No American wants to be assigned a unique personal Identification number. George Orwell's Big Brother still looms large. Identity theft is the worry of the day. The Federal Trade Commission just mandated a new set of requirements under the name of "Red Flags" to help prevent identity theft. Every American is mandated to have a social security number for tax purposes. So in fact everyone has a unique number, however, the law clearly states that this number can not and should not be used outside of the IRS to identify a person.
We all know that many institutions including, banks, credit cards, insurance, State Government etc, etc. ask for and use our Social Security Number to identify us. Although it is truly against the law to do so and you as a person can refuse to provide your SS NO and should not be denied services if you do so.
What does this have to do with EHR adoption? Because there is no official identification number unique to every person in the United States there is no unique that can be used to identify patients. Usually patients will go to multiple physicians and be seen at multiple institutions over their life time. There is no way to transfer records from one facility to another reliably.
Typically, a patient who is being referred by their primary care physician to a specialist will have their records sent to the specialist. This most often occurs by having the primary care employees select pages from the patient's chart that are relevant to the question at hand and faxing the pages hopefully with the patient's name on every page, along with their date of birth and possibly their address to the specialist's office. The fax pages come in among all the other Fax's being sent at the same time. The paper then gets routed to the medical records department and put in an "In Box" to be collated and alphabetized. Once this occurs some medical record clerk will then look at the name and DOB and see if there is already a medical record for you. Heaven forbid that you are named John Smith or some common name for your community because that means there are several medical records that end up with your information (only one of which is the correct one). With no unique number the medical records staff has to "eye ball" each patient record to make sure they pick the correct one. In an electronic world this is no easier. There needs to be special programs that do the job of the medical record's personnel and try to match name, DOB, address to find the correct person. Now lets suppose that one physician spell your name Robert and the other physician you have known for years and he spells your name Bob (well you can imagine the problem).
How are we suppose to move medical information between providers and between facilities in a quick and cost efficient manner with out a unique number to make sure we are correct. We can't. Because there are no unique number the interface cost 10 times what it should cost. One simple interface to one other system can cost a provider $5,000 or more. Now here is the kicker. Currently, your physician has to pay the cost out of his own pocket if he wants an electronic interface. He gets no money from anyone to do it or he can use the old fashion way of faxing the information for the cost of a telephone line. What would you do? Once a provider goes to a EHR he must take into consideration how this will change his overall work flow and cost of doing business. I will come back to interfaces in later blogs there are a whole host of other problems that make these costly propositions and I will speak to some of them.
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Personal identification and identity protection are among the most controversial topics in America today. We have experienced implementation of the most sweeping personal privacy rights legislation in American history with HIPAA. Now we embark upon similarly onerous, mandated rules for identity theft protection with Red Flag. All of this unfunded by the government, and all the requirements for education, training, implementation, and documentation borne by the medical practice. Rodger correctly cautions the EHR "visionarys" to remember that American culture rejects the notion of being "tagged". Couriously, we accept our social security number as a universal identifier but established limited uses for it. We are directed to protect that number from criminals, yet we know that hundreds and thousands of illegal aliens use fraudulent social security numbers to gain employment and access many social services for no cost.
ReplyDeleteThe message here is that a universal health record, sans the universal identifier, is unlikely.
All of the rhetoric about healthcare inefficiency makes me very suspicious . Where is there an example of a publicly funded enterprise held out as an example of efficiency. Private enterprise, when offered the objective to achieve ehr transparency, will invent the model when the profitability of that objective is definitive, and the government doesn't demonize and penalize the reward of success.
It is unlikely that the government will sanction a universal identifier for health care anytime soon. If they expect data to be shared between systems, institutions, physicians and the like they should make plans to pay for it because it won't be cheap and the providers are not capable of paying for it.
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