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HEALTH 2.0: Creating a Universal Individual Healthcare Identifier By Barry Hieb

Hieb2_2For many years it has been widely acknowledged that there are many benefits which could be realized by
healthcare through the creation of a system of unique individual healthcare identifiers. These identifiers could enable the creation of a comprehensive medical record for each participant and would virtually eliminate the risk of inappropriate merging of some other individual’s information into a medical record. In addition, these identifiers have the potential to play a significant role in enhancing the privacy and security of medical information.

Unfortunately, a well entrenched set of barriers and objections have prevented the creation of any such system: 1) there are many technical issues to be resolved, 2) the cost of any such system has been estimated to be significantly greater than $1 billion, 3) there has been a lack of a national consensus on how to create such a system, 4) the federal government has specifically prohibited funding for such an effort, 5) there are serious (and well-founded) privacy concerns about the risks associated with the creation of a national healthcare database, and 6) it is not clear how one could pull off the “Big Bang” implementation of such a system

In 1995 the ASTM E 31 medical informatics standards group passed standard E 1714 describing the functional requirements for a healthcare individual identifier and this standard has subsequently been updated twice. Approximately 2 ½ years ago efforts began to create a companion implementation guide which would describe how to actually implement such a system despite the barriers listed above. The result was standard E 2553 which was published in September of 2007. It is the opinion of the ASTM E31.25 medical informatics committee that this implementation guide offers a strategy which can avoid or resolve each of the six barriers listed above. Based on that accomplishment, a small group of individuals has embarked on an effort to create such a system. The system is entitled a “Voluntary Universal Healthcare Identification System” (VUHID, pronounced ‘view hid’) with a target of having the system operational by the middle of 2008.

The proposed system is described at http://vuhid.org and also in the E 1714 and E 2553 standards which can be acquired at www.astm.org. This system will issue identifiers at no charge to any patient who requests one from a physician who is participating in the VUHID network. Both ’open’ identifiers for medical information which the patient wishes to freely share and ‘private’ identifiers for sensitive medical information will be supported. ASTM and the developers of this system would welcome analysis of and feedback on this project. The VUHID web site contains an option where comments may be posted and, of course, this BLOG is meant to stimulate discussion as well.

By Barry Hieb

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Mark Singh MDJeff GoldsmithMark Glen-Walker Recent comment authors
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Mark Singh MD
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Finally someone has has the guts to challenge the assumption that a national patient Identifier is not possible. Currently, we are forced to do algorithmic gymnastics in order to match a patient correctly, and even then, are at best 90% effective. This has led to the dependence on high priced MPI solutions.
The problem will only get worse as more health IT infrastructure is deployed. From a safety standpoint, 90% is not acceptable. Allowing patients to “opt-in” for use of a national patient Id is a great way to address any possible privacy concerns.
Mark Singh MD
http://www.clinicore.blogspot.com

Jeff Goldsmith
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Jeff Goldsmith

Sloppy reading, Mark. ASTM is a voluntary, non-governmental international standards body with an excellent reputation for independence. The proposal does not speak to who actually maintains medical history info. It is opt-in, not governmentally mandated, and uses a well accepted public key methodology familiar to those who have studied encryption technology. This is a very clever and potentially workable solution to a complex political and technical problem. If we want people to “own” their own medical records, and for the health system to be able to use them, we need to have some type of universal patient identifier.

Mark Glen-Walker
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Sounds scary to me. I don’t mind having a personal vault, a one-source database for all my medical records so I have an accurate history, but I’m not so keen on the idea of the government maintaining this database.