Médicarte software developed for the Quebec microprocessor health card project

The Quebec Patient Smart Card Project is a Provincial Government initiative under the responsibility of the Rgie de l'assurance-maladie du Québec (Quebec Health Insurance Board). Development, implementation, and assessment duties were assigned to a team from Université Laval, which in turn joined a group from the Direction de la santé publique du Bas-St-Laurent in Rimouski, where the experiment is taking place. The pilot project seeks to evaluate the use and acceptance of a microprocessor card as a way to improve the exchange of clinical information between card users and various health professionals. The card can be best described as a résumé containing information pertinent to an individual's health history. It is not a complete medical file; rather, it is a summary to be used as a starting point for a discussion between health professionals and patients. The target population is composed of persons 60 years and over, pregnant women, infants under 18 months, and the residents of a small town located in the target area, St-Fabien, regardless of age. The health professionals involved are general practitioners, specialists, pharmacists, nurses, and ambulance personnel. Participation in the project is on a voluntary basis. Each health care provider participating in the project has a personal identification number (PIN) and must use both an access card and a user card to access information. This prevents unauthorized access to a patient's card and allows the staff to sign and date information entered onto the patient card. To test the microprocessor card, we developed software based on a problem-oriented approach integrating diagnosis, investigations, treatments, and referrals. This software is not an expert system that constrains the clinician to a particular decisional algorithm. Instead, the software supports the physician in decision making. The software was developed with a graphical interface (Windows 3.1) to maximize its user friendliness. A version of the software was developed for each of the four groups of health care providers involved. In addition we designed an application to interface with existing pharmaceutical software. For practical reasons and to make it possible to differentiate between the different access profiles, the information stored on the card is divided in several blocks: Identification, Emergency, History (personal and family), Screening Tests, Vaccinations, Drug Profile, General follow-up, and some Specific follow-ups (Pregnancy, Ophthalmology, Kidney failure, Cardiology, Pediatrics, Diabetes, Pneumology, Specific parameters). Over 14,000 diagnoses and symptoms are classified with four levels of precision, the codification being based on the ICPC (International Classification for Primary Care). The software contains different applications to assist the clinician in decision making. A "Drug Advisor" helps the prescriber by detecting possible interactions between drugs, giving indications (doses) and contraindications, cautions, potential side-effects and therapeutic alternatives. There is also a prevention module providing recommendations for vaccination and periodic examinations based on the patient's age and sex. The pharmaceutical, vaccination, and screening tests data banks are updated every six months. These sections of the software are accessible to access card holders at any times, even without a patient card, and constitute in themselves an interesting clinical tool. We developed a software server (SCAM) allowing the different applications to access the data in a memory card regardless of the type of memory card used. Using a single high level command language, this server provides a standardized utilization of memory cards from various manufacturers. It ensures the compatibility of the applications using the card as a storage medium. (abstract truncated)