@Brian - That last paragraph is what I'm talking about. From any system perspective, you then have two people with the same name and DOB, but with different government ID? Is this the same person? Better cross reference a dozen other variables to verify, which is what we do today. Adding to this with @IANAL's comment, SSN isn't a unique identifier, and neither would this government ID be for the exact same underlying reason; they can change, and they are insecure to use by themselves. These wonky edge cases exist today and they would continue to exist after this hypothetical ID. I'm skeptical of the 20% duplicate claim, not in the systems I work on, that's for sure.
The banking comment wasn't meant to be some kind of smug dig. Moving stocks between brokerages involves a lot of verification and involves moving the transaction history, not just money, since it's needed for tax purposes. My point was that it's a fair comparison. If your point is that these accounts could be combined automatically with this ID, I do not think that this will be any different than what mychart/care everywhere does today with automatically detecting and syncing data after prompting you.
IANAL - 3 years ago
FYI your SSN isn’t a unique national identifier.
Brian - 3 years ago
Bob, I’m not sure what my personal banking history has to do with this but here, let me help.
First, the miss rates in the example you provided in marketing are wholly permissible. They’re trawling, not making prescribing decisions. I can tell you all about 0 pixel images, cookies, and the other clever ways they build a shadow of your online presence to serve more targeted ads to you. But, buy your parent an incontinence product from your Amazon account one time and see how suddenly you’re in a new demographic for the next month everywhere you go on the Internet.
Moving assets between accounts is mediated by me, the holder of two IDs that I provide during that transaction. I can’t just create a new account and say “you know who I am now, go find and move my securities!” If I don’t connect the dots, it doesn’t work.
The fraud use case is real and of course there will be needs to create a new ID for use cases like this. The new ID would be issued by the same party as the original and linked for historical purposes. Still a much better scenario than the average health system that has 20% duplicate patient entities in their own enterprise systems before they even try to connect external.
Bob - 3 years ago
@Brian - You're right that these are problems. Problems that the current system is able to cope with. Problems that a national patient ID do not solve. Suppose a government issued ID exists, there are two possibilities; they allow you to change it or it's constant for your entire life. Fraud and true verification will always be a thing. If you're allowed to change your ID, it's just another variable in the current system. If it never changes, it is insufficient by itself to be solely relied on as an ID, so it's just another variable in the current system. Your SSN basically fills this role already, you can't do any better, in reality. To your comparisons, I see you've never tried to move stocks between brokerages and I think you'd be very surprised to find out what advertising/eCommerce sites know about you as an individual, again, all without a government issued ID.
Brian - 3 years ago
This problem has not been solved by other industries, because other industries don't have this problem. Your bank doesn't have (or need) a record of all your other banks. Your Amazon account doesn't have (despite their interest in having) info about all of your other eCommerce accounts. Your Pandora account isn't cross-referencing your Spotify playlist. Even the credit bureaus use oodles of different identifiers to pull together your credit report and still get it wrong sometimes. Demographics just don't cut it. How many John Smiths also have the same DOB? More than a few. What about people who change names at some point in their lives, sometimes use a nickname, etc? Or when they get new insurance? Or move across state lines and get a new driver's license? Even inside the same enterprise person matching is a bear; expanding to some semblance of national identity matching is impossible without a common, unique identifier.
Bob - 3 years ago
The results of this poll confuse me. What problem does this solve that hasn't already been solved by other means? Every industry, healthcare included, seems to get along just fine without a universal, government issued ID. The amalgamation of other identifiers (name and dob, chiefly) are already highly unique and solve the problem today.
Why stop at National - 3 years ago
Why not look to a universal voluntary healthcare ID and associate it with a travel passport.
Let Business Drive It - 3 years ago
A national patient identifier obviously has to be issued by the federal government, so they should create it. But the government shouldn't force patients to use it. Healthcare organizations should! Let them require patients to participate in the program. If nearly every healthcare organization and independent provider required patients to use the national identifier to receive anything more than EMTALA-type care, you would get nearly universal adoption while still letting those crazies who think the government put microchips in the COVID vaccine opt out.
Mike Nolte - 3 years ago
The ARRA was well intended but Instead of “meaningful use” which created an unsustainable number of EHR providers with an equal number of data models, the Obama administration could have advanced the success of EHRs w/o wasting billions of dollars of capital by focusing on 3 simple measures.
1 - A universal patient identifier.
2 - The ability and requirement for any healthcare provider to digitally generate a complete medical history for a patient
3 - Rigid data standards that simplify the creation and transmission of 2
The inability for a provider in the US to see the complete medical history of a patient is restricted by these issues.
@Brian - That last paragraph is what I'm talking about. From any system perspective, you then have two people with the same name and DOB, but with different government ID? Is this the same person? Better cross reference a dozen other variables to verify, which is what we do today. Adding to this with @IANAL's comment, SSN isn't a unique identifier, and neither would this government ID be for the exact same underlying reason; they can change, and they are insecure to use by themselves. These wonky edge cases exist today and they would continue to exist after this hypothetical ID. I'm skeptical of the 20% duplicate claim, not in the systems I work on, that's for sure.
The banking comment wasn't meant to be some kind of smug dig. Moving stocks between brokerages involves a lot of verification and involves moving the transaction history, not just money, since it's needed for tax purposes. My point was that it's a fair comparison. If your point is that these accounts could be combined automatically with this ID, I do not think that this will be any different than what mychart/care everywhere does today with automatically detecting and syncing data after prompting you.
FYI your SSN isn’t a unique national identifier.
Bob, I’m not sure what my personal banking history has to do with this but here, let me help.
First, the miss rates in the example you provided in marketing are wholly permissible. They’re trawling, not making prescribing decisions. I can tell you all about 0 pixel images, cookies, and the other clever ways they build a shadow of your online presence to serve more targeted ads to you. But, buy your parent an incontinence product from your Amazon account one time and see how suddenly you’re in a new demographic for the next month everywhere you go on the Internet.
Moving assets between accounts is mediated by me, the holder of two IDs that I provide during that transaction. I can’t just create a new account and say “you know who I am now, go find and move my securities!” If I don’t connect the dots, it doesn’t work.
The fraud use case is real and of course there will be needs to create a new ID for use cases like this. The new ID would be issued by the same party as the original and linked for historical purposes. Still a much better scenario than the average health system that has 20% duplicate patient entities in their own enterprise systems before they even try to connect external.
@Brian - You're right that these are problems. Problems that the current system is able to cope with. Problems that a national patient ID do not solve. Suppose a government issued ID exists, there are two possibilities; they allow you to change it or it's constant for your entire life. Fraud and true verification will always be a thing. If you're allowed to change your ID, it's just another variable in the current system. If it never changes, it is insufficient by itself to be solely relied on as an ID, so it's just another variable in the current system. Your SSN basically fills this role already, you can't do any better, in reality. To your comparisons, I see you've never tried to move stocks between brokerages and I think you'd be very surprised to find out what advertising/eCommerce sites know about you as an individual, again, all without a government issued ID.
This problem has not been solved by other industries, because other industries don't have this problem. Your bank doesn't have (or need) a record of all your other banks. Your Amazon account doesn't have (despite their interest in having) info about all of your other eCommerce accounts. Your Pandora account isn't cross-referencing your Spotify playlist. Even the credit bureaus use oodles of different identifiers to pull together your credit report and still get it wrong sometimes. Demographics just don't cut it. How many John Smiths also have the same DOB? More than a few. What about people who change names at some point in their lives, sometimes use a nickname, etc? Or when they get new insurance? Or move across state lines and get a new driver's license? Even inside the same enterprise person matching is a bear; expanding to some semblance of national identity matching is impossible without a common, unique identifier.
The results of this poll confuse me. What problem does this solve that hasn't already been solved by other means? Every industry, healthcare included, seems to get along just fine without a universal, government issued ID. The amalgamation of other identifiers (name and dob, chiefly) are already highly unique and solve the problem today.
Why not look to a universal voluntary healthcare ID and associate it with a travel passport.
A national patient identifier obviously has to be issued by the federal government, so they should create it. But the government shouldn't force patients to use it. Healthcare organizations should! Let them require patients to participate in the program. If nearly every healthcare organization and independent provider required patients to use the national identifier to receive anything more than EMTALA-type care, you would get nearly universal adoption while still letting those crazies who think the government put microchips in the COVID vaccine opt out.
The ARRA was well intended but Instead of “meaningful use” which created an unsustainable number of EHR providers with an equal number of data models, the Obama administration could have advanced the success of EHRs w/o wasting billions of dollars of capital by focusing on 3 simple measures.
1 - A universal patient identifier.
2 - The ability and requirement for any healthcare provider to digitally generate a complete medical history for a patient
3 - Rigid data standards that simplify the creation and transmission of 2
The inability for a provider in the US to see the complete medical history of a patient is restricted by these issues.
Fixing 1. Would be progress.
None