1. Voluntary Universal Healthcare Identifiers for 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

2. Agenda Need & Objectives The VUHID System System Operation Showstoppers Recognized and Addressed RAND Study VUHID Identifiers for Devices Current Status VUHID Benefits Conclusions

3. 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

4. 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

5. 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

6. 6 Two Categories of Identifiers VUHID identifiers are either an OVID or PVID Open 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

7. 7 VUHID Identifier Syntax 0000008562837139.749174221800000 Prefix Identifier syntax Open identifier 0000003693664829.210573940000000 Delimiter Check digits Privacy class 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 display3693664829.21057394

8. Private Voluntary Identifier (PVID) 8 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

9. 9 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?

10. 10 Sample Identifiers for an Individual OVID 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

11. 11 Six Critical HIE functions Hospital 1 Hospital 3 Hospital 2 EMPI and RLS Clinic MD office MD office MD office Long- term care 1.User authentication 2.Patient registration 3.Demographic matching 4.Identifier mapping 5.Record locator service 6.Information sharing policies HIE = Health Information Exchange

12. 12 VUHID System Architecture VUHID

13. 13 Obtaining an Open Identifier Provider’s Office VUHID Server EMPI System 1. Patient requests ID 2. 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 by provider 7. EMPI registers the patient including demographics and OVID 5. OVID request Demographic and clinical data No demographic or clinical data

14. 14 Clinical Data Request Processing VUHID Request Validation Response

15. 15 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 office Reduced risk of identity theft Better privacy control over medical information Ability to “recover’ from errors involving improper use of medical information by issuing a replacement identifier(s)

16. 16 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

17. RAND White Paper Identity 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

18. 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.”

19. 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

20. 20 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.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

22. 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

23. 23 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

24. 24 Additional Information The Case for a Voluntary National Healthcare Identifier, B. Hieb, Journal of ASTM International, February 2006, Vol. 3, No. 2 Designing a Voluntary Universal Healthcare Identification System, B. Hieb, Gartner research paper G00155382, 24 March 2008 Q&A for Obstacles to Creation of a National Patient Identification Capability, B. Hieb, Gartner research paper G00155261, 24 March 2008 E 1714, Standard Guide for Properties of a Universal Healthcare Identifier (UHID) www.astm.orgwww.astm.org E 2553, Standard Guide for the Implementation of a Voluntary National Healthcare Identification System www.astm.orgwww.astm.org http://vuhid.orghttp://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 http://www.rand.org/pubs/monographs/2008/RAND_MG753.pdf

25. Contact Information Barry Hieb, MD –bhieb@vuhid.orgbhieb@vuhid.org –520.320.6220 www.vuhid.org Thank you!