Can We Talk about Unique Patient Identifiers Yet?

Optimized-identitycardThis is the story of an old idea that sat around for so long, it became new again. In the mid-1990s Barry Hieb, MD, thought all conditions were perfect for the national rollout of the unique patient identifier. The year before he had just wrapped up a project with ASTM International’s Medical Informatics Standards Group. Through their work they had produced criterion for medical identifiers.

“We thought we were golden because in 1996 Congress came out with HIPAA that required a unique identifier for individuals. And we said great. Here we are! Use our standard,” Hieb said.

But the requirement was immediately met with opposition from groups that believed government-issued identifiers infringed on liberty and security. As a result, it was abandoned a few years later.

“And so we sat there and waited for a while because we knew that they needed it, but nothing happened. And after about 12 years of nothing happening we said, gee whiz. Maybe they’re serious, they’re not going to do anything.”

Today the idea of the patient identifier is still not popular, however, its close relative, health information exchange, is. With various groups across the country laying infrastructure to ultimately allow for patient information exchange from hospitals in New York to hospitals in California, it might simultaneously be paving the way for the adoption of unique patient IDs.

Chief Scientist Hieb and CEO Rob Macmillan run a nonprofit called Global Patient Identifiers, Inc. (GPII). The company was formed in 1998 but only formally launched its product, the Voluntary Universal Healthcare Identifier (VUHID), at HIMSS this year. The logistics of the system have been rethought and reworked over the years in response to national progress around health information exchanges. It’s changed quite significantly,” Hieb said. “And fortunately it’s made it a lot simpler.”

Here’s how it might work 

A patient named Mike asks his local provider for a unique identifier. The doctor’s office, located in Tucson, AZ, is in a regional health information exchange, so Mike’s information is already stored in an enterprise master person index (EMPI). The EMPI contains identifying information like an individual’s name, address and social security number.

Mike’s provider contacts GPII and asks for a new unique patient ID. GPII sends the identifier and notes in the system the date it was created and which health information exchange it was sent to. GPII neither collects nor stores any patient information.

Mike receives a card with his unique identifier, which is stored in the EMPI as a part of Mike’s identifying information. This way he can go to any health care facility within the Tucson health information exchange, and the facility will be able to retrieve his health record. It can send the identification number on his card to the EMPI, which finds the records associated with that number.

Later Mike is on a business trip in Indiana, and he suddenly needs to seek emergency care. Upon entering the ID on his card, the hospital sees that Mike’s information isn’t located in the regional health exchange. The hospital contacts GPII, which replies that the identifier is valid, and GPII names the health information exchange where Mike’s information is located so that the hospital can retrieve it.

The system has two strengths. It never records patient data, so it doesn’t pose a security or patient privacy threat. Even if hackers got into the database, they would only find numbers. And two, it allows regional HIEs to control information so they can comply with their own local policies and procedures.

The future of the unique patient identifier 

Just last week a petition, “Ask Congress to no longer prohibit HHS from establishing standards for a unique patient identifier,” was posted on whitehouse.gov. The website’s We the People platform allows citizens to create petitions, and if they get enough signatures in a certain amount of time, they’re reviewed by White House staff.

Hieb said government involvement isn’t going to happen. In a brief conversation he had at HIMSS with National Coordinator for Health Information Technology Dr. Farzad Mostashari, Hieb said Mostashari indicated that the government has no intention of creating a unique identifier. But Mostashari gave his blessing to any private company that wanted to try.

GPII is getting there. Last year it received a grant from the Robert Wood Johnson Foundation to implement its system at a site on the West Coast. “Unfortunately in month 11 out 12, the health information exchange that we were working with went bankrupt,” Hieb said. Still, through the project, GPII was able to develop most of the software it uses today. The company isn’t ready to reveal anything it’s currently working on, but within the next three to six months Hieb hopes to have some announcements.

“Even though I do believe it’s going to take time to get wide acceptance, the interest that’s starting to show in the last few months has convinced me that we’re on the verge,” Macmillan said.

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