Exploring the Past, Future of SMART Health Cards, Patient Data Access

It’s been a banner year for patient data access, with innovations like SMART Health Cards from the Vaccine Credential Initiative (VCI) and the Commons Project putting information like COVID-19 test results and proof of vaccination directly into patients’ hands.

These digital vaccine credentialing tools are used by countless healthcare organizations and EHR vendors, five nationwide pharmacies, and nine states plus Puerto Rico, granting patients across the country—and around the globe—the ability to view their COVID-19 vaccine records and prove vaccination where applicable.

Candidly, that was a surprising journey for JP Pollack, co-founder and chief architect of the Commons Project and one of the masterminds behind VCI. Pollack and his colleagues initially envisioned a digital vaccine card that they’d be able to develop by tapping into state and federal public health data infrastructure.

“It quickly became pretty apparent that the state of the federal infrastructure as it were, as well as the state of many of the states’ registries, were really putting us in a position where the likelihood of that kind of consolidated place for people to go get their SMART Health Cards was really not going to be an option,” Pollack told PatientEngagementHIT in a video chat.

That prompted VCI to start focusing nearly all of its efforts on the EHR vendor community, health systems, pharmacies, and insurance companies. These entities would have patient vaccine records, and through private partnership could enable patient data access through digital credentialing.

But Pollack and his team didn’t expect just how effective and widespread that private partnership would end up being.

“One of the things that was most, very pleasantly surprising and very positive was the speed that that community came together to address the problem,” he stated. “Going from having a spec that a handful of people were working on to something that is now validated for a standard and is available to well over a hundred million Americans today is pretty unprecedented in terms of the speed that that happened.”

He’s right. Such deep collaboration between the EHR vendor and health IT community isn’t exactly commonplace, but according to Pollack, the COVID-19 pandemic represented a confluence of opportunity.

For one thing, the healthcare industry was coming up against information blocking regulations that mandated some level of patient data access.

“So, there was a little bit of momentum already building in terms of all the various healthcare stakeholders making data available to individuals,” Pollack explained. “Some were doing it out of obligations. Some were doing it out of obligation, but being a little bit more forward looking and trying to already on path to building new tools and services for patient access.”

There was also the pandemic, which pushed organizations in all industries to examine how they could make a meaningful impact to ease the burden COVID-19 was putting on everyone. In the health IT space, that meant coming together for the common good and determining how to help people navigate their own health and wellness.

And patients were communicating that demand, Pollack said. COVID-19 meant people were more concerned than ever with their health and wellness, needing to test regularly for the virus and keep track of how they were preventing spread.

That demand hadn’t been seen before. Pollack, a longtime advocate for patient data access, had historically seen patient demand for their own health data among the chronically ill population, or maybe those who simply have a passion for data.

“We finally saw that with the need to get access to vaccination records and test results,” he noted. “That confluence of things led to a real situation where everybody was really highly motivated to solve this problem.”

Pollack did acknowledge that a lot of the groundwork had been laid to make VCI and SMART Health Cards happen. Ongoing projects like Argonaut, FHIR, and SMART on FHIR use cases meant there were already a lot of connections and work streams in place that enabled VCI to make SMART Health Cards happen quickly and effectively.

And now, it’s starting to see its original goals of working with state public health data infrastructure come to fruition. At the time of the interview, Pollack said nine states plus Puerto Rico had signed onto SMART Health Cards, but about 15 or 20 more states were on the horizon to join in the near future.

“We're really looking at being in a place where over half the country will have their SMART Health Cards available to them directly through the states where they live or were vaccinated in, which is a pretty huge accomplishment,” Pollack stated.

But as the medical industry looks to the future, Pollack said one of two things can happen.

“We're at a crossroads and over the next few months it will be telling to see which direction people go,” he said. “This could be the trigger that sort of pushes people over the hurdle and say, yeah, actually this is pretty nice being able to access my electronic health data and more people will start to further this demand.”

There’s potential in this area, he pointed out, as more non-traditional actors get in on the patient data access game. For example, pharmacies, which aren’t necessarily obligated by the information blocking regulations, are coming more online and embracing patient data access moving forward.

But there’s also the chance this momentum comes to a standstill, Pollack acknowledged.

“The other way that it could go is everybody will say, okay, great, we had this one use case and we did really well with it,” he stated. “Look at all these millions of people that are accessing their data, that's great. That could shut down some of the existing work streams around access to broader health data and interoperability and some of the work streams that we have going in terms of people being able to push data back into the EMR.”

There is certainly a path forward for that first option, where the medical industry embraces patient data access and applies it to further use cases. Patient data access and a tool like SMART Health Cards have a lot of application for the chronic disease population, but there are a lot of areas where the generally well population will also need their medical information to move about their daily lives. Specifically, access to information that absolutely must be verifiable and reliable might find a good home in a SMART Health Card.

“We have some use cases that folks are already working on it in various degrees, like a digital representation of your insurance card is one,” Pollack posited. “Complete childhood immunization records is one that lots of the states and pharmacies are already working on enabling for 2022. Things like workplace drug testing, things along those lines.”

Information about a recent acute procedure or a list of prescriptions, for example, would be useful inside a digital app like a SMART Health Card, Pollack offered. Mobile and digital forms of this information would be useful for travel purposes, especially, he said.

There’s also room for opportunity simply to make peoples’ lives easier, he said. SMART Health Cards have a scannable QR code, making information sharing more streamlined.

“One possibility would be that you store, either in a single QR code or in a link within a QR code, access to all of the kind of information that you need to check into a new care provider or a virtual medicine visit,” Pollack offered. “You could imagine replacing the filling out all of those forms and back checking with other EMRs and things like that with simply holding up and scanning a QR code to transmit some of that key information.”

Of course, there still are some limitations on the technology side, as regulations continue to catch up to patient need and demand. For one thing, there isn’t a significant regulatory push for private payer data to land in the hands of patients, even as developers ramp up in preparation for Blue Button 2.0 requirements.

“We need to see that open up to the broader insured population is one place where we need to see some of that,” Pollack said.

Additionally, the health tech market needs to continue to uncover good use cases that are compelling to patient end-users, which Pollack called a chicken and egg problem. App developers need to know patients will come to the tool, but patients will only come if there is a good reason.

“We need app developers to be building in use cases that are sticky for people and get people excited about access to data,” Pollack concluded. “At the same time, we need everyone who's providing those data to understand that the demand is there so that they have real motivation to make it available beyond just regulations.”