Tech

Moving Toward An Identity and Patient Records Locator

Last week, five health IT vendors came together to announce the CommonWell Health Alliance, a nonprofit focused on developing a national secure network and standards that will:

  1. Unambiguously identify patients
  2. Provide a national, secure record locator service. For treatment purposes, providers can know where a patient’s records are located.
  3. Enable peer-to-peer sharing of patient records requested via a targeted (or directed) query
  4. Enable patients and consumers to withhold consent / authorization for participation in the network

Unambiguous patient identity matters

In banking, without certainty about identity, ATM machines would not give out cash.  And in healthcare without certainty about identity, physicians are working with one hand tied behind their backs.

This problem will never be solved by the Feds. In fact, Congress has restricted any spending on it by the government at all.  Industry working together may be the only practical alternative.

CommonWell doesn’t intend to create a national patient identifier.  Instead it will use practical, robust identity mechanisms that a patient or consumer could provide to each physician or caregiver.  That might be based on a one-way hash of a cell phone number, an email address or a swipe of a driver’s license.  The Alliance members will decide on this as part of its standards.

Locating data is critical to clinical decisions

Imagine a cancer patient with a primary care doc they visit in a family practice, a surgical oncologist in private practice, a plastic surgeon and medical oncologist at one academic medical center and a second opinion oncology team at yet another academic medical center.

Chances are those caregivers all using different EHRs, and they may even be in different geographies.  The physicians don’t know where the records are.  Yet each physician needs real-time access to ALL of the patient’s information with critical clinical decisions hanging in the balance.

CommonWell intends to address these gaps by delivering a secure national record locator service and standards for peer-to-peer targeted queries.  Data that is returned to the physician are not stored on the CommonWell network, nor is the data normalized.

Founding members want every health IT vendor to join CommonWell Health Alliance

Those of us in the Alliance are aligned in our desire to be inclusive and welcoming to all.  The founding members are making significant commitments of money and product developer time for the good of each patient and physician.

I have personally worked with the thought leaders of this effort over several years on ONC initiatives, including the Direct Project and Meaningful Use standards for Stage 2, and I can vouch for their integrity, goals and expertise.  They’ve thought this approach through carefully, not only technically, but also in connection with governance, policy, privacy and security.

Allscripts and the CommonWell Health Alliance are committed to practical, standards-based solutions that can make healthcare safer and more responsive to the physician and patient.  To that end, the Alliance looks forward to working collaboratively with the Office of the National Coordinator for Health IT, other vendors and with standards bodies to achieve these objectives.

Rich Elmore is Vice President for Strategic Initiatives at Allscripts.

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Meet Me LoginsribekiranreddyE TalMargalit Gur-Arie Recent comment authors
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Guest

I love your blog.. very nice colors & theme. Did you create this website yourself
or did you hire someone to do it for you? Plz answer back
as I’m looking to construct my own blog and would like to know where u got this
from. thanks a lot

sribe
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sribe

“…one-way hash of a cell phone number, an email address or a swipe of a driver’s license.”

Well, I hope they consider identifiers that will work for pediatric specialties, and even neonatal…

kiranreddy
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Health is important for all people in world…. use this all people

Health

kiranreddy
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Health is important for all people in world…. use thisall people

Health

Peter Bachman
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Peter Bachman

The locality of healthcare is incredibly important as a protective element or genius loci. That’s because the locality matters in the healing nature of the architecture duly noted by Vitruvius in terms of site location for the askepilon. The network itself is more organic than tcp-ip nicely depicted in the movie Avatar. Meaningful use is a brilliant tool to avoid wasted resources as exemplified by Alexander Pope who describes its role in leveraging the genius loci in the organic human centric healing network.. ‘Tis use alone that sanctifies expense, And splendour borrows all her rays from sense This is not… Read more »

Margalit Gur-Arie
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Love the way you write, Peter!! It’s like reading a painting….

Margalit Gur-Arie
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May I ask how Surescripts is able to conduct hundreds of millions of prescription transactions between hundreds of thousands of providers, without a National Patient Identifier? Why is this not good enough? How often is it clinically imperative to obtain all medical records for a patient, from unknown sources, in an emergency situation, where offline requests for a push are impossible? To Steve’s comment at the very top, lack of a national patient identifier is absolutely not the reason why the “competing” hospital down the street will not share data with you. I don’t see why the Feds should not… Read more »

J. Stefan Walker, M.D.
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J. Stefan Walker, M.D.

The medical Internet has apparently been founded. Like the general Internet, which has enjoyed and still does enjoy broad and persistent success, the Alliance is a plurality of separate and even competing entities with an offering to bring in still others, and appears to cultivate broad and inclusive governance, yet not control too deeply the actual transactions or storage of data. Also – thankfully – it is not a governmental institution. Had this not come when it did, the HIT movement could have faltered and even dissolved at a weak point without the coveted interoperability it needs to thrive…or worse,… Read more »

E Tal
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E Tal

I’m worried that this alliance is merely a cartel, established by market leaders in the legacy EHR business to protect their investments against an obvious market shift toward interoperability (which negates their business model of locking clients into a proprietary system with high switching costs). There are no real technical barriers to most of the issues mentioned, unless you choose to consider legacy EHRs as having a divine right to stay in the market no matter where technology goes. The only reason the federal government can’t do this, nor anyone else who ever tried, is that this cartel lobbies heavily,… Read more »

Peter Bachman
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Peter Bachman

I have to agree that patient identity is not going to solved by the Feds. However there are are multiple existing solutions of which one is voluntary patient ID described by the ASTM standard on the subject is in fact was supported by the RAND report on the subject. The fact this already a part of the ISO X.500 Directory is obvious along with client certificates. I have joked with the NSTIC IDESG privacy experts that we might have to put the entire country through the witness protection / privacy protection program in terms of massive deindentification first however to… Read more »

Adrian Gropper MD
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It’s nice to see some specifics. It enables open discussion and could lead to open governance. 1 – We all seek unambiguous patient ID. The three methods you suggest could all be acceptable. However, the ID strategy needs to respect people’s privacy by not being coercive. Involuntary IDs, be they probabilistic master patient indexes or biometric “tattoos” that we can’t escape are not going to work on a regional or national scale regardless of federal funding. If we can’t wait for NSTIC / IDESG to reach some conclusions for citizens as opposed to patients, then the patient ID discussion needs… Read more »

David Fore
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Rich, I applaud your efforts. It all goes back to fragmentation of the healthcare system, which is a big driver of inefficiencies, as everybody knows (even if at the same time many among the ‘everybody’ consciously make profit from that fragmentation.) Less attention is paid to how that fragmentation threatens peoples’ sense of identity (and therefore safety, comfort, and other ‘healthy’ things). That’s in part because we lack an easy, uniform way to identify patients and link them to their health data, doctors, hospitals, pharmacies, insurance plans and others. The Babylon of patient-identity numbers are bogging down our medical-records system,… Read more »

steve
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steve

If a pt has a stress test at a local competing hospital, I cannot obtain the results from them. I can hope that I can obtain them, usually with lots of delay, from their cardiologist. If it is an EKG or a blood test, I just have them repeated. It is much faster and more certain. If this can be fixed, it will be a major boon for all of us. We really need a universal (organized) record for everyone that is accessible.

Steve