Jimmy Devins (Sligo-Leitrim, Fianna Fail)
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We are in the midst of reform of the health service and it is hoped this reform will take many different shapes and sizes. I welcome the fact that information technology or IT services will be centralised. Until now, IT services have been run on an ad hoc basis by each health board. In the past, certain health boards could not communicate with others through their IT services. I hope this problem will soon be a thing of the past.

Arising out of the fact that IT services will be centralised, I ask the Minister of State to give serious consideration to the introduction of medical smart cards. Everyone is aware that patient records are extremely important. Most GPs now keep comprehensive computerised records of their patients' histories, including information on drugs they are taking, their relevant past medical details, allergies they may have, their blood groups, etc. When a patient is referred to a hospital, it is frequently the case that all that accompanies them is a letter. Sometimes such letters are comprehensive and outline in great detail the information to which I have just referred. In many cases, however, tests are duplicated in hospitals.

Let us consider a case where a patient becomes ill while away from home. A doctor in a hospital or the GP who sees him will frequently not have access to the information relative to him. I propose, therefore, that each patient should have a smart card, similar to a bank card, to carry. All the relevant information could be stored on the card. Whoever sees the patient would then be able to access the information immediately. There will be situations where patient confidentiality could be disturbed. I propose, therefore, that each patient would be given a unique PIN number — again, similar to that which accompanies one's bank card — of which only he or she would have knowledge. Introducing smart cards would represent a strong step forward, while PIN numbers would ensure that patient confidentiality would be totally and utterly maintained.

In light of the reforms being put in place, I ask the Minister of State to seriously consider the introduction of such a card. I understand that such cards are available in certain states in Australia and that the system is working well.

Tim O'Malley (Limerick East, Progressive Democrats)
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At present, there are no plans to introduce medical smart cards. The national health information strategy was launched earlier this year. This sets out a strategic direction for the future application of information technology in the health services. Following on from this, an information technology strategy is being finalised under the auspices of the Health Boards Executive. This will be more technology oriented and is designed to facilitate, in due course, consideration of the appropriateness of specific technology tools and services which would include smart cards.

In general the use of smart cards in health is being considered internationally for patient identification only, patient identification and emergency medical data or patient identification, emergency medical data, and some part of the patient's medical record. However, the use of smart cards in health is not widespread. Various pilot trials are in operation and the jury seems to be still out on the precise role smart cards will play in the future in health. The predominant view seems to be that they will be used for patient identification only, with medical information held on a separate database rather than on the card itself. Considerations of data security, costs and acceptability to patients are high on the agenda in discussions about the use of smart cards in the area of health. While the concept of using smart cards in health has been discussed for a considerable period, this has not been reflected in implementation on the ground.

The Department of Health and Children is participating in a recent initiative of the Department of Social and Family Affairs regarding the development of a standards-based framework for the public service card, using the personal public service number as a unique identifier. This will mean that any initiative for a public service card to access services, including those relating to health, will be fully compatible with the framework, rather than a client having to carry multiple cards that would, perhaps, require different types of access equipment. It is envisaged that use of the personal public service number as a unique identifier in the health service will be covered by legislation which will follow as part of the overall e-Government programme.

As well as our national initiative under the e-Government programme, the European Commission is also active in this area and is planning adoption of an electronic health insurance card by 2008. Discussion on this is at a very early stage. This would replace the European health insurance cards introduced this year as a replacement for E111 cards.

While there are no smart cards in use in the health services, the general medical services payments board uses a card with a magnetic strip for drug refunds. This can be used in a community pharmacy to validate eligibility. The general medical services board is participating in the Department of Social and Family Affairs initiative to which I referred earlier and any future developments of cards, including medical cards, managed by the board will be in compliance with whatever outcome emerges from that initiative.