Tiny implant puts portable medical records in reach

A small but increasing number of people are getting a portable health record in an intimate way -- by having a computer chip implanted in their arms.

When read by a scanner, the chip, the size of a grain of rice, would give an identification number physicians and hospitals would use to log on to a secure Web site containing that patient's identification and medical information. The chip and technology is produced by VeriChip, whose corporate parent owns another company -- Digital Angel --that has sold 6 million similar chips implanted in dogs and cats since 1991. Former Health and Human Services Secretary Tommy Thompson is a VeriChip board member and has pledged to get himself "chipped."

Advocates of the chips say they represent a huge advance in patient safety. The idea is that having the chips will help physicians, particularly those in emergency departments, in cases where a patient is unconscious, unable to communicate or unable to remember, say, what medications he or she is taking. Privacy advocates worry, though, that the chips could be used to track people without their consent or otherwise misused by people who have access to information gleaned from the chip.

Also, ethics experts are cautioning physicians to not make chip implantation a mere money-making operation. VeriChip's preferred way of distributing chips to patients is by having doctors buy the chips then re-sell them through their offices. Physicians selling the chip who were contacted by AMNews said they were, at most, charging no more than what they paid VeriChip for it.

The Delray Beach, Fla.-based company, which in October 2004 became the only company to receive Food and Drug Administration approval to implant radio frequency identification chips into people, said that during the March 16-18 American Medical Directors Assn. Annual Symposium in Dallas, it signed up 172 physicians from around the country to purchase the chips. That boosts the total number of physicians buying chips to 230.

At least one insurer -- Horizon Blue Cross Blue Shield of New Jersey -- is considering reimbursing physicians for chip implantation. Although it hasn't signed a contract, the Blues plan told AMNews it plans to test the technology this year with 100 to 200 members.

"If a patient with dementia wanders off and you have the technology to read [and help] them, why not do it? It's like a super bracelet," said Daniel Haimowitz, MD, a geriatrician in Levittown, Pa.

Dr. Haimowitz has not purchased or implanted any chips. He said he is planning to work with long-term care facilities and geriatric organizations to buy the chips in bulk, so cost-savings can be passed on to patients.

"I mean, what is the buzz now? Cutting down errors and improving quality of care. Honestly, too, how does this not do that?" Dr. Haimowitz said. "We need to embrace new technology on numerous levels [to help patients]. I think it's happening in our personal lives, and I think it's happening in our professional lives, too, with medical records, monitoring devices, patient assessments and all sorts of things."

Here's how the chip would work: Whenever a patient comes into the emergency department, particularly if he or she is unconscious or confused, someone would take a scanner and run it over the patient's upper right arm. That's where the company suggests doctors implant the chip.

If the person is chipped, an identification number will pop up on the scanner. If not, nothing happens. But assuming there's a hit, ED personnel then enters the number onto a secure VeriChip Web site, and up pops whatever information the patient stored on it.

Right now, VeriChip allows users to store their name, emergency contact information, and the name and phone number of their physician for a $10 annual fee. For an additional $70 or $80 annually, users also can store their living will, power of attorney, do-not-resuscitate order, and health insurance and medical information, including medications, past diagnoses and test results.

To implant the chips, physicians must buy a starter kit that includes 10 insertion packets, each containing a single chip, for a total of $1,450. VeriChip suggests physicians charge patients $200 for the cost of the chip and another $200 for their professional services, but the final price is at the physician's discretion, said Richard Seelig, MD, vice president of medical applications at the company.

To minimize potential financial conflict of interest and exploitation of patients, physicians should sell from their offices only health-related products that serve the immediate and pressing needs of patients, said Priscilla Ray, MD, a Houston psychiatrist who chairs the AMA's Council on Ethical and Judicial Affairs. Under CEJA's guidelines, those products also should be offered for free or at cost to patients, Dr. Ray said. Physicians also must fully disclose the financial arrangement to patients.

The company is targeting physicians treating patients who have chronic conditions, are cognitively impaired or have implanted medical devices such as pacemakers. Nearly 2,500 people worldwide have implanted chips under their skin, including 100 in the United States, said John Procter, a VeriChip spokesman.

To help create a market for its product, VeriChip, which has registered with the Securities and Exchange Commission to sell stock to the public, also is marketing to hospitals, Procter said. The firm is offering free scanners, which otherwise would cost $600 apiece, to the first 200 hospitals that sign up.

Approximately 80 hospitals have signed up. So far, eight, including Beth Israel Deaconess Medical Center, Boston; Trinitas Hospital, Elizabeth, N.J.; and Hackensack (N.J.) University Medical Center, have the equipment in place to read the chips, Procter said.

"Our expectation is that this technology is really going to take off, and the only way to make it real is to have a protocol in place and operationalize it," said Joseph Feldman, MD, chair of the emergency trauma department at Hackensack.