IDESG Is a Glimpse of Our Digital Future

I’ve recently returned from the 7th ID Ecosystem Steering Group Plenary in Atlanta. This is an international public-private project focused on the anything-but-trivial issue of issuing people authoritative cyber-credentials: digital passports you can use to access government services, healthcare, banks and everything else online.

Cyber ID is more than a single-sign-on convenience, or a money-saver when businesses can stop asking you for the names of your pets, it’s rapidly becoming a critical foundation for cyber-security because it impacts the resiliency of our critical infrastructure.

Healthcare, it turns out, is becoming a design center for IDESG because healthcare represents the most diverse collection of human interactions of any large market sector. If we can solve cyber-identity for healthcare, we will have solved most of the other application domains.

The cyber-identity landscape includes:

  • proving who you are without showing a physical driver’s license
  • opening a new account without having to release private information
  • eliminating the risk of identity theft
  • civil or criminal accountability for your actions based on a digital ID
  • reducing your privacy risks through anonymous or pseudonymous ID
  • enabling delegation to family members or professional colleagues without impersonation
  • reducing hidden surveillance by state or private institutions
  • when appropriate, shifting control of our digital tools to us and away from corporations

The IDESG process is deliberate and comprehensive. It impacts many hot issues in health care including patient matching, information sharing for accountable care and population healthhealth information exchangesprescription drug monitoring programsaccounting for disclosurespatient engagement and meaningful usethe physician’s ability to communicate and refer without institutional censorshipthe patient’s ability to control information from our increasingly connected devices and implants, and more.

Hospitals and health industry incumbents that seek to solve the hot issues raised by health reform are not eager to wait for a deliberate and comprehensive process. For them, privacy and cyber-security is a nice-to-have. Who will pay for this digital enlightenment?

This results in a tension between public and industry interest as the healthcare industry tries to decide whether to fund the IDESG path or spawn ever more incremental solutions.

Our Healthcare Working Group is an interesting example. Although the chair, the vice-chair and many active members are physicians, there’s not a single hospital, insurer, health records, or information exchange vendor! I suspect this is about to change.

For me, the most exciting presentation at this meeting was from kindred spirits in the UK. Their cyber identity program, driven by the Digital by Default government mandate, is well under way. This summer, they begin a beta rollout of digital access to driver accident “points” and to employer tax deduction information. Health care, they acknowledge, is the most complex and likely among the last of the digital by default cyber-identity transitions.

IDESG is arguably the only current health IT program that makes citizen privacy and autonomy the design foundation. Necessity, in this case for digital efficiencies and cybersecurity, is the mother of invention. For me, as a patient and physician advocate, it’s an exciting time as industry and professional societies begin to see Digital by Default on the horizon and join the parade.

Adrian Gropper, MD is Chief Technical Officer of Patient Privacy Rights and participates in Blue Button+, Direct secure messaging governance efforts and the evolution of patient-directed health information exchange.

3 replies »

  1. All doctors who really have a concern for their patients welfare, should let them know how to get their brand name and generic drugs up to 90% off! Tell them this is no regular discount rinkydink card, but an unbelievable prescription benefits card for the entire family for just $7.95 a month that includes the whole family, not per person. This includes your pets too! They are part of your family too right? Super Cheap Meds dotcom will take you there!

  2. Paul,

    I think your instincts are the same as mine. Cultures will maintain the physician-patient relationship because it’s an effective way to regulate the delivery of critical resources and promotes innovation at the local and personal level. Medicine is not capital-intensive but it is communication-intensive. The Internet is a perfect fit to support local medical practices and the physician-patient relationship.

    Modern identity management will enable “off-the-grid” patient records and will shift the balance of power in favor of the physician-patient relationship. “off-the-grid” records will drive research and public health users to ask rather than take and greatly accelerate the rate of medical progress.

  3. Dr. Gropper,

    Given your position as CTO of Patient Privacy Rights I find it encouraging that you are so optimistic about the work of IDESG with respect to it all working out eventually for patient privacy concerns of electronic health records.

    My instincts are that in an age of NSA surveillance scandals that the system will not work…..and that there will be an increasing movement toward non compliance by physicians and patients who revert to “off the grid” patient health records….paper and pen records or perhaps heavily firewalled standalone secure electronic records firewalled to be off the internet (do you know if these scenarios are or will be deemed illegal?).

    My concerns were reinforced in a panel discussion held Jan. 7th…..Georgetown law professor Randy Barnett commented:

    “One thing that hasn’t happened yet….and I don’t know when it is going to….I hope it is soon….and that is the digital records….digital medical records…..means that the NSA isn’t going to have to monitor your cell phone or emails to figure out what illnesses we have. It is all going to be digitized and within reach….not encrypted….or not encrypted enough to prevent then from accessing it. So every doctor you have seen and every shrink you may have talked to is going to be something the federal government is going to have access to because of this mandated digitization. We haven’t got there yet. The public hasn’t focused….even the intelligentsia hasn’t focused on this yet.”
    Randy Barnett
    Comments January 7, 2014
    Randy E. Barnett is the Carmack Waterhouse Professor of Legal Theory at the Georgetown University Law Center

    Thank you for your article. Any further reassurances or insights regarding this issue would be appreciated.