February 2009 Archives

Woodbury, NY-- Within the photo-imaging industry, the term "kiosk" brings a limited vision to our eyes. However, to the general public, the term is more likely to conjure up thoughts of self-service, ATM and airport check-in.

The Kiosk Invasion and What It Means to the Photo Retailer
by Burkardt and Don Franz

Admittedly, the proliferation of photo-imaging kiosks being installed is substantially greater than we could ever image for the number of minilabs, but they still form only a minor share of the overall kiosk population.

According to Francie Mendelsohn of Summit Research Associates (summit-res.com), there were about 1.2 million kiosks operating in North America at the close of 2008 (see Figure 1). Photofinishing News (photo-news.com) estimates that 116,000 were photo-imaging kiosks, representing 9 percent of the total, and more than half serve as input stations without an integral printer.

However, photo-imaging kiosks are the dominant category for countertop models. According to NCR, consumers are increasingly willing to use self-service devices. A 2008 Self-Service Consumer Survey by NCR indicated that: • 86 percent of U.S. and Canadian consumers are more likely to do business with companies that offer self-service--whether via the Internet, on a mobile device, at a kiosk or at an ATM. That's an increase of 12 percent from the 2007 study. •

The self-service revolution is real. Consumers demand it and want more; 56 percent of respondents said the likelihood of them using self-service has increased over the past year.

Whether banking, shopping, traveling or interacting with a healthcare provider, more consumers look for, and even expect, self-service as an "essential convenience" that improves their overall experience. • 66 percent of the respondents said the availability of self-service technologies creates a more positive perception of the deployer's brand. • Speed, followed by convenience and ease of use are the main reasons why respondents choose self-service over personal assistance, although the preferences vary in different industry segments (see chart at left). In recent years, corporations have shown an increasing willingness to deploy self-service devices, and customers have shown a similar eagerness to use them.

What does this mean to Photo Industry Reporter readers? We need to open our eyes to the "wide world of kiosks" and recognize both the opportunities and the threats. Tony Burkardt ([email protected]) has been attending the twice-yearly KioskCom show (held alternatively in New York City and Las Vegas) for the past two years. Despite the strong attendance by representatives from many different retailing fields, there have only been one or two "photo" kiosk companies exhibiting. Giant Food Stores offers its customers what most grocery stores do: food, household items, a deli, some specialty items and a pharmacy.

What it lacked was an approach to unite the various departments in a way that would make shopping easier, and less costly to provide for itself. Turning to self-service and integration for a solution, Giant Food has about six to eight interactive multifunctional self-serve kiosks in over 100 stores. Besides the traditional applications, you will find suggested wine selections with recommended recipes, deli and bakery ordering, coupon printing, personalized gift cards, on-demand music, movies, ringtones, product ingredients, product lookup and a product locator.

Sadly, at least from our industry's viewpoint, you won't find photo-processing services. Similarly, the company's website has most of these offers and also is devoid of any photo-processing information. This is just one example of how retailers are aggressively pursuing interactive multifunctional self-serve kiosk installations to educate and assist their customers, but photo processing is being ignored.

However, if retailers begin to understand and start adding comprehensive photo-processing capabilities to these multifunctional kiosks, they could become serious competitors. For independent photo specialty retailers, this might seem like a remote possibility, based up the lack of success among retailers. But when they ignore (is overlook a better term?) photo, it actually affects all of us. Consumers who frequent these stores and rarely visit the knowledgeable photo retailers are not learning about the various products they could make from their photo memories.

At a recent non-photo industry conference at which he spoke, Don Franz ([email protected]) asked the audience--about 75 people--how many were familiar with photo books. Only one person raised her hand, and she admitted that her husband was the one who had made the one photo book she had, and he had a difficult time creating it--three years earlier.

Our industry has changed significantly over the past three years in the ease of producing personalized photo products at a kiosk, but she was completely unaware of these improvements. How can we, as an industry, leverage the expansive capability of our photo-imaging kiosks to improve our sales and profitability? With the advanced technology of our kiosks and diversity of software at our fingertips, what can we do to promote higher margin products and services? Are we really aware of all the products and services we could be offering? Can we add services to our existing kiosks that will help drive our core businesses by adding incremental sales from existing customers and attracting new ones? Do we recognize that our customers, who entrust us to create keepsakes from their treasured photos, also may have business lives and need personalized books (without photos), presentations, catalogs, calendars, brochures, framing? We're all businesspeople; what do we use?

We asked Rick Glomb, vice president, Business Development, at Lucidiom (lucidiom.com), how the industry could increase its sales and improve its margins. "Our customers are looking for kiosk software and services that simplify social expression for digital imaging consumers. That means having a complete, yet flexible kiosk platform that's adaptable in order to incorporate new products that come to market and yet suits each retailer's particular needs, including interfacing with their current equipment.

Since local shelf and inventory space, as well as capital and training for on-site production systems, are limited, the Internet-connected kiosk opens upon an infinite virtual production capability, allowing retailers the opportunity for suggestive selling and letting customers see and order a wide range of personalized photo products." Lucidiom gathers statistics from all of their kiosks, to track market trends.

Despite the dismal economic outlook, year-over-year same store sales in November 2008 showed orders for photo books jumping 248 percent, calendar orders were up 181 percent and folded card orders rose 145 percent, although traditional greeting card orders fell slightly by 18 percent (attributed to the late Thanksgiving Day holiday). Previously reported year-over-year data for the month of October showed that photo book orders increased 576 percent, calendar orders 373 percent, orders for folded cards 460 percent and traditional greeting cards rose 172 percent.

Today's photo-imaging kiosk has become a dynamic marketing and sales tool for photo-processing retailers, one which should be continually evaluated and upgraded to meet the changing needs of the market and the retailer's business. It also represents an important bridge to the online market, with both Web-based and PC-residing software available to emulate the kiosk experience. This means a photo book order file can be started at home, transferred to a kiosk in your shop for suggestions and advice, if needed, or for collaborative development with a friend. By having the same products online as in-store, customers who might otherwise be wary of online ordering will find a familiar product line on the retailer's website once they venture online.

This product line "synchronization" also means streamlined production and assembly for the retailer. Consumers have come to discover how easy and fun it is to order from the kiosk, and having the same experience available online empowers the retailer to vastly expand the sales opportunity. The upcoming PMA trade show will give us all a chance to see the latest kiosk developments.

Technology is an ever-changing and evolving aspect of modern business. In healthcare, most
 agree that the use of technology is essential to achieving many of the milestones critical to
healthcare reform. Three primary drivers are increasing the use of technology in healthcare:

• The need to lower costs and create administrative efficiencies
• The need to improve patient outcomes and enhance physician and patient relations
• The need to meet increasing privacy, security and identity concerns, as a result of
Federal and state directives mandating increased control over private information

TABLE OF CONTENTS
1 INTRODUCTION .................................................................................... 4
2 HOW SMART IS A SMART CARD? ........................................................ 4
3 SMART CARD USE WORLDWIDE............................................................. 4
3.1 IDENTIFICATION CARDS........................................................................ 5
3.2 PAYMENT.............................................................................................. 5
3.3 MOBILE TELECOMMUNICATIONS........................................................... 5
3.4 HEALTHCARE........................................................................................ 6
4 HOW SMART CARDS CAN IMPROVE HEALTHCARE ................................. 7
4.1 COST REDUCTIONS ............................................................................... 8
4.2 USER AUTHENTICATION AND AUTHORIZATION....................................... 9
4.3 IMPROVED PATIENT IDENTIFICATION AND WORK FLOW....................... 10
4.4 CLAIMS DENIAL AND REVENUE CAPTURE............................................. 11
4.5 EMPLOYEE CREDENTIALS FOR STRONG AUTHENTICATION................... 11
4.5.1 HIPAA Compliance................................................................................ 12
4.5.2 Benefits throughout the Hospital ............................................................. 12
4.5.3 Network Security.................................................................................... 13
4.6 IMMEDIATE ACCESS TO LIFESAVING INFORMATION............................... 13
4.7 HEALTHCARE FRAUD, ABUSE, AND MISUSE.......................................... 14
4.8 LANGUAGE ISSUES AND PATIENT HEALTH RECORDS ........................... 14
4.9 PATIENT AND PHYSICIAN SATISFACTION ............................................... 14
4.10 SUPPORT FOR A NATIONAL HEALTH NETWORK ................................... 15
5 CONCLUSION.............................................................................................. 16
6 RESOURCES AND REFERENCES .............................................................. 17
7 PUBLICATION ACKNOWLEDGEMENTS........................................................ 19



2009_Healthcare_CFO_Guide_to_Smart_Cards_FINAL_012809.pdf

Visit the Smart Card Alliance at http://www.smartcardalliance.org/ for more information

Excerpts

Table 2. Smart Card Benefits
Stakeholder Benefit

Patient
• Positive identification at initial registration
• Secure and portable health record
• Personal ownership and control of access to medical records
• Easier and faster registration
• Improved and faster treatment and medical care
• Positive identification for payer coverage, treatment, and billing
• Accelerated treatment in emergencies
• Audit trail through a course of treatment that crosses multiple organizations

Healthcare Provider
• Instant patient identification
• Accurate link between patients and institutional medical records
• Elimination of duplicate and overlaid records
• Faster care delivery in emergency care settings
• Rapid accessibility to patient medical history
• Potential reduction in adverse events and medical errors due to lack of patient information
• Reduction in claims denials
• Faster access to key medical record data
• Integration with legacy systems with nominal IT costs
• Audit trail through a course of treatment that crosses multiple organizations
• Reduction in unnecessary/duplicate diagnostic tests or procedures by showing results from other medical providers

Healthcare Delivery Organization
• Accurate patient identity
• Reduced medical record maintenance costs (duplicate/overlaid)
• Streamlined administrative processing
• Increased awareness of provider brand, in and out of the service area
• Strengthened voluntary physician/referral relationships
• Ability to support value-added service to patient community Payer (Insurance, Pharmancy Benefits Manager)
• Positive identification of the insured
• Verification of eligibility and health plan information
• Reduction in medical fraud
• Reduction of duplicate tests and reduction in payments
• Enforced formulary compliance
• Immediate adjudication at point of care
• Potential integration with health savings account (HSA) cards Healthcare Employer
• Highly secure identity credential for both physical and logical access
• Single sign-on capabilities (reduction in help desk calls/password management requirements)
• Link to other employee services (ID badge, parking, cafeteria)

4.1 Cost Reductions
A major advantage of using smart cards in healthcare is the reduction in costs that results from improving the efficiency of handling medical and administrative information, which also increases the quality of service. Smart cards support strong authentication of the patient's identity and quickly deliver accurate patient information to the provider. Smart cards can be integrated into current systems and processes within the healthcare industry to provide numerous benefits:

• Secure patient identification.
• Reduced administrative time and cost by automating patient identification.
• Reduced duplication of records.
• Fewer errors and adverse events through the use of accurate and timely information.
• Reduced number of rejected claims and faster payments, by using accurate patient
information.
• Reduced fraud and abuse through proper patient identification.
• Reduced claims processing costs through real-time adjudication of claims and insurance
coverage verification.
• Increased patient satisfaction, resulting in improved patient loyalty.
As an example, smart cards can facilitate rapid identification of a patient arriving at an emergency room
and rapid retrieval of lifesaving information about medical history, recent tests, treatments, and medications. This critical information can be stored on the smart card chip or the smart card can provide secure access to data stored elsewhere. Smart cards can also provide fast access to demographic and insurance information, critical to an accurate  registration/admissions process and to downstream billing and payment processes.

4.2 User Authentication and Authorization
Identification, authentication, and authorization are the pillars of security in the electronic world. As the industry moves from paper to electronic medical records, there is growing awareness of the need for secure and encrypted transitional solutions. The National Health Care Anti-Fraud Association estimates that 3% of annual healthcare spending ($68 billion in 2007) is lost due to healthcare fraud.

In addition to the financial loss incurred by healthcare fraud, fraud poses tangible health risks for patients whose records are compromised or manipulated. The case is therefore even stronger for imposing stricter security controls on health information. With the creation of large clinical data exchanges and the ready availability of information on the Internet, all system users need to be properly authenticated before being allowed to access information.

System user privileges must be assigned using role-based access controls. And finally, all individuals must have the appropriate authorization to initiate particular transactions. Smart cards play the critical role, which is properly to identify and authenticate the individual who
needs access to a system. If an unauthorized user accesses the system, all other functions fail. Therefore, it is critical that the way in which the user is authenticated be secure.
Smart cards trust nothing until proven otherwise. For example, smart cards can require
cardholders to authenticate themselves first (with a personal identification number (PIN) or
biometric) before the cards will release any data. And smart cards support encryption, providing patient data privacy and enabling at-home or self-service applications in suspect or untrusted environments to be secure.

The smart card's embedded secure microcontroller provides it with built-in tamper resistance and the unique ability to securely store large amounts of data, carry out own on-card functions (e.g., encryption and digital signatures), and interact intelligently with a smart card reader.

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Smart cards have a long history in the security sector. Governments, financial institutions, and healthcare entities worldwide have recognized the security of smart card systems for user
identification, authentication and authorization. Smart card technology is being deployed for
international citizen identification cards and within the U.S. Federal Government. In both the
security and identity sectors, multi-factor authentication methods have been used aggressively to protect both logical and physical access.20 It is a natural and much-needed progression for smart cards to provide robust and proven solutions for healthcare.

4.3 Improved Patient Identification and Work Flow
Accurate registration and identity verification can be extremely challenging for hospitals and
clinics. Busy waiting rooms, thin staffing levels, and manual transcription of important data from handwritten forms create many opportunities for error. Smart cards can provide positive
identification of the patient at the registration desk, by allowing personnel to verify that the patient who is presenting the card matches the photograph on the card or by use of a biometric stored on the smart card.

Using a smart card to verify patient identity can offer healthcare providers the following benefits:

• Make it easy to link patients to the correct medical records
• Reduce the creation of duplicate records
• Reduce the potential for medical identity theft and fraud
• Improve the efficiency of the registration process and the accuracy of data
• Improve the revenue cycle and reduce the number of denied claims

Studies have found that on average, 5%-15% of a hospital's medical records are duplicated or
overlaid.21 This is a serious problem, which many institutions have attempted to remedy with
costly and inefficient medical record cleanup initiatives. The flaw in these efforts is that they
address the problem after it has occurred rather than addressing the root cause, so duplication continues year after year.

Industry benchmarks place the cost of medical record correction at $20-$100 per duplicate, but these figures can quickly escalate to hundreds of dollars per case when multiple systems are involved and total personnel resources are considered.22,23 The more duplicates there are in a system, the higher the rate of new duplicates. The growth rate becomes exponential with the size of the patient database.

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One manifestation of these issues is the additional cost incurred by an institution. Unnecessary or redundant tests and procedures are often performed due to incomplete or unavailable medical records. In addition, duplicate and overlaid medical records can have dire consequences for patient care and outcomes, exposing an institution to malpractice liability, errors, and adverse events.

Consider, for example, a 300-bed hospital facility with a database of 250,000 patients. If 10% of these records are duplicated (25,000 records), the average cost of cleanup is $500,000-$2,500,000.

Unfortunately, without any change in process, this cleanup will need to be repeated every 2-3 years. By implementing smart card technology as part of the admission and registration process, an institution can reliably identify its patients, increase the accuracy of data capture, optimize patient throughput, accurately link patients to their medical records, and ultimately improve patient experience and satisfaction.

Smart cards can greatly reduce medical record maintenance costs associated with errors from duplicate or commingled patient records. These errors occur when a new record is created for an existing patient, or the wrong patient record is selected. Reducing identity errors during patient registration can also greatly improve billing and collection processes and enhance revenue capture.

4.4 Claims Denial and Revenue Capture
Two of the most common reasons for claims denials are incomplete demographic information and incomplete insurance information, which can cost a healthcare institution millions of dollars in lost or delayed revenue. Most healthcare CFOs are acutely aware of the high cost of reviewing and resubmitting old claims and the revenue lost because of cumbersome claims processing, including detailed chart reviews and outreach to patients and physicians for additional information.

The healthcare revenue cycle is highly dependent on the front-end registration process, which
drives much of the downstream claims process. Studies estimate that 50%-90% of claim denials could be prevented by securing accurate patient information at the front desk.25,26 According to a study by PNC Financial Services, one out of five claims submitted is delayed or denied by insurers, and 96% of claims must be resubmitted at least once.27 The statistics highlight serious administrative problems that burden providers, payers, and patients. Smart card technology can greatly improve the accuracy of routine data capture. Instead of transcribing information from paper forms and increasing the risk of human error, smart cards can access or provide insurance information, demographics and other patient information, reducing claim denials and increasing cash flow.

4.5 Employee Credentials for Strong Authentication
Smart cards are deployed in hospitals around the world as secure employee credentials. The
cards give healthcare providers and hospitals the ability to consolidate a wide variety of functions without compromising on security. Smart cards can be used to authorize physical access, permitting only those personnel who are authorized to enter certain areas of a hospital (such as the pharmacy, operating room, network server room, or human resources).

They can also be used to authorize logical access to hospital networks and computers and assist in complying with the HIPAA requirements for privacy and security. Smart cards provide two-factor authentication, allowing employees to prove their identities in two ways: using something they have (the secure and personalized ID badge) and something they
know (their PIN) or something they are (a biometric, such as a fingerprint). Multi-factor
authentication provides a higher level of identity verification. In addition, the multi-factor
authentication process can be cryptographically protected to assure robust security for corporate network resources.

Smart cards can be deployed easily into existing infrastructures and operate with many industry leading security applications. Smart card support for standards and interoperability are key advantages for using smart card technology in identification systems.

4.5.1 HIPAA Compliance
The security and privacy of medical records have increasingly been in the news. A recent Harris Interactive Poll28 estimated that 9 million adult Americans, or 4 percent of the population, believe that they or a family member have lost confidential personal medical information or had the information stolen. The poll suggests that Americans are not only concerned about medical identity theft but are also concerned that their personal information might be violated.

Implementing strong authentication within a medical facility will not eliminate but will certainly
reduce the risk that personal heath information is compromised. Adopting smart card technology for use as a secure employee credential for physical and logical access assists with HIPAA compliance for privacy and security. Smart cards comply with the strong privacy guidelines in HIPAA and can be a key component in enforcing a medical facility's privacy and security policies.

Smart cards can provide easier information access management, ensuring that users are
following established security policies.

Read entire article
2009_Healthcare_CFO_Guide_to_Smart_Cards_FINAL_012809.pdf

Technology ROI -- By moving to a thin-client software architecture using the Microsoft Windows Server operating system, Domino's has been able to lower the investment cost for franchisees by several thousand dollars. In addition, by moving to the thin-client environment, Domino's has reduced the amount of information stored at each of its workstations to help achieve compliance with Payment Card Industry (PCI) data security standards.