Patient Identity Richard Moore eHealth Ohio October 12, 2012 CSOHIMSS Fall Conference 2012 Columbus State Community College

1. © CSOHIMSS 2012 Slide 1 Fall Conference 2012
Oct 12th , 2012
Patient Identity
Richard Moore
eHealth Ohio
October 12, 2012
CSOHIMSS Fall Conference 2012
Columbus State Community College

2. © CSOHIMSS 2012 Slide 2 Fall Conference 2012
Oct 12th , 2012
The Patient ID Issue
 Quality Data starts with having the right Patient
 Identity of the patient from matching algorithms fail
– What percentage failure is acceptable 1%, 5%, 10%?
 Patient Names, Sex, Age as a matching value
– Mis-keyed values in the record
– Variability of entry
– System mistakes – batch clean-up
– Aliases
– Multiple identities – names, sex, age
 Data clean-up requires 1 valid patient ID
 Nationwide Health Information Network needs a Patient ID to
work effectively
 National Strategy for Trusted Identities in Cyberspace (NSTIC)

3. © CSOHIMSS 2012 Slide 3 Fall Conference 2012
Oct 12th , 2012
Why isn’t there a national patient ID?
 1996 HIPAA - Required HHS to “develop a unique identifier for
healthcare.”
 1998 National Committee on Vital and Health Statistics
(NCVHS) hearings – Identity Crisis: An Examination of the
Costs and Benefits of a Unique Patient Identifier, “revealed
significant concerns that the privacy and security of patient
information could be threatened if it were networked beyond
local health care information systems.”

4. © CSOHIMSS 2012 Slide 4 Fall Conference 2012
Oct 12th , 2012
Legislative Restriction
 The 1999 Omnibus Appropriations Act signed into law
(PL 105-277) stated:
– “SEC. 516: None of the funds made available in this Act may
be used to ‘promulgate’ or adopt any final standard under
section 1173(b) of the Social Security Act (42 U.S.C. 1320d-
2(b)) providing for, or providing for the assignment of, a
unique health identifier for an individual (except in an
individual's capacity as an employer or a health care
provider), until legislation is enacted specifically approving
the standard.”
 To this day, the legislative language has been carried forward
in every Labor, Health and Human Services, Education, and
Related Agencies Appropriations bill.

5. © CSOHIMSS 2012 Slide 5 Fall Conference 2012
Oct 12th , 2012
Administrations’ Interpretation
 Clinton Administration halted the NCVHS work on the
topic immediately after FY99 Appropriations bill was
passed.
 Succeeding Administrations (Bush, Obama) have
interpreted the language as a prohibition against HHS
spending ANY funds on investigating ANY form of
patient identity solution.

6. © CSOHIMSS 2012 Slide 6 Fall Conference 2012
Oct 12th , 2012
2008 RAND Corporation Study
 Between 8 and 14 percent of all EHRs contain identity
related errors.
 A Hybrid system utilizing both statistical matching and a
UPI will be necessary for the foreseeable future.
 Security and privacy could be strengthened with a UPI.
 Recommendation - “Congress [should] remove the
current and clearly counterproductive constraints on HHS
with regard to the UPI. Instead, Congress should be
encouraging HHS to make a full assessment of the
privacy, security, and operational implications of all of the
alternatives for linking patients to their health records
within the NHIN.”

7. © CSOHIMSS 2012 Slide 7 Fall Conference 2012
Oct 12th , 2012
Health IT Policy Committee
Direction
 Summer of 2011, the HITECH Authorized Health IT Policy
Committee asked the Health IT Standards Committee to:
Recommend standards to: “(1) Standardize the formats for patient
matching demographics; (2) Internally evaluate matching accuracy;
(3) Address Accountability ; and (4) Develop and disseminate best
practices.”
 Health IT Standards Committee formed the Patient
Matching Power Team which recommended:
“The [ONC] or other appropriate agencies should sponsor specific
research and analysis to identify the most relevant and achievable
metrics to return in response to a patient matching query. Meanwhile,
the response should, at a minimum, provide a URL that provides
information on the matching approach used, any available
characterization of the matching approach, and a point of contact for
additional information.”

8. © CSOHIMSS 2012 Slide 8 Fall Conference 2012
Oct 12th , 2012
HIMSS Involvement
 2009 HIMSS established the Patient Identity Integrity Work
Group
 December 2009 HIMSS released the Patient Identity
Integrity White Paper
 Recommendations included:
– Secretary HHS, under the direction of the Congress, should
establish an informed patient identity solution
– Congress should lift the prohibition against HHS studying UPI
solutions
– HHS should conduct a study of the cost/benefit and practicality of
implementing a UPI solution
– HHS should establish pilot implementations of unique identifiers to
document the challenges and benefits.

9. © CSOHIMSS 2012 Slide 9 Fall Conference 2012
Oct 12th , 2012
HIMSS Strategy
Legislative Recommendations & Letter writing
GAO Study Recommendation
Coalition for an Informed Patient Identity Integrity
Solution
HIMSS-specific activities
Other Collaborations
Policy Summit member asks 2010, 2011 & 2012

10. © CSOHIMSS 2012 Slide 10 Fall Conference 2012
Oct 12th , 2012
HIMSS Strategy
Legislative Action: The Labor, HHS Appropriations
Subcommittee could:
Delete the prohibition language from the FY12 bill
Insert alternative bill language
Use the same draft as Legislative Report Language
GAO Study: A Congressional committee chair or key
subcommittee chair could request that GAO
undertake a study (As an agency of Congress, GAO
does not require designated funding and is not bound
by the Labor HHS Appropriations language)

11. © CSOHIMSS 2012 Slide 11 Fall Conference 2012
Oct 12th , 2012
Results of 2012 ask
In the interest of patient safety, privacy, and security,
and in order to achieve the full potential of health
information technology, Congress should direct a study
of patient data matching issues and best approaches to
identify an appropriate nationwide patient data
matching strategy.
– Support & Likely to Support = 73%
– Neutral = 24%
– Likely to Oppose = 2.9%
– Opposed = 0%

12. © CSOHIMSS 2012 Slide 12 Fall Conference 2012
Oct 12th , 2012
Action steps
Help add legislative support in Washington DC
– Talk, write, email your Representatives and Senators
– HIMSS Policy Summit meetings
Work on the HIMSS Patient Identity Integrity
Work Group
Join Kantara Healthcare Identity Assurance
Workgroup
National Strategy for Trusted Identities in
Cyberspace (NSTIC)

13. © CSOHIMSS 2012 Slide 13 Fall Conference 2012
Oct 12th , 2012
Kantara HIAWG
Workgroup is focusing on:
– Identity Assurance
– Identity Assurance Framework
– Trusted Authority relationships
– Voluntary User Health ID
– Exchange of Patient Health Information
– Patient Identity Service
http://kantarainitiative.org/confluence/display/hea
lthidassurance/Home

14. © CSOHIMSS 2012 Slide 14 Fall Conference 2012
Oct 12th , 2012
NSTIC
White House initiative to work collaboratively
with the private sector, advocacy groups, public
sector agencies, and other organizations to
improve the privacy, security, and convenience
of sensitive online transactions.
The Strategy calls for the development of
interoperable technology standards and policies
— an "Identity Ecosystem"
5 pilot projects announced 9/20/12
http://www.nist.gov/nstic/

15. © CSOHIMSS 2012 Slide 15 Fall Conference 2012
Oct 12th , 2012
Questions
Rick Moore
eHealth Ohio
DME Consulting Services
rkmoore@dmeconsult.com
614-530-2350