Patient Identification: Paving the Way for Electronic Healthcare

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Following my testimony before NHIN earlier this year, I have met a number of visionaries in the healthcare sector who have been deeply involved in tackling some of the hardest and somewhat quixotesque challenges facing true electronic healthcare.

Of no surprise -a t least to me- is the fact that at the heart of many of these challenges is the issue of how individuals are actually identified. This very issue remains a fundamental roadblock for mass adoption and, whether due to cost, privacy, or technology, all of which are essential in creating a tipping point effect that can represent a much needed paradigm shift.

A good example of this kind of visionary in healthcare is Barry Hieb, M.D., Chief Scientist at Global Patient Identifiers Inc. (GPII), who has focused on the identification of patients as a stepping stone in enabling electronic healthcare in a scalable and privacy-respecting manner.  

Given my interest in both identity assurance and privacy as enablers for business transformation, I talked Barry into enlightening me on GPII's approach and its merits. GPII has introduced the Voluntary Universal Healthcare Identifier (VUHID) project as the solution to enabling digital identification of patients. Understanding how VUHID works in the context of patient identification is the focus of this blog article. Below is a transcript of my Q&A session with Barry.

Frank: What is the business problem you are tackling?  Aren't things fine as they are?

Barry: Accurate exchange of clinical information is an essential requirement of the NHIN, as well as supporting initiatives such as meaningful use and interoperability.  Healthcare uses enterprise master person index (EMPI) systems to ensure that independent clinical automation systems exchanging information are actually "discussing" the same individual.  However, documented experience indicates an 8%-10% error rate for this process due to poor data quality.  This error rate represents a serious patient safety issue because it can lead to missing data or inappropriate mixing of information among individuals.

Frank: What is being solved with the VUHID approach?

Barry: The Voluntary Universal Healthcare Identification (VUHID) system has two primary goals:

1) Enabling accurate patient identification, and

2) Enhancing proper privacy management of clinical information. 

VUHID issues unique identifiers that can be used to identify patients across all venues of care within a collaborating network - and eventually across regions and the nation.  It also provides enhanced protection for information that must be treated as sensitive.

Frank: What are the tangible benefits? Can they be measured?

Barry: Eliminating errors in patient identification yields substantial benefits in operational efficiency and patient safety.  Preventing avoidable complications and improving patient outcomes are just two examples of this.  In addition, benefits such as improved patient registration efficiency, elimination of duplicate testing and avoiding time wasted looking for missing information represent measurable and tangible benefits for care delivery organizations.

Frank: Why isn't the government doing this?

Barry: The original HIPAA legislation passed by Congress included a mandate to create an individual healthcare identifier.  Two years later, based on valid privacy concerns, Congress reversed itself and prohibited any work on a national healthcare identifier.  That prohibition remains in effect today with the result that, for the past decade, there has been no federal activity on this topic despite significant progress on how to accomplish this in a cost effective manner that actually enhances patient privacy.

Frank: How about the private sector? What would be their incentive?

Barry: Creation of a national healthcare identification system has generally been considered to be beyond the scope of any private sector organization.  Global Patient Identifiers Inc. (GPII) was formed two years ago as a healthcare nonprofit organization using international standards and an innovative deployment strategy to avoid previous obstacles.  Our goal is to enable healthcare to solve the patient identification problem through the use of unique patient identifiers.

Frank: Can this be done today? How? 

Barry: The VUHID system is currently available.  We are looking for beta test sites interested in performing pilot studies to demonstrate the feasibility and value of this approach.  A minor modification to the EMPI system of a health information exchange (HIE) or healthcare enterprise, and corresponding changes to the patient registration process, are all that are required.

Frank: From experience, I know that most healthcare organizations have a lot of legacy applications in their IT environment, what do they need to consider now in light of electronic healthcare and patient identification?

Barry: One of the advantages to the VUHID approach is that it does not require modification to underlying clinical automation systems in order to get started.  Only those changes required to integrate VUHID with your current EMPI and registration systems are needed.

Frank: What steps can I take to better understand this issue and begin to plan a solution for my organization?

Barry: HIMSS Patient Identity Integrity Work Group published a whitepaper in December, 2009, which provides background information.  There are also a number of other studies on the GPII web site. 

If your organization is an HIE or a large integrated delivery network that has an EMPI system in place, and you would like to discuss how to get started, there is contact information on the GPII web site as well.

Frank: Are there privacy implications? How should I deal with them? What's the tradeoff if any?

Barry: Any exchange of clinical information must be carefully structured to ensure that it does not impinge on patient privacy.  The VUHID system has been carefully architected from the ground up to ensure that it does not represent any threat to patient privacy but rather enhances the ability of HIEs and other healthcare enterprises to better manage the privacy of clinical information.  VUHID identifiers can support and enhance the privacy policies of healthcare institutions.

Frank: What is the current status of the VUHID system?

Barry: VUHID is operational in a test environment.  We are ready and actively seeking beta test sites that are interested in performing pilot studies to demonstrate the feasibility and value of this approach.  We are also seeking systems integration vendors that would like to partner in order to embed VUHID capabilities into their HIE integration solutions.

Frank: How does this fit in with healthcare reform?

Barry: The federal healthcare reform effort is trying to combine a variety of projects and capabilities such as NHIN, NHIN Direct, meaningful use, interoperability, enhanced privacy and many others into a set of solutions that can improve the quality and efficiency of our healthcare system.  Accurate patient identification is an indispensible prerequisite infrastructure in order to achieve these goals.

Frank: Thanks Barry for this insight. Establishing identity in electronic healthcare is evidently a very broad and fundamental issue, your perspective helps me understand the scope of the challenges a bit further. This has been very informational for me, and I sure hope that our readers concur.

As always, we look forward to your comments and questions.