Voluntary Universal Healthcare Identifiersfor Patient and Device Identification

• Barry R. Hieb, MD• Chief Scientist, Global Patient Identifiers Inc.

• OHT Architecture Technical Exchange Meeting• December 9, 2008

• \presentations\OHT2009\OHTtechnical12-9-08

Agenda

Need & ObjectivesThe VUHID SystemSystem OperationShowstoppers Recognized and AddressedRAND StudyVUHID Identifiers for DevicesCurrent StatusVUHID Benefits Conclusions

What is the Need?

Heterogeneous clinical automation environment

No consistency in patient/device identification

8% error rate in EMPI demographic matching

Increased cost, time, errors, and complications

Increased identity theft risk

Not possible to properly address privacy needs

Inhibition of clinical information sharing

Unable to assemble comprehensive record

Enable NHIN & advanced information analysis

The VUHID System

Voluntary system

Operates with cooperating EMPIs and HIEs

System in development– Software in testing– Web site design in

process– Beta sites in 2009

IDs will be issued (at no cost) to any person who requests one from a participating physician

Based on two ASTM/ANSI standards

John Q Public

18563823043.271457280

Open Identifier

VUHID Mission Statement

The goal of the Voluntary Universal Healthcare Identification (VUHID) project is to make unique healthcare identifiers available at no cost to individual patients who want one to enable:– unambiguous patient identification – error-free linkage of clinical information – enhance the privacy of patient information – improve the quality of medical care – reduce the rate of medical errors – decrease the incidence of healthcare-related identity theft – help control healthcare costs

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Two Categories of Identifiers

VUHID identifiers are either an OVID or PVIDOpen Voluntary Identifier – OVID– Shared patient information for administrative, financial and

clinical uses– Patient identity is known– Wide variety of “open” medical uses

Private Voluntary Identifier – PVID– Many different classes:

• Psychiatry, STDs, research, genetics, etc.– Patient identity is not necessarily known

• Patient, selected physician(s), EMPI system– Specific set of “rules” for each privacy class

Ideally, a person has one OVID and many PVIDs Multiple OVIDs for one person are not ideal but tolerated

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VUHID Identifier Syntax

0000008562837139.749174221800000

Prefix

Identifier syntax

Open identifier 0000003693664829.210573940000000

DelimiterCheckdigits

Privacyclass

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

Private identifier 0000005637623757.077328571370000

Note: Private identifiers are anonymous

Compact display 3693664829.21057394

Private Voluntary Identifier (PVID)

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Used for data to be kept private

Anonymous operation

No name on card

Multiple PVIDs expected for each patient

Each PVID class can be used for one or more types of confidential information

________________

83673447252.1172853407

Private Identifier

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Anticipated Sample Privacy Classes OVID identifiers

– All open data PVID identifiers

– Temporary identifiers – Test identifiers– General private identifiers – Psychiatric information– Genetic information – Financial

transactions– Permanently blinded research – Legal and policy issues– Unblindable research – Clinical trials– Pharmaceutical R&D – Specialty-specific– Patient-requested – Geography/political entity-

“Single use” identifiers specific– Participation in a disease registry – Cancer data– Single use for ‘sensitive’ diagnostic tests?

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Sample Identifiers for an IndividualOVID for a person– 0000005091093234.215712900000000

Compact representation of the OVID above– 5091093234.21571290

PVIDs for the same person– 0000056285294729.265932365824980– 0000025234750372.025025026389256– 1528810573905739.953057293059000– 0000000519385638.795629763800000

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Six Critical HIE functions

Hospital1

Hospital3

Hospital2

EMPIandRLSClinic

Clinic

MDoffice

MDoffice

MDoffice

Long-termcare

1. User authentication 2. Patient registration3. Demographic matching4. Identifier mapping5. Record locator service6. Information sharing policies

HIE = Health Information Exchange

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VUHID System Architecture

VUHID

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Obtaining an Open Identifier

Provider’sOffice

VUHIDServer

EMPISystem

1. Patient requests ID2. Staff collects demo-graphic data

3. Demographic data and request for OVID sent to EMPI

4. Demographic match

6. OVID issued

9. OVID card given to patient

8. OVID used byprovider

7. EMPI registers the patient including demographics andOVID

5. OVID request

Demographic and clinical data

No demographic or clinical data

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Clinical Data Request Processing

VUHID Request

Validation

Response

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VUHID Patient Benefits

Unambiguous identification – No matching errors, no risk of mixing your medical data with

someone else’s data or missing some of your data due to improper identification

Improved information linkage – No need to bring your own medical records to the physician’s

office– Ability over time to create a comprehensive medical record

Less hassle – No need to repetitively provide extensive identifying information in

physician’s officeReduced risk of identity theftBetter privacy control over medical informationAbility to “recover’ from errors involving improper use of medical information by issuing a replacement identifier(s)

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National Healthcare ID: Previous “Show Stoppers”

Cost

Technical issues

Federal legislation required

Federal/national consensus and approval required

Privacy risks

System conversion costs

Big-bang implementation needed

RAND White PaperIdentity Crisis: An Examination of the Costs and

Benefits of a Unique Patient Identifier

90% EHR adoption would save $77 to $154 billion annually

Mean EMPI matching error rate is 8%, data is the problem, not software

Implementing a UPI would eliminate false + & - going forward

EMPIs will continue to be needed

UPI can facilitate privacy & help prevent unauthorized access

67% of patients have privacy concerns but 92% are willing to share information

$12-25 million cost for 5 years but $1.5 billion for enrollment

$8-10 billion in annual savings from UPI

12%-20% hide information from their medical record

RAND Conclusions

“… a unique, nondisclosing patient identifier is clearly desirable for reducing errors, simplifying interoperability, promoting NHIN architectural flexibility and protecting patient privacy.”

“… depending only on statistical matching will perpetuate errors in health-records retrieval …”

“… recommend that Congress remove the current and clearly counterproductive constraints on HHS with regard to the UPI.”

“Continuing de facto endorsement of the statistical matching method as the only practicable approach to linking patients to their electronic health records is likely to inhibit the effective development of the NHIN.”

VUHID Identifiers for Devices

Existing VUHID server infrastructure is appropriate

Uniform Identifier syntax

Use one or more dedicated privacy classes

Batch issuance of IDs

Support checks for validity and current status

No support for clinical information queries

Low cost per identifier

Global scope

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Current VUHID Status VUHID standards

– E 1714 – properties– E 2553 – implementation guide

RAND “Identity Crisis” study http://www.rand.org/pubs/monographs/2008/RAND_MG753.pdf. Discussions with EMPI vendors Prototype system – batch issuance, interactive under development Implementation project Preliminary discussion with privacy advocates ONC informed but no involvement (by Congressional mandate) Grant applications being prepared Demonstration in preparation for HIMSS Ready for beta sites – 2009

VUHID Benefits

International standard

Globally unique identifiers, ready internationalization

Uniform identifier syntax with easy readability

‘Unlimited’ capacity

Cost effective

Flexibility – IDs for patients & devices

Evolving acceptance by privacy community

Immediate availability

Counterfeit resistance

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Conclusions

VUHID system will facilitate interoperability of healthcare data

It constitutes a robust and flexible platform to address healthcare privacy issues

Voluntary system avoids virtually all of the pitfalls and barriers to previous proposals

Cost effective

Rapidly and incrementally deployable

Evolutionary path: system benefit grows with the number of participating HIEs

Significant advance in unambiguous patient identification and privacy of clinical information

Increasing healthcare automation makes accurate identification of patients and devices essential

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Additional InformationThe Case for a Voluntary National Healthcare Identifier, B. Hieb, Journal of ASTM International, February 2006, Vol. 3, No. 2Designing a Voluntary Universal Healthcare Identification System, B. Hieb, Gartner research paper G00155382, 24 March 2008Q&A for Obstacles to Creation of a National Patient Identification Capability, B. Hieb, Gartner research paper G00155261, 24 March 2008E 1714, Standard Guide for Properties of a Universal Healthcare Identifier (UHID) www.astm.org E 2553 , Standard Guide for the Implementation of a Voluntary National Healthcare Identification System www.astm.org http://vuhid.org, information-only web site“Identity Crisis: An Examination of the Costs and Benefits of a Unique Patient Identifier”, Richard Hillestad, et. al., Oct. 2008, RAND Corporation Monograph # 753, http://www.rand.org/pubs/monographs/2008/RAND_MG753.pdf

Contact Information

Barry Hieb, MD– bhieb@vuhid.org– 520.320.6220

www.vuhid.org

Thank you!