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A Unique Patient Identifier could be Beneficial, But At What Price?

Linda was in constant pain so she went to the hospital emergency room where she was diagnosed with a severe stomach virus. After two weeks the pain got worse so she went to a clinic where she saw a gastroenterologist who ordered a CT scan which showed a large mass on her pancreas. Linda had a biopsy and was diagnosed with acute pancreatitis, given medication, and instructed to follow up in six months. The results of this incident were recorded in an electronic record. Six months later, Linda had changed jobs and relocated to another State. She tried to access her record, but discovered that the clinic had merged with a large hospital and they could not find the record. Her new doctors were unable to compare her current CT scan with the initial test, thus compromising their ability to give her the best follow-up care.

There is much talk about the benefits of electronic health records enabling doctors to have full information on a patient at the point of care. However, considering the mobility of the American population, there is a missing link, the absence of a unique patient identifier for every individual that enables the healthcare provider to look up data on that patient whenever and wherever they seek care. By their very nature, electronic records demand that individuals be uniquely identified if the processes of enrollment and authentication are done right.

Rand Research in 2008 conducted a study that concluded that a unique patient identification number system is necessary to reduce medical errors, protect privacy and simplify the use of electronic records. The idea is that associating data such as a sequence of numbers and letters with a particular human enables authentication of the individual and their health information that is resident in digital format. Current systems that match individuals with their information using attributes such as name, birth date, address, zip code, gender, medical record numbers, and all or part of the social security number are not as efficient since some of these factors such as name or address/zip code can change over time.

Unique Patient Identification is not a new idea. In 1996 HIPAA legislation included a provision that asked that the Department of Health and Human Services issue unique patient ID numbers for all Americans’ medical information. The United States Congress reversed that provision after privacy advocates protested that such a system would violate the individual’s privacy protections and bring too much government interference into the health care system. With a massive database of over 300 million individuals with individual patient identifications, privacy issues loom large. Furthermore the Rand Study estimates that building that database could cost as much as $11 billion.

In the United Kingdom and in other European countries national identity smart cards have been tried with some level of success. It would be highly beneficial to individuals and the American healthcare system that an electronic record that includes an individual’s comprehensive health information could be accessed with a unique 9 or 10 digit ID. This is a task for Mr. Daschle’s Federal Health Board to consider as the new administration establishes its short and long term objectives.

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