Patient ID is trouble spot for commission

Why a national health care ID isn’t worth the fight

In its last in-person meeting, a federal advisory commission on interoperability among health information systems was unable to agree on whether to recommend issuance of national health identification numbers for Americans.

Although members of the Commission on Systemic Interoperability earlier had tentatively agreed that such an ID number would be the “most direct” way to link patients’ records residing in doctors’ offices, hospitals, pharmacies and health plans, they backed off the recommendation Wednesday and were considering what recommendation they could agree on.

Members Simon Cohn, associate executive director for health information policy at the Kaiser Permanente health service, and William W. Stead, associate vice chancellor for health affairs at Vanderbilt University, balked at the national identifier recommendation. “It will be expensive,” Stead said. “It will have errors. It will have privacy concerns.”

The issue was deferred and probably will be resolved through e-mail or in a conference call shortly before the 11-member commission’s report goes to press. The report will go to the Department of Health and Human Services and to Congress by the end of October.

The draft recommendation being considered would have allowed patients to decline to have a national ID number on their health records. In cases where patients opted out, doctors’ liability for mistakes that occurred because the information was unavailable would have been limited.

The commissioners did agree that HHS needed to choose a single approach to identifying patient records so that they could be linked through a national health information network.

The most often discussed alternative to a national health ID number is a system that relies on multiple elements of identity, such as name, age, address and date of birth, to establish the patient’s identity and link records from two or more systems.

Among other actions at its final in-person meeting at HHS headquarters in Washington, D.C., the commission agreed to recommend:

* HHS should modify its Stark Act and anti-kickback rules to allow hospitals and other entities to give computer systems to doctors in the interest of getting patient records exchanged online.

* Laws should be modified to ensure that individuals who disclose or misuse health information are subject to criminal prosecution. A recent Department of Justice opinion says that only institutions such as hospitals and doctors’ offices can be prosecuted for disclosures under the Health Insurance Portability and Accountability Act (HIPAA).

* HHS should offer incentives for the use of health information technology. The commission, which earlier decided that health IT use should not be made mandatory at this time, did not agree on specifics with respect to incentives.

* The American Health Information Community, another high-level commission now being formed by HHS, should identify a complete set of interoperable and not overlapping health data standards, leveraging work done by federal agencies in the Consolidated Health Informatics interagency project.

* Medications and medical instruments should be labeled electronically by their manufacturers, simplifying record keeping as those items are used and patients are billed for their use. Commissioners likened this to the Universal Product Code system used in food stores.