they should choose what information is on the card and who should have access to the information. Patients were more conservative regarding what information should be included, but staff were more conservative regarding who should have access to the information. Significantly fewer staff believed that patients could reliably handle the cards. Overall, however, the cards were considered acceptable and useful, and their introduction would be supported.

Aust Health Rev 2009: 33(1): 136-143

A SMART CARD is a plastic card containing a microchip that has a memory capacity superior to magnetic stripes and that can be updated readily.1-4 The card can be equipped with a personal identification number (PIN), can require an authorised card reader system and can be configured to reveal certain information depending on the person seeking access. 1,2,5 It is one manifestation of the inexorable move to electronic documents and the ease with which they can be transported and shared. Indeed, smart card portability and improved access are compelling. Health smart cards have a number of potential advantages including large memory capacity, owner identification, waterproofing of electronics, readability without computer network access and immediate access to a patient's medical history in an emergency situation.3 There is concern, however, regarding the security and confidentiality of smart card information as evidenced by the scrapping of the Australia Card first proposed in 1986.5

The Consumers Health Forum of Australia Inc (CHF) helps shape health policy and program development and has an interest in the development of e-health.6 Its research indicates that consumers want their health information available when and where they need it for best health outcomes.7 Based on its 2005-06 E-Health Records Project activities, CHF recommended practical strategies related to privacy, governance, and shared decision-making between health providers and consumers.8 Governmental agencies have also addressed these issues. The HealthConnect strategy, a partnership between the Australian, state and territory governments, will facilitate the adoption of common standards by all e-health systems so that vital health information can be securely exchanged between health care providers such as doctors, specialists, pharmacists and hospitals.9

Meanwhile, health smart technology is used in Australia. In 2004, the trial of a Medicare smart card was launched in Tasmania.10 It includes data relating to the owner's organ donor and Medicare safety net status, immunisation records, and Pharmaceutical Benefits Scheme (PBS) expenditure data, and provides access to standard Medicare services.10 This Medicare card allows access to the owner's records via HealthConnect but does not store these data itself.1112 The former Australian coalition government had proposed an Access card - a smart card which would hold the owner's name, address, date of birth and concession status.13 Like the Medicare card, there was the option of storing health-related data such as allergies, health alerts, chronic illnesses, immunisation information or organ donor status.14 The Access card may have replaced 17 health and social services cards, including the Medicare card. …

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