Nurseweek/Healthweek|Controversial ID system brings up privacy issues

Controversial ID system brings up privacy issues

Posted 8-3-98

Discussion of a controversial national system for patient ID numbers began last week before a public advisory panel. The ID will tap into a national database that holds every American’s healthcare history.

Supporters of the idea believe identifiers have the potential to improve continuity of care, but critics are concerned the IDs will compromise the confidentiality of patient records.

Healthcare identifiers were mandated by the 1996 Health Insurance Portability and Accountability Act (HIPPA), praised for improving Americans’ health insurance portability. One of its lesser-known provisions is that the government assign an "identifier" to each healthcare consumer.

HIPPA also requires the federal government to issue unique identifiers to health plans, employers, and healthcare providers. Clinicians who provide health services will receive unique identifying numbers from the Health Care Financing Administration (HCFA) to use for electronic financial and administrative transactions. HCFA is preparing to publish the final rule on providers’ IDs in the Federal Register early next year. Most health organizations will have two years to comply with the law; small health groups will have three.

During last month’s two-day meeting in Chicago, the National Committee on Vital and Health Statistics subcommittee on standards and security heard from patient advocates and industry officials about alternatives to patient identifiers, the cost of issuing the IDs, and confidentiality concerns.

Twila Brase, RN, president of Citizens for Choice in Health Care, a consumer advocacy group based in St. Paul, Minn., spoke out against the healthcare ID. In addition to her concerns about patient confidentiality, Brase fears that people without IDs might be denied access to health care.

But others nurses believe the technical knowledge exists to preserve patient confidentiality. Patricia Starck, MSN, RN, FAAN, dean of the School of Nursing at the University of Texas-Houston Health Science Center, is convinced the benefits of having universal access to patients’ records outweigh privacy concerns. The IDs could improve continuity of care and increase the ability to track healthcare costs, she said.

Most everyone agrees that before that can happen the mechanisms for delivering—and protecting—patients’ healthcare records must be developed. "The potential for abuse is very great," said Dale Miller, director of consulting for Irongate Inc., a computer security consulting firm in San Rafael, Calif.

The fact this unique identifier will be so widely available also makes it harder to protect, said Miller, who works with healthcare organizations across the country. "This is the time to look at how to implement security privileges for unique ID numbers." The panel is planning more public hearings this fall.