Creating a Universal Individual Healthcare Identification System by Barry Hieb

Barry Hieb is a senior healthcare analyst with Gartner Consulting.

For many years it has been widely acknowledged that there are many benefits which could be realized by healthcare through the creation of a system of unique individual healthcare identifiers. These identifiers could enable the creation of a comprehensive medical record for each participant and would virtually eliminate the risk of inappropriate merging of some other individual’s information into a medical record. In addition, these identifiers have the potential to play a significant role in enhancing the privacy and security of medical information.

Unfortunately, a well entrenched set of barriers and objections have prevented the creation of any such system: 1) there are many technical issues to be resolved, 2) the cost of any such system has been estimated to be significantly greater than $1 billion, 3) there has been a lack of a national consensus on how to create such a system, 4) the federal government has specifically prohibited funding for such an effort, 5) there are serious (and well-founded) privacy concerns about the risks associated with the creation of a national healthcare database, and 6) it is not clear how one could pull off the “Big Bang” implementation of such a system.

In 1995 the ASTM E 31 medical informatics standards group passed standard E 1714 describing the functional requirements for a healthcare individual identifier and this standard has subsequently been updated twice. Approximately 2 ½ years ago efforts began to create a companion implementation guide which would describe how to actually implement such a system despite the barriers listed above. The result was standard E 2553 which was published in September of 2007. It is the opinion of the ASTM E31.25 medical informatics committee that this implementation guide offers a strategy which can avoid or resolve each of the six barriers listed above. Based on that accomplishment, a small group of individuals has embarked on an effort to create such a system. The system is entitled a “Voluntary Universal Healthcare Identification System” (VUHID, pronounced ‘view hid’) with a target of having the system operational by the middle of 2008.

The proposed system is described at http://vuhid.org and also in the E 1714 and E 2553 standards which can be acquired at www.astm.org. This system will issue identifiers at no charge to any patient who requests one from a physician who is participating in the VUHID network. Both ’open’ identifiers for medical information which the patient wishes to freely share and ‘private’ identifiers for sensitive medical information will be supported. ASTM and the developers of this system would welcome analysis of and feedback on this project. The VUHID web site contains an option where comments may be posted and, of course, this BLOG is meant to stimulate discussion as well.

By Barry Hieb

Comments

[jd]

Very interesting.

I'm not sure I understand how the red privacy cards work. I looked at the website and it wasn't clear.

I understand the strategy of making it voluntary, but how do you plan to address the main drawback? Namely, even if the privacy issues are effectively handled, people will only gradually volunteer to get a UHID so that the critical mass needed to regularly rely on the system is probably many years away. At least providers and insurers should be mandated to accept them when provided and enter them into their databases.

[Amy Harmon]

I have to ask.... If Health 2.0 Blog is simply reposting of entries from "The Healthcare Blog," is there any point to it??

So far, I've been looking for Health 2.0 blogging, and all I'm seeing is the same entries from the other blog... I know they are run by the same people, but really, what's the point then?

[John]

Er ... good catch Amy!

There are actually a fair number of posts here hiding out in the archives that aren't visible at the moment, because Typepad has pushed them off the main page. (Yep. That's something I'll be fixing.)

But yeah -- you're right, We've cross-posted a lot of stuff over the past few days. Generally, we just run the first graph of a piece and then link people over from THCB ...

If you're looking for good Health 2.0 blogging, there are a lot of people doing interesting things. The archive at THCB has quite a few Health 2.0 posts that haven't yet made it over here, which should give you some leads ...

http://www.thehealthcareblog.com/the_health_care_blog/health_20/index.html

If you give me an idea what you're looking for, I'll try to point you in the right direction. Feel free to drop me an email. - John