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For other articles and previous issues click here. January 17, 2005 Identity
Crisis The proposal to adopt a universal healthcare identifier raises several questions over exactly how patients will be identified. Is the implementation of a universal healthcare identifier an alpha-numeric medical necessity or another nuisance number to be stored in our memory banks? According to healthcare and legal experts, the need for individuals to be issued a unique healthcare identifier—preferably one not tied to a Social Security number—is of utmost importance when it comes to cutting down on duplication of medical procedures and potentially deadly medical errors. What’s In A Name? Schneider says without question, the need for a unique, universal healthcare identifier is a necessity being driven by many requirements in the healthcare industry. “When you look at the avoidable medical errors that occur on a daily basis in our country, many are associated with patient misidentification, and a universal identifier could prevent this as well as reduce duplicate medical testing,” he says. While the topic of a universal identifier is deemed necessary by many, it is still a controversial topic as the issue dredges up more concerns about privacy and security. Consumers fear that a single unique identifier would make it easier for someone to access their health information and use it for unintended purposes. In California, a system has already been instituted to assign unique healthcare identifiers that do not coincide with individual Social Security numbers, thereby cutting down on the risk of identity theft. Also, some insurance carriers have implemented procedures to remove the Social Security numbers from subscribers’ identifying information. In a statement issued in early November, the board of the American Medical Informatics Association (AMIA) noted that it “has always been a leading proponent of the use of the health information technology throughout the healthcare system to improve patient safety, reduce medical errors, and achieve streamlined systems that assure ‘just-in-time’ knowledge and service and decision support. The Voluntary Health Care Identifier is just one way to enhance dissemination of Electronic Health Records and support interoperability of those systems.” The AMIA also stated that creating a universal method for identifying patients must be a top priority if the nation is to reduce medical errors. Implementation Procedures “When the HIPAA mandates were put in place, it called for a universal, uniform identifier, but privacy advocates and those concerned about identity theft directed that aspect of HIPAA would remain unfunded,” he states. Kongstvedt says that the “quasi-official” direction would be to come up with an identifier that would incorporate Social Security numbers or their equivalent. “The Social Security number is the only unique numeric identifier out there for each and every individual,” he says. In addition to maintaining accurate healthcare records, Kongstvedt says a universal healthcare identifier is necessary for the implementation of a national electronic medical record (EMR) system. Why? “Because any national EMR system in the United States is going to be operating on a peer-to-peer platform as opposed to a centralized system, such as is found in the U.K. In order to access all those healthcare system records, providers have to find a way to route the information and deposit it into the right record,” he explains. “That is best accomplished with a unique identifier.” Kongstvedt says implementation of a unique identifier would be quite feasible with the use of a Social Security number, but without that option there is one of two choices: issue everyone another unique identifier or find another identifier, perhaps one that is a combination of names and birth dates. “A new identifier would certainly be a massive undertaking, but it is doable,” he says. “With a combination identifier, it wouldn’t be common, but it could increase the chances for coding errors and there would be no way to check it against a central directory.” Ultra-Scan has come up with a system of identifying patients by a fingerprint scan, thus eliminating the need for issuing more numeric codes. Ultra-Scan technology is not a patient identifier but rather an identity management infrastructure that can retrofit with systems presently in operation in healthcare facilities. Ultra-Scan has developed a Master Person Indexing System that links vital patient identification and medical record information from disparate databases through the use of its Livescan Ultrasonic Identification System. The system ensures accurate patient identification and facilitates rapid dissemination of clinical information across various departments throughout a healthcare facility. “The technology we offer identifies a patient not by name, address, or telephone number but by a physical characteristic—their fingerprint,” he explains. “If a unique number has to be issued and if we don’t also implement biometrics, then that unique number is as suspect to theft, fraud, or error as the ones we have now.” What the healthcare industry is looking to accomplish Ultra-Scan can do and then some, Schneider says. “There is no more unique characteristic than a person’s fingerprint.” The idea of using a fingerprint identifier is not a new one, he says. The concept has been around for years, but Ultra-Scan developed a system that uses ultrasound technology to capture the fingerprint image. “The existing fingerprint devices on the market used optics to take a picture, and it turns out that if the finger wasn’t pristine clean, the device would take a picture of the dirt and grime accumulated on the finger so it couldn’t be read reliably by an optical scanner,” Schneider explains. “An optical scanner isn’t adequate for this application. Ultra-Scan pioneered the use of ultrasound imaging for the fingerprint that has resulted in superior accuracy rates in patient identification.” Once the initial identifying demographic information about the patient is entered into the healthcare organization’s databanks—a process that takes less than two minutes—all patients have to do on their next visit is lay their finger on the touch pad and their medical records can be accessed. The finger imaging system has been put in place in many hospitals and healthcare systems nationwide, Schneider says. The Ultra-Scan technology also ties in with systems that presently operate a biometric identification system. In addition to identifying patients, the Ultra-Scan technology can help cut down on pharmacy fraud. “One of the other uses for the fingerprint scanning technology, rather than a computer log-in, would be as a way to identify the pharmacists who are filling electronically transmitted prescriptions and doctors who are requesting them,” Schneider explains. “It would also be a way to accurately identify the person picking up that prescription. The era of electronic prescriptions makes the present system vulnerable to the click of a mouse.” Kongstvedt says the bottom line is that there is a glaring need for a universal healthcare identifier. “Anything that will promote and enhance continuity and better communication in healthcare is to be supported,” he says. Security And Legal Issues Funding for an identifier program could also be an issue, Kongstvedt explains, saying that if Congress had chosen to fund that aspect of HIPAA, then it could have been funded on a national basis. By Washington choosing not to fund it, the issue is raised as to who will fork over the dollars for the implementation of such a program. Cheryl S. Camin, an attorney at Gardere Wynne Sewell LLP who specializes in healthcare and HIPAA privacy regulations, says the implementation of a universal healthcare identifier also affects the legal profession because of public policy arguments. Camin says HIPAA slightly impedes the adoption of a universal identifier because its rules and regulations make it more difficult to freely transmit information. “A universal healthcare identifier is helpful because it will allow individuals to access information more freely,” she says. “Right now, HIPAA has implemented national identifiers for employers and insurance providers. One of HIPAA’s main purposes was to increase the efficiency and effectiveness of healthcare administration. “On the other end of the spectrum, because a healthcare provider could get the whole gamut of a person’s healthcare information if this identifier links to this huge database—in particular, if it leads to all health information—it could open Pandora’s Box depending on how it’s used.” Despite that possibility, Camin says there may be a way to get around the problem by using tighter security. “Access to healthcare records that have a patient’s identifier linked to them will likely have to have restricted access so that only certain people can obtain information linked to that identifier,” she says. “Secure encryption methods will have to be put in place to make certain the information is as secure as possible.” Increasing efficiency and effectiveness electronically is commendable, but it also has to be secure. “There are issues of information going to the wrong people,” Camin notes. “There is a need to have information encrypted and the privacy rules cover that piece. But the biggest issue of security is the nuts and bolts of implementing administrative policy and technical procedures.” The need for a universal identifier is evident, Camin says. “It will hopefully reduce the risk of errors because a physician will be more assured they are dealing with the correct patient and that the correct medications are tied to one person and one identifier.” As for using a Social Security number, Camin says the potential for trouble is too great. Medical personnel would have access to Social Security numbers, which in turn could lead them to other information, such as a patient’s financial records. “If we want to be more conservative, a cautious approach would be to use a number that is separate from the Social Security number,” she says. The potential for legal concerns is also great. Camin cites an example of a physician who is treating Mrs. Smith for AIDS. If Mrs. Smith is identified through her Social Security number, then there is the possibility that the other medical professionals she visits could discover her affliction. “Release and access to too much information could arise because all of Mrs. Smith’s healthcare information is tied to that one number,” Camin says. “She could now sue everyone [who] disclosed that information, which could lead to more legal battles, damages, and harm caused because of it.” Camin says costs for implementation of extra security measures could be prohibitive but necessary. However, down the road, everything would be more efficient, and healthcare facilities would save money in the long term. — Robbi Hess, a journalist for more than 20 years, is a writer/editor for a weekly newspaper and a monthly business magazine in western New York. • Deaths Due to Medical Errors • Deaths Due to Patient Identity Errors • 2000 Death Statistics, according to the
IOM • Using IOM wrong patient deaths in 2004 with
death statistics from 2000 reveals that people are: — RH Resources • Association of periOperative Registered
Nurses • Bridge Medical • Institute of Medicine • JCAHO |
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