ANALYSIS OF UNIQUE PATIENT IDENTIFIER OPTIONS FINAL REPORT November 24, 1997 Prepared for THE DEPARTMENT OF HEALTH AND HUMAN SERVICES by Soloman I. Appavu Table of Contents Part One: Executive Summary.......................................... 1 Introduction................................................. 1 Objective................................................... 1 Method of Analysis........................................... 1 Report Template. ............................................ 2 Functions and Objectives of Unique Patient Identifier. 2 Required Components of Unique Patient Identifier. 3 Privacy, Confidentiality & Security............................... 3 Unique Patient Identifier Options................................ 5 Result of the Analysis......................................... 6 I. General Findings............................................ 6 II. Compliance Summary...................................... 10 Available Courses of Action................................... 11 Part Two: Patient Identifier. .......................................... 15 Introduction................................................ 15 Patient Identifier - An Integral Part of the Delivery of Patient Care . 16 Patient Identifier - A Critical Component of Patient Care Information and Management................................ 16 Typical Uses of Patient Identifier............................... 16 Current Method of Patient Identification used in Healthcare Organizations............................................. 17 Impact of Information and Communication Technologies on the Patient Identifier................................................. 17 The Various Levels of Patient Identifier Usage. 18 Part Three: Unique Patient Identifier.................................... 19 Unique Patient Identifier...................................... 19 Industry Initiatives........................................... 19 The Significance of Unique Patient Identifier...................... 20 Unique Patient Identifier - Definition............................ 20 Unique Patient Identifier - Basic Functions and Objectives. 21 Components & Processes Integral to Unique Patient Identifier. 23 Part Four: Privacy, Confidentiality & Security. ........................... 28 Privacy, Confidentiality and Security of Patient Care Information.. 28 Unique Patient Identifier’s Role in Protecting the Privacy of Patient Care Information.................................... 28 Security Risks and the Unique Patient Identifier.................... 29 The Privacy and Confidentiality Challenge........................ 29 1. Judicious Design.......................................... 30 2. Organizational Security Measures............................. 31 3. Federal Legislation. ....................................... 31 4. Individual Responsibility ................................... 31 Part Five: Method of Analysis......................................... 32 Scope and Method of Analysis. ................................ 32 Part Six: Unique Patient Identifier Options and Alternatives.. 35 Unique Patient Identifier Options............................... 35 Non Unique Patient Identifier Options. .......................... 35 Alternatives to Unique Patient Identifier.......................... 35 Part Seven: Analysis of Unique Patient Identifier Options. 37 Report Template. ........................................... 37 Manual Process............................................. 37 1. Enhanced Social Security Number.................................... 39 I. Description of the Option.................................... 39 II. Author/Proponent and Documentation......................... 41 III. Compliance with ASTM Conceptual Characteristics. 41 IV Compliance with Operational Characteristics and Readiness................................................ 44 V. Compliance with Unique Patient Identifier Components Requirements............................................. 45 VI. Compliance with Basic Functions Criteria..................... 45 VII. Strengths and Weaknesses................................. 46 VIII. Potential Barriers & Challenges to Overcoming the Barriers. ................................................ 48 IX. Solutions to the Barriers:.................................. 49 2. Sample Universal Healthcare Identifier (UHID). ........................ 50 I. Description of the Option.................................... 50 II. Author/Proponent and Documentation......................... 51 UHID SAMPLE............................................. 51 III. Compliance with ASTM Conceptual Characteristics. 51 IV. Compliance with Operational Characteristics and Readiness................................................ 54 V. Compliance with Unique Patient Identifier Components Requirements............................................. 55 VI Compliance with Basic Functions Criteria...................... 55 VII. Strengths and Weaknesses................................. 57 VIII. Potential Barriers & Challenges to Overcoming the Barriers. ................................................ 58 IX. Solutions to the Barriers:................................... 58 3. Unique Patient Identifier based on Bank Card Method.................... 60 I. Description of the Option.................................... 60 II. Author/Proponent and Documentation......................... 60 III. Compliance with ASTM Conceptual Characteristics. 60 e) Design Characteristics...................................... 62 IV. Compliance with Operational Characteristics and Readiness................................................ 64 V. Compliance with Unique Patient Identifier Components Requirements............................................. 64 VI. Compliance with Basic Functions Criteria..................... 65 VII. Strengths and Weaknesses................................. 66 VIII. Potential Barriers & Challenges to Overcoming the Barriers. ................................................ 67 IX. Solutions to the Barriers:................................... 68 4. Cryptography-based Patient Identifier................................. 69 I. Description of the Option.................................... 69 II. Author/Proponent and Documentation......................... 70 Compliance with ASTM Conceptual Characteristics. 70 IV Compliance with Operational Characteristics. 73 V. Compliance with Unique Patient Identifier Components Requirements............................................. 73 VI. Compliance with Basic Functions Criteria..................... 74 VII. Strengths and Weaknesses................................. 75 VIII. Potential Barriers & Challenges to Overcoming the Barriers. ................................................ 76 IX. Solutions to the Barriers:................................... 76 5. Unique Patient Identifier based on Personal Immutable Properties. 78 I. Description of the Option.................................... 78 II. Author/Proponent and Documentation......................... 78 III. Compliance with ASTM Conceptual Characteristics. 78 IV. Compliance with Operational Characteristics and Readiness. ............................................... 81 V. Compliance with Unique Patient Identifier Components Requirements............................................. 81 VI Compliance with Basic Functions Criteria...................... 82 VII. Strengths and Weaknesses................................. 83 VIII. Potential Barriers & Challenges to Overcoming the Barriers. ................................................ 84 IX. Solutions to the Barriers:................................... 85 6. Unique Patient Identifier based on Biometrics .......................... 86 I. Description of the Option.................................... 86 II. Author/Proponent and Documentation......................... 86 III. Compliance with ASTM Conceptual Characteristics .. 86 IV. Compliance with Operational Characteristics and Readiness. ............................................... 89 V. Compliance with Unique Patient Identifier Components Requirements............................................. 89 VI. Compliance with Basic Functions Criteria..................... 90 VII. Strengths and Weaknesses................................. 91 VIII. Potential Barriers & Challenges to Overcoming the Barriers. ................................................ 92 IX. Solutions to the Barriers:................................... 93 7. Lifetime Human Service & Treatment Record (LHSTR) Number based on Birth Certificate . ........................................ 94 I. Description of the Identifier.................................. 94 II. Author/Proponent and Documentation......................... 95 III. Compliance with ASTM Conceptual Characteristics. 95 IV. Compliance with Operational Characteristics and Readiness................................................ 98 V. Compliance with Unique Patient Identifier Components Requirements............................................. 98 VI. Compliance with Basic Functions Criteria..................... 99 VII. Strengths and Weaknesses................................ 100 VIII. Potential Barriers & Challenges to Overcoming the Barriers. ............................................... 101 IX. Solutions to the Barriers:.................................. 102 8. Existing Medical Record Number (MRN) based identification. 103 I. Description of the Option . ................................. 103 II. Author/Proponent and Documentation........................ 103 III. Compliance with ASTM Conceptual Characteristics.