HHS mulls health care ID system

The Department of Health and Human Services last week issued a white paper on a plan to create a standard identification code for health care patients so that patient records could be stored in a central database, a project that critics fear could result in a new nationwide ID card that could compromise the privacy of medical records.

The "unique health identifier for individuals," mandated by the Health Insurance Portability and Accountability Act of 1996, will provide a set of standards for electronic administrative and financial health care transactions.

The law requires HHS to adopt standards for the electronic exchange of administrative and financial health care transactions. All health plans, health care clearinghouses and health care providers that elect to conduct electronic transactions of records will be required to comply with the standards.

Now, health care plans and insurance companies use various ways to identify the same patient via their electronic records. A unique identifier, such as a number, would allow health officials to integrate records from multiple systems into a single lifetime electronic record, which would give a more complete picture of a patient's health. It also would allow a doctor or hospital to access the record, according to the white paper.

"A unique identifier would allow for rapid and accurate identification of the proper records and their integration for the purpose of providing high-quality, patient-focused care," the white paper noted.

But opponents of the identifier see something potentially sinister in trying to link patient records through a single identification code. Critics believe the identifier could supplant the Social Security number as a means of tracking all types of data on citizens.

Dave Banisar, staff counsel at the Electronic Privacy Information Center in Washington, D.C., said the identifier is similar to a Social Security number, which is linked to credit reports and financial records. "Anytime you create a number that can be easily found, then you have people surfing medical records like they have [been doing] with credit reports now," he said.

Although Congress has said the identifier will be available only to health care providers, some observers said restricting the use of the identifier would not keep it out of the hands of organizations such as credit card companies, employers, the Internal Revenue Service, schools and other organizations that may have an interest in an individual's health care history.

"There are not a lot of institutions that wouldn't get it," said Robert Gellman, a privacy and information consultant in Washington, D.C.

Gellman said the identifiers would be superior to Social Security numbers because they would probably include "check digits," which are digits that would be used to verify the user's identity. He said the identifier's superiority will attract law enforcement organizations and others who would want to use it for their own purposes.

William Braithwaite, senior adviser for health care information policy at HHS, said the department is aware of the controversy surrounding the identifier and is in the process of issuing a notice in the Federal Register to seek comments on how the agency should proceed. "There isn't any consensus out there, so it has to be developed," he said.

Braithwaite said he could not predict how long it would take for HHS officials to approve the notice for publication. He added that the National Committee on Vital and Health Statistics (NCVHS), a private-sector group that advises the HHS secretary on various issues, will hold hearings on the identifier next week in Chicago and then will hold additional hearings in the fall. The committee will then advise HHS on how to proceed.

Braithwaite acknowledged that the February 1998 deadline imposed by Congress for adoption of the standards has long passed, but he said the department wants to proceed cautiously.

Gellman, who is an NCVHS member, said the group overwhelmingly disagrees with his privacy concerns and already has stated its support for some type of identifier. But privately, one health professional on the committee who said she supports the identifier expressed the same concerns as Gellman.

"A lot of members are worried not so much about the unique health identifier per se but whether it will end up being used for things besides health," she said. "I don't believe the people who developed the Social Security number ever thought it would be used for driver's licenses and by credit companies."

Denise Nagel, executive director of the Lexington, Mass.-based National Coalition of Patient Rights, said the identifier would not allow people seeking mental health or reproductive health care to ensure their privacy by paying cash.