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News and Trends

September 1, 1998
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Public Outcry Over Patient IDs

THE MOVE TO ASSIGN EVERY MAN, WOMAN ANDchild in the U.S. a medical ID number is so volatile the Department of Health and Human Services (HHS) is extending its implentation deadline in order to better explain the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

According to Solomon Appavu, director of HIS financial control at Cook County Hospital in Chicago, the unique ID for patients will ease the burden of transferring patient data from one organization to another. It also could mean the creation of a national database for maintaining patient medical information. "Today there is a master patient index for each organization," he explains. "Healthcare organizations are beginning to come up with enterprisewide solutions, but when you have a national patient identifier you can envision a national master patient index."

Appavu, who leads the ANSI Healthcare Informatics Standards Board’s Unique Health Identifier task force, wrote a 180-page white paper explaining the unique health identifier for patients. He says the biggest obstacle to implementing this unique ID is assuring patients and physicians that every computer system used in the healthcare industry is secure, and that only individuals authorized to gain access will be able to do so.

"The news media seem to be focusing on information from those opposed to the unique patient identifier," he says. Citing the public hearing in July by the National Committee on Vital and Health Statistics (NCVHS), an advisory group to the secretary of HHS, Appavu adds: "Most of the people that testified said they would like to have the unique patient ID."

In his analysis of this identifier, Appavu stressed that there must be six components to create a complete patient identifier. Each of these components must be considered in context with the others for the ID to perform as it should. The areas to consider are:

  1. identifier scheme (numeric, alphanumeric, etc.)
  2. identifying information
  3. index
  4. mechanism to hide or the tool to encrypt the ID
  5. technology infrastructure including the software, hardware and communication technologies to search identify, match, encrypt, etc.
  6. administrative infrastructure including the Central Governing Authority.

HIPAA’s unique patient ID is going to happen--regardless of popular opinion against the measure. According to Appavu, the best strategy for healthcare’s information technology specialists is to continue setting up and improving security measures within their own organizations for current and future information systems. "To address the privacy concerns of the public, [healthcare organizations] need to have good privacy and security methods in place," he says.

Following the NCVHS public hearings, officials from the American Health Information Management Association announced they favor adoption of unique health identifiers "only if comprehensive federal confidentiality legislation is enacted first."

For more information on the Unique Patient ID or HIPAA, visit NCVHS’ Web site at

--Lisa Paul

Y2K Tops List of Priorities

THE YEAR 2000 BUG HAS TUNNELED ITS WAY TOthe top of every technology professional’s "to do" list. When asked to identify the top five information systems priorities, officials of 340 integrated delivery systems overwhelmingly indicated that the year 2000 crisis is their organization’s top IS priority. The results were compiled by GartnerGroup IT Healthcare in its ninth annual IDS Market Segment Database.

Ironically, the year 2000 issue wasn’t so much as whispered in last year’s survey. "I couldn’t believe it," says Gartner research director Dave Garets, who went back to the old records to verify its absence. "Y2K wasn’t mentioned by anybody." But this year "it was 2-to-1 the hottest [issue] over the next hottest [issue]--clinical information systems," he says.

The findings lead experts to believe that although it has now caught the attention of healthcare executives, planning for the problem only now means you’re late for the dance. "It’s obvious that healthcare organizations have awakened to the need," Garets says. "But it has taken them too long." If organizations haven’t yet moved from assessment to remediation, they need to consider the fact that all their systems won’t be ready in time and their next task will be to prioritize what will get fixed, he says.

Bugged out

But provider organizations aren’t the only ones scrambling for contingency plans. After receiving an "F" from a house subcommittee that graded the largest government agencies on their Y2K readiness, the Department of Health and Human Services is pulling out the stops to fix the problem.

The Health Care Financing Administration (HCFA), the HHS department that administers Medicare and Medicaid, received particularly heavy criticism because of its heavy reliance on computers for provider reimbursement. HCFA is so behind in its year 2000 revamp that administrator Nancy-Ann Min DeParle asked the House Committee on Ways and Means to delay implementing the portions of the Balanced Budget Act of 1997 that affect HCFA.

Renovating all computer and information systems "must be our top priority," says DeParle, who requested that updates be postponed for prospective payment systems for outpatient hospital care and home health services, among other things. This would delay reimbursement increases for providers.