Patient identifier one step closer to reality
Move would help track patients
A national group attempting to nudge the health care industry closer to computerized patient records has taken a key step in that direction.
The Computer-based Patient Record Institute (CPRI), is recommending that the federal government adopt a new universal health identifier number for people based on Social Security numbers (SSN). That number would be used to keep track of patients down through the years and all across the country.
The lack of a key identifier has been a major problem, says Paul Carpenter, MD, an endocrinologist at the Mayo Clinic in Rochester, MN, and a member of the executive committee of the Schaumburg, IL-based CPRI.
Alternatives to the SSN were discussed, but using the numbers and infrastructure of the Social Security Administration (SSA) was the best, cheapest, and fastest way to implement an identifier system, he says.
"We looked at three options: Come up with a new number, to use the SSN, or use some real-person identifier like a finger print." The third option is not practical since about 80% of health care transactions take place without the patient, says Carpenter. "If I call in a prescription, the patient isn’t there." The new number system would take up to 10 years to develop, implement, and build trust among consumers, he says.
Carpenter says there are five compelling reasons to use the SSN as a health identifier:
• The SSA has offices across the country.
• About 90% of the population has a Social Security number already.
• The agency does not have to build trust among the population, so it will save time.
• It will be about four times cheaper, although Carpenter did not have figures available, to use an existing infrastructure than to develop a new one.
• The public accepts the Social Security number as a valid identifier.
There still are problems that must be overcome. For instance, people who received an SSN more than 10 years ago may have the same number as someone else. There also are thousands of people who have more than one SSN, usually for fraudulent reasons, says Carpenter.
One of the changes the SSA will have to make is including a "check digit" in SSNs: one or two numbers at the end of a string that tell a computer to make a calculation based on the preceding numbers. If the calculation comes out incorrectly, the string is invalid. "It eliminates people making up their own numbers, as well as typographical errors."
There also are concerns about confidentiality, but Carpenter notes that health reform legislation approved last year requires security and confidentiality legislation that imposes severe criminal and civil punishments on people who release identifier information without consent. "We have to have some preemptive federal legislation that penalizes those who breach security," says Carpenter. "But people have to realize that the security of the number is not about the string of digits, but about confidentiality and security authority.
Legislation is expected in Congress to require the SSA to start work on changes needed to implement a health identifier program.
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