Elsevier

Social Science & Medicine

Volume 53, Issue 7, October 2001, Pages 879-894
Social Science & Medicine

Adoption of smart cards in the medical sector:: the Canadian experience

https://doi.org/10.1016/S0277-9536(00)00388-9Get rights and content

Abstract

This research evaluates the factors influencing the adoption of smart cards in the medical sector (a smart card has a micro-processor containing information about the patient: identification, emergency data (allergies, blood type, etc.), vaccination, drugs used, and the general medical record). This research was conducted after a pilot study designed to evaluate the use of such smart cards. Two hundred and ninety-nine professionals, along with 7248 clients, used the smart card for a year. The targeted population included mostly elderly people, infants, and pregnant women (the most intensive users of health care services). Following this pilot study, two surveys were conducted, together with numerous interviews, to assess the factors influencing adoption of the technology. A general picture emerged, indicating that although the new card is well-perceived by individuals, tangible benefits must be available to motivate professionals and clients to adopt the technology. Results show that the fundamental dimension that needs to be assessed before massive diffusion is the relative advantage to the professional. The system must provide a direct benefit to its user. The relative advantage of the system for the professional is directly linked to the obligation for the client to use the card. The system is beneficial for the professional only if the information on the card is complete. Technical adequacy is a necessary but not sufficient condition for adoption.

Introduction

A smart card is a card with micro-processor containing information. It is the size of a regular credit card. In the medical sector, it contains information about the patient: identification, emergency data (allergies, blood type, etc.), vaccination, drugs used, and the general medical record. Therefore, the card becomes an electronic medical record for the patient. For two years, a smart card has been tested by 7248 clients of the health care system in Canada. These cards (known as “Health Cards” in the project) enable doctors, pharmacists, nurses and ambulance workers to share information more easily. The card is very easy to use. When interacting with a health care professional, the client produces his card. The professional inserts it into the computer and has access to the information stored in the card. Depending on the type of professional (doctor, nurse, pharmacist, etc.) some areas may not be accessible, or accessible in a read-only mode (no modification allowed). It is important to note that the system stores the information solely on the card (not on the computer or a server). Therefore, if a patient, voluntarily or not, omits to use the card for a period, the information will be missing on the card until a professional enters it (patients have a read-only access to the information). These entries are very easy to make. They rely on codes and abbreviations professionals have been using already. The smart card reduces delays for taking charge of a patient and improves caregiver-patient communication since it provides information that was not readily available before (because it was only stored in another hospital or clinic for example). This smart card was also linked to an expert system that detected potential drug interactions. The system was expected to reduce costs because all exams, results and prescriptions would be filed and professionals would not have to redo work already performed by a colleague. Before using the smart card, professionals had no access to files kept in another establishment. This was a pilot study meant to evaluate the potential of smart cards.

For such a system to be useful, massive adoption is required. However, the confidentiality of medical records is currently guaranteed by law, and so the use of the card cannot be made mandatory. Even if the value of the Health Card is recognised by everyone in the health system, there has to be some individual advantage to motivate adoption. This has to be true for professionals and clients. Usage is conditional on adoption by both groups. The study described in this paper looks at the critical factors that would lead to adoption of the system.

In the research, certain adoption factors were reviewed and tested. Two surveys were conducted, together with numerous interviews, to assess the factors. A general picture emerged, indicating that although the new card is well-perceived by individuals, tangible benefits must be available to motivate professionals and clients to adopt the technology.

Section snippets

Theoretical framework

Rogers (1962) defined innovation as “an idea perceived as new by the individual. For an organization, an innovation can be any product, input, process, service or technology perceived as new by the adopting organization (Moore, 1994). Its success can be measured by assessing its benefits, both financial and of other types. The adoption process has previously been studied from a variety of standpoints. Langley and Truax (1994) identified three types of model for innovation adoption: sequential,

The smart card project

The small card project was undertaken by a research team from Laval University, in Quebec City. It was financed by a government agency and approved by all professional associations. All those facts were public and known by the health care professionals (it was advertised in bulletins and other publications from the various professional associations). The professionals were given training before the beginning of the experimentation. All the required equipment (PCs equipped with a card reader and

Results

Results from the four groups are presented. First the results of the survey of professionals using the Health Card in the pilot study are reported, followed by the survey results of the professionals outside the pilot region. Coming after are the results of the interviews with the clients using the Health Card, followed by the ones of the interviews with the clients outside the pilot region.

Discussion

The study provides interesting results on many aspects. First, the role played by the classical adoption factors was investigated and the critical nature of some of these factors revealed. Second, the complexity linked to an innovation for which two distinct (but interacting) groups had to adopt the technology was brought to light. Finally, the most important finding is probably the critical role of the relative advantage provided to the adopter. This is particularly important for an innovation

Limitations and avenues for future research

The most important limitation of this study is the fact that it was conducted as a pilot study. Although the number of participants was high (299 professionals and 7248 clients), all the persons involved knew that it was carried in a pilot setting and that adoption of the technology in the pilot study was not a commitment for definitive adoption. Curiosity regarding the technology and peer pressure could also have increased temporary adoption. These considerations might explain why the analysis

Acknowledgements

The authors wish to thank Jean-Paul Fortin and his team at Laval University for their precious contribution. This project was financed by the RAMQ.

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