The identity Problem

I struggle to keep my contacts in order and synchronized, not just across devices but across ecosystems and channels. How do you keep your old style digitized version of the rolodex in sync with your twitter followers and LinkedIn connections? How do you know when your friends join a new social media channel that you are member of so you can connect there?

I’ve tried many tools and techniques and had been using Brewster which recently was acquired by FullContact and the transition offered me 3 months of premium access to their service. The free version offers backup and some syncing across limited accounts – the premium version expands to multiple accounts and includes business card scanning.

The early results were surprising – in my contact database the system was offering me updates to over 40% of my contacts. I was suspicious but as I investigated I discovered that using some clever back end algorithms it was revealing updates to many of my connections including some I validated manually that good friends revealed were early forays into social media including a blog on Ice Cream and a corresponding Pinterest account.

So in social media and the commercial world we can link data and people – in fact the commercial organizations do this very effectively that Target collected enough information on individuals linked through a unique identifier to identify a high school student was pregnant and mail her maternity adverts before the “news” had leaker to her father

“Target assigns every customer a Guest ID number, tied to their credit card, name, or email address that becomes a bucket that stores a history of everything they’ve bought and any demographic information Target has collected from them or bought from other sources”

The healthcare system is rife with enough challenges – why is it we have one that is of our own making. Why is there so much resistance to the idea of uniquely identifying a patient so we can attach the correct medical data to the correct person and deliver the correct medical treatment to that same individual?

In 1996 the Health Insurance Portability and Accountability Act (HIPAA) was signed into law and it specifically called for

“a standard unique health identifier for each individual”

But in 1998, Congress eliminated that requirement and even prohibited the use of federal funds to develop a unique identifier. Anyone who knows me will know my passion for privacy and individual rights but in this instance the harm and cost foisted on the system, providers, payers and ultimately the patients is gargantuan!

Figure: The Percentage of Waste by country spent on Healthcare Administrative and Insurance

The Social Security number has become the de facto universal (and most valued) US national identifier. Created in 1935 for the purposes of tracking social security benefits it has been hijacked and subsumed into multiple other uses. The gathering and use of this placed a large target on the back of healthcare data and as of the end of last year over 112 Million healthcare records were breached.

As far back as 2009 HIMSS issued a Patient Identity Integrity White Paper making the case for identity management and in 2010 the recently retired Gartner Analyst and Research Director Barry Hieb and now Chief Scientist at Global Patient Identifiers wrote this piece in e-Journal of Health Informatics: A Cost Effective Method to Create a Universal Healthcare Identifier System (full pdf here) advocating the need and a path to the creation of a universal patient identifier

The prohibitive cost associated with creating a universal healthcare identifier has been one of the primary barriers to the creation of such a system. The Voluntary Universal Healthcare Identifier (VUHID) project takes a radically different approach to solving this problem compared to previous proposals. This article examines the economic impact of this approach and discusses why the unique VUHID approach permits implementation of the system at a small fraction of previously estimated costs.

Despite a rational approach that enabled individualized control and security it has not taken off. We continue to waste resources, duplicate tests, decrease the overall safety and increase errors in our healthcare system that according to the RAND study: Identity Crisis; An Examination of the Costs and Benefits of a Unique Patient Identifier for the U.S. Health Care System could offer a saving of $77 billion per year if implemented with sufficient penetration – they cite 90% level of adoption.

Have a I raised your heckles advocating for a unique identifier – is it as Adrian Gropper chief technology officer for Patient Privacy Rights stated

Implementing a unique patient identifier would add nothing to our health care system beyond coercive surveillance

Or as Twila Brase, RN, is cofounder and president of Citizens’ Council for Health Freedom, says its important not to have it to prevent the creation of a “nationalized” healthcare system (I’d interpret this as a single payer system like the VA and Medicare?)

The most important reason is our opposition to building a national health care system. Without a national identification card for patients, it would be difficult to nationalize health care

 

Or do you side with Douglas Fridsma, MD, PhD, is president and CEO of the American Medical Informatics Association who says people care a lot about the privacy and security of their medical data but want immediate access and transferability with control over who can see and use their medical data and believes that

Giving every American a unique patient ID could help address all of those issues.

 

Join me Thursday April 28 at 7pm for #CMIOChat: The Identity Problem. We will be covering the following questions

 

1. Why does the US not have a Unique Patient Identifier?
2. Is it possible we can come up with agree and use a Unique National Patient Identifier and if so how?
3. What alternatives are practical and cost effective to a Unique patient identifier
4. How do we protect patient confidentiality and privacy in a world with a unique patient identifier?

 

The identity Problem was originally published on Dr Nick van Terheyden, MD

Reviewing the World’s Best Voice Recogni

Reviewing the World’s Best Voice Recognition Software #speechrecognition http://www.nanalyze.com/2016/04/reviewing-the-worlds-best-voice-recognition-software/

The Dell World DoMoreHIT Panel

On Tuesday March 15th, 2016 a the Dell Lounge at South by Southwest (SXSW) we hosted the #DoMoreHIT Thinktank event.

This was Dell’s 5th’s annual healthcare Think Tank. Together with my good friend and colleague Mandi Bishop – Healthcare Analytics Innovations & Consulting Practice Lead, Dell, #HIT100 influencer, @MandiBPro we were joined by a veritable who’s who of thought leaders from healthcare and related industries for an outstanding set of panelists:

• Wen Dombrowski, MD, MBA Physician Executive
  • @HealthcareWen
• Joe Kim, MD, MPH, Physician Executive
  • @DrJosephKim
• Dan Munro, Forbes Healthcare Contributor
  • @danmunro
• John Lynn, Blogger and Entrepreneur
  • @techguy & @ehrandhit
• ‘e-Patient Dave’ deBronkart, Patient Advocate, Speaker
  • @ePatientDave
• Robin Farmanfarmaian, Patient, COO, Best-Selling Author
  • @Robinff3
• Nick Cifuentes, Director of Digital Engagement, Dignity Health
  • @HumanKindness, @DignityHealth, @NickCifuentes
• Mini Kahlon, Vice Dean, Dell Medical School
  • @DellMedSchool, @mkahlon
• Stacey Burr, Digital Sports Managing Director, Adidas
  • @adidas
• Scott Lundstrom, Group VP and GM of IDC Financial, Government and Health Insights
  • @IDC , @IDCInsights

• Claudia Williams, Sr. Advisor, Health Innovation and Technology at White House Office of Science and Technology Policy
  • @claudiawilliams, @WhiteHouse

 

 

We divided the session up into three segments –  Data explosion in Healthcare, Embracing New Technology and How to be Future Ready

 

The Data Explosion in Healthcare

• Physicians, patients and health systems are over whelmed with data – is there too much noise to discern the signal of relevance?
• Is there any focus area for gathering or managing data that healthcare should target over others (wearables vs genomics vs population health vs clinical data vs lab values vs imaging for example)? And are there data sources outside those traditionally considered “health” that you’d consider particularly relevant?
• What can patients – and clinicians – do to get ready for the deluge of data and information that they will be receiving and become increasingly responsible for managing?
• How can we, as an industry, and our individual organizations help make the vast quantities of diverse data into meaningful information that can be readily understood?
• How much do you trust the quality of the data sources your organization is using for BI and analytics? And how do you address it if/when you don’t trust the data quality?
• If your organization is collecting data about your patients/consumers, do you offer that data – and any health insights derived from it – back to those patients/consumers? If so, how? And if not, why not?

 

 

Embracing New Technology

• How do we embrace technology while keeping the focus on patient and compassion?
• Is there any new technology that stands out as delivering value that patients, clinicians and health systems can jump on, now?
• Do you think there’s a fear amongst healthcare providers that digital health technology, in conjunction with advanced analytics, will change – perhaps reduce – the role of the clinician in healthcare delivery?
• What do you see as ripe opportunities for emerging technology to disrupt healthcare? What’s already been done that’s working, and what do you think is on the horizon that’s about to break?
• How do we make wearable technology and remote monitoring accessible to the underserved populations who may best benefit?
• What do you think are the biggest obstacles to tech adoption (for consumers and for providers/industry)?

 

 

Future Ready Healthcare

• What does being “future-ready” mean to you and your organization? How can you be future ready in the age of constant and increasingly rapid change?
• What one thing do you think will change the future of healthcare this year, in 3 years and in 10 years?
• Increasingly people want personalized health and wellness care – how do we deliver that with the current system that does not readily enable personalization (both from a technology perspective and from an incentives perspective)?
• Do you believe precision medicine principles – genomics informing personalized clinical pathways – are sustainable across vast numbers of people? Or are they perhaps best narrowly applied to complex disease states with limited number of affected persons? And how will incentives have to change to align?
• When was the last time your doctor asked you how you’d like to be engaged? And if they’ve asked you, have they done what you suggested?
• Do you have a formal patient/member advisory board/council? If so, how does it work? And if not, why not?

 

The event was a great success and despite the global LiveStream issues at the time we managed to trend #2 on Twitter just behind #IndianaJones

 

As of writing there have been over 20M #DoMoreHIT impressions and the material continues to provide additional utility and is in use in other forums. The venue itself was packed and there have to date been 2,500+ Livestream views and ongoing On-Demand promotion and use. In house attendees and online described it as the “best panel yet!”

The 3 sessions from LiveStream can be viewed here

http://livestream.com/Dell/2016DoMoreHIT

The Highlight Reel from the Dell Lounge Week Long Activities

Dell lounge Photos here

The Dell World DoMoreHIT Panel was originally published on Dr Nick van Terheyden, MD