New medical ID number one step closer to reality
Unique numbers will ease outcomes tracking efforts
Mary is a single mother with two children under age 10. She has a good job and uses a family medical clinic, a hospital, a pharmacy, and a radiology lab, all under the same system umbrella. But in each of the last five years, Mary’s employer has changed insurance carriers. How can she and her health care providers track her and her children’s medical histories and outcomes?
It is a question that has long plagued the medical profession, 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 Computer-based Patient Record Institute (CPRI).
A solution is near at hand one that also can help you track outcomes at your facility. Last month, the CPRI called on the Department of Health and Human Services to adopt a new health identifier number that can track patients across the years and across borders.
Based on existing Social Security numbers and the infrastructure of the Social Security Administration (SSA), Carpenter says the CPRI plan is the best, cheapest, and fastest way to implement a health identifier system.
"We looked at three options: to come up with a new number, to use the Social Security number, or to use some real-person identifier like a finger print." The latter 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 Social Security number as the basis of the 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 cost substantially less although Carpenter did not have figures readily available to use an existing infrastructure than to develop a new one.
• The public accepts the Social Security number as a valid identifier.
There are still flaws in the system, however. For example, anyone who received a Social Security number more than 10 years ago may have a number duplicated by someone else. There also are thousands of people who have more than one Social Security number usually for fraudulent reasons, says Carpenter.
Before a new health identifier system can be implemented, the SSA must "clean up the system," Carpenter says, and be given the money to do so.
Among the changes the SSA will have to make is to include a "check digit" in Social Security numbers. This is 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."
Big Brother is watching
There are people worried about confidentiality. But Carpenter notes another aspect of the Health Insurance Portability Act 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. People are the problem."
A bill on this aspect was introduced during the last legislative session but was defeated after an enormous lobbying effort by insurance companies and law enforcement representatives, says Carpenter. It likely will be resurrected this session. Congress also will probably see legislation requiring the SSA to start work on the reforms necessary to implement a health identifier program.
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