Re: The French medical system, in your pocket

[David Farber <dave () farber net>]

Begin forwarded message:

From: Mr Richard Berlin <rberlin () pacbell net>
Date: June 13, 2010 12:41:04 PM EDT
To: dave () farber net
Subject: Re: [IP] he French medical system, in your pocket

Dave:

For IP if you wish.

Having carried such a card as my employee badge for many years, let me clear up some misinformation.  The "gold chip" 
is a giveaway that Vitale is a "smart card," e.g. http://en.wikipedia.org/wiki/ISO/IEC_7816    They are capable of 
computation and storage, but the data that are typically stored on them are of relatively small memory footprint, and 
replaceable if the card is lost or damaged.  

In one application I have seen demonstrated, the bearer's fingerprint might be digitized, encrypted and stored on the 
card, with the computational capacity of the card used to check the stored fingerprint against a newly-scanned one, 
thereby never exposing the stored biometric data.  One would of course assume there is a validation system in place 
that makes it difficult to forge a card.   (That wasn't covered in the demo; I hope the system is more than 
security-through-obscurity.  But I digress.)

So, despite the way it must seem to Jack, this is just an enhanced national ID card.    You would not actually want to 
put full medical records on the card, in part because:

1) loss or damage of the card would entail potential loss of bearer's medical records
2) there is limited memory capacity.   The first-generation cards only had 4k of memory

This of course has implications, most notably the fact that citizens are trusting some central authority to keep their 
records and reveal them only to appropriate parties.

The benefits of digitized medical records almost certainly outweigh the detriments, provided there are solid, 
trustworthy barriers to misuse of the data.   I am left wondering whether French government is more deserving of trust 
than other governments which come to mind.

-- Rich

From: Dave Farber <dfarber () me com>
To: ip <ip () v2 listbox com>
Sent: Sun, June 13, 2010 8:48:27 AM
Subject: [IP] he French medical system, in your pocket





Begin forwarded message:

> From: Ted Nelson <tandm () xanadu net>
> Date: June 12, 2010 6:01:45 PM EDT
> To: David Farber <dave () farber net>
> Cc: Ted Nelson <tandm () xanadu net>
> Subject: Dave-- the French medical system, in your pocket
> Reply-To: tandm () xanadu net
>
> ---------- Forwarded message ----------
> From: Jack Richey <torchbearer1 () msn com>
> Date: Sat, Jun 12, 2010 at 10:59 AM
> Subject: Carte vitale (Card of life)
> To:
>
>
> Dear Friends:
>
>      The Carte  Vitale is a green plastic credit card with a small
> gold memory chip in the middle.  Each of the 61 million residents of
> France carries it all the time.  Embedded in the gold metallic square
> is a digital record of every doctor visit, referral, injection,
> operation, x-ray, diagnostic test, prescription, warning, etc together
> with a report on how much the doctor billed and how much was paid, by
> the insurance funds and by the patient.  Everybody in France has this
> card. A child under 15 has his records maintained on his mothers card.
> When the doctor receives the card from his patient he slides it into a
> small reader on his desk and the patients medical record is displayed
> on the doctor's computer screen.  Thus, doctors and hospitals do not
> have large file cabinets full of records.  The doctor proposes a
> remedy (shot, course of drugs, referral to specialist, whatever) and
> types a record of the visit and his treatment.  That goes onto the
> carte vitale.  The patient takes his carte vitale with him to the drug
> store, or hospital or specialist and the treatment is carried out.
> The golf chip is encrypted and there is no breach of patient privacy
> from lost cards.
>       When the doctor completes his treatment and enters the days
> treatment on card, he simply hits the "transmit" key and all the
> billing information is transmitted to each of the relevant insurance
> plans.  The insurance funds are required to pay him and pay him
> quickly.  They do.  No quibbles.
>       Doctors and hospitals do not need to hire clerks and
> administrative people to bill insurance companies.  No necessity to
> hire collection companies.  No paper handlers.  No secretaries or
> office managers.  No administrative or clerical personnel  whose main
> task is billing hundreds of payers and documenting all medical
> procedures.
>       This email is not a political statement by me.  I am not
> endorsing the universal health care system of France, Germany,
> England, Switzerland, Canada, Japan, Taiwan or any other country.  I
> just wanted to let you know how this amazing Carte Vitale card saves a
> huge amount of money in France.
>
> Best regards, Jack
>
>
>
>
>
>
> -- 
> Theodor Holm Nelson PhD
> Founder of computer hypertext, 1960
> Fifty years fighting for a better world
>  of rich parallel documents, visibly connected.
> .
> Visiting Professor of Electronics and Computer Science
> University of Southampton, UK.
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