• Smart cards provide a convenient and secure medium for storing medical information.
• Medical applications of smart cards can be divided into six broad categories:

• Smart card technology was invented in France and both France and Germany are leading the way in health care applications.
• Medical applications of smart cards are being developed in both public and private sectors.
• The design of smart card systems can differ significantly i.e. built in encryption and electronic signature abilities (microprocessor-chip smart card system) or inexpensive 256-byte memory cards.
• Microprocessor-chip smart cards can offer unparalleled security features.

Healthcare smart cards are widely used in some European Nations, however they have not taken hold in the United States. This is mainly due to America's fragmented health care system and concerns about cost.

Smart cards are offered with either 4000 bits of memory or 8000 bits and at present are expensive to use. Smart card readers require to be purchased and are attached to a pentium-class Windows based personal computer.

Software companies involved in the development of healthcare smart cards will supply software embedded in the PC to read information, display it and encode updated information on the card.

Savings resulting from fewer duplicate tests and better treatment outcomes may offset costs. Therefore the use of smart cards will facilitate the process of care by saving time.

Doctors will have access to a wider range of information about patients, which will help, implement preventive health measures.

Initial investigations by countries into the use of smart cards have looked at storing basic demographic data e.g. a list of allergies and current medications, past treatment history, disease history and doctors notes.

Many software companies are developing a smart card system that links patients, emergency response teams, general practitioners, hospitals and pharmacies. In the future it is anticipated smart card readers will be located at health care facilities, including hospitals, doctors surgeries, mobile emergency units (ambulances) and pharmacies.

Smart cards will expedite the delivery of medical care while reducing administrative time and costs because they provide accurate information, decrease the likelihood of harmful drug interactions, improve provider/patient relationship and provide a private and secure information storage system.

Concerns about cost may stall the efforts to use the technology within the UK and the United States.

Some providers of health care believe a smart card with a computer chip that holds basic medical information will provide a database that patients can take with them.

Storing information using the smart card concept will eliminate errors and take a lot of guesswork out of the passage of information as patients move through the health care system.

Providers suggest that initially smart cards will have a niche application in health care but as the healthcare sector consolidates and the value of information on the card becomes more quantifiable they hope to see smart cards becoming the patient identification card.

Cedars-sinai Medical Centre in Los Angeles is piloting smart cards on prenatal care patients.

Storing medical information in an electronic format raises concerns about patient privacy and confidentiality. It is recognised that a security breach of electronic medical records might involve hundreds of thousands of records and go unnoticed. However as mentioned previously, microprocessor chip smart cards offer excellent security features as this type of technology has been used in banking for many years and has never been breached.

• Health card technology will allow patients discretion in limiting access to portions of their most sensitive medical information, particularly where there is no reason to do so.
• Patients may obtain their medical records and will be notified how the health and medical information in it is used.
• Legislation will determine that providers of health care smart cards will not engage in the marketing of personal health or medical information

Smart cards have the potential to help deliver better care to patients, cut down on costs and provide a more effective and efficient way of determining treatment.