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December 2012 Editors: For more than three years, Barry Hieb, MD, has been trying to crack the Maria Garcia puzzle. The problem with Maria? There are way too many of her. The multiple Marias of Harris County, Tex., are a prime example of the patient safety issue Dr. Hieb is trying to solve as chief scientist of Tucson-based Global Patient Identifiers Inc. As a pioneer of the Voluntary Universal Healthcare Identifier, or VUHID, system, Dr. Hieb has struggled to gain acceptance for a solution meant to overcome a federal funding freeze and inertia among health care organizations. Maria Garcia is an emblem of the need for better patient identification, Dr. Hieb believes. There are 2,400 patients by that name in Harris County’s enterprise master patient index, or EMPI—the industry standard for keeping track of patient identities. Of the 3.4 million patients in the database, Dr. Hieb says, 249,000 of them have the same first and last names as someone else. And among the 2,400 Maria Garcias, 231 have the same birthdate. “Everybody knows how dangerous misidentification of a patient is,” Dr. Hieb continues. So imagine one of our Marias needs a blood transfusion. If her birthdate matches that of another Maria Garcia, the chances of giving her a blood type that doesn’t match, with potentially deadly results, are inevitably increased. This is where VUHID comes in. Not only do EMPIs allow for too great a chance of misidentification due to people having the same name or sharing the same address and birthdate, such as twins, says Dr. Hieb, but federal law explicitly bans government agencies from trying to come up with a better system. Not long after it passed the Health Insurance Portability and Accountability Act in 1996, Congress got cold feet about that law’s requirement establishing a national patient identifier. There were just too many privacy concerns, lawmakers felt, to move forward on what had seemed a sensible idea when the original legislation was on the floor of Congress. “A subsequent 1999 law has been interpreted as forbidding federal entities from even discussing a national identifier,” Dr. Hieb adds. Consequently, he says, many health care entities have recognized that an alternative system is needed. But until recently, health care organizations, as a whole, were reluctant to go down this road. “Very few people are interested in being the first into the swimming pool,” Dr. Hieb notes. In 2008, Dr. Hieb and his fledgling company, GPII, began promoting the VUHID concept. (“National patient ID: Could a voluntary system fill the gap?,” CAP TODAY, November 2009, page 18.) The idea behind it is to allow patients to adopt unique health care identifiers if they so desire, while enabling them to maintain both open ID numbers for information they want all care providers to see and private identifiers for medical details they may want to compartmentalize so only certain providers can see it. Backed by a grant from the Robert Wood Johnson Foundation, GPII rolled out a pilot VUHID project in 2010 at the Community Health Alliance of Pasadena, or ChapCare, a three-clinic nonprofit chain north of Los Angeles. Partnering with GPII on the project was Western Health Information Network, a health information exchange in Long Beach, Calif. Sergio Bautista, chief operating officer of ChapCare, tells CAP TODAY the project went smoothly. The alliance did not have to customize its electronic medical record system to implement VUHID. And the one-time cost of issuing an ID card was about 20 cents per person. Patients readily participated once they understood the system would mean less paperwork on subsequent visits, he says. The rate at which they remembered to bring their ID cards to future visits was nearly 100 percent. “We were able to show that a system similar to that is needed.”
Dr. Hieb, too, feels the project at ChapCare validated VUHID. “We were able to demonstrate that it works,” he says. “The site we used, the patients, all were very happy with it.” The only vexation: Eleven months into the 12-month test run, for reasons unrelated to the VUHID project, the Western Health Information Network filed for bankruptcy. Because of WHIN’s collapse, the Robert Wood Johnson Foundation withheld the last quarter of its grant. Despite the setback, Dr. Hieb says, “we’re moving forward, and we’re talking with various organizations about putting new projects out there.” The Office of the National Coordinator for Health Information Technology will send a survey to a sample of clinical laboratories nationwide next month to determine the extent to which they exchange electronic data with ordering physicians. The ONC is seeking to determine both the percentage of laboratories that can electronically transmit structured laboratory test results to ordering physicians and the percentage of lab test results that are currently being electronically transmitted in a coded format to ordering physicians. The ONC stated in an announcement in the Oct. 19 Federal Register that it will use the findings to determine the baseline level of information exchange for clinical laboratories and to provide assistance to states and territories as they develop strategies for exchanging laboratory data. The ONC will mail the survey, titled the National Survey of Health Information Exchange in Clinical Laboratories, in mid-January. Responses will be due in May, and the ONC plans to report the findings in August, ONC spokesperson Peter Ashkenaz told CAP TODAY. The ONC will mail two similar versions of its questionnaire—one to 2,729 hospital-based labs and the other to 1,963 independent labs. The results will be stratified based on the type of laboratory, Ashkenaz says. The United Kingdom-based software company Room4 has expanded the availability of Interpath, its application for viewing high-resolution pathology slides on mobile devices. Previously available only on the Apple iPhone, iPod Touch, and iPad, Interpath can now display whole slide images on all mobile platforms, including Android devices and Windows Phone 7 and 8. Interpath provides smooth, multi-touch panning and zooming. It natively supports slide scanners and servers from Hamamatsu and Aperio, as well as other scanners and image formats via Room4’s server application. The server application does not require image preprocessing and can be installed on a standard PC. Interpath is available through Apple’s online App Store, the Microsoft Windows Phone store, and Google Play store. The information and business intelligence firm Wolters Kluwer Health has entered into an agreement to acquire the medical terminology software company Health Language. “This acquisition allows Wolters Kluwer Health to enhance its current market-leading point-of-care solutions and better position its customers to fully leverage existing and emerging health care quality and reimbursement initiatives,” says Arvind Subramanian, president and CEO of Wolters Kluwer Health Clinical Solutions. “The acquisition,” he adds, “also provides Wolters Kluwer Health with greater access to payers, key customers for various Health Language offerings.” Health Language databases and software products include more than 180 standard terminologies and proprietary content sets. The company also provides clinical content and professional services focused on interoperability, Web-based terminology mapping, meaningful use compliance, and ICD-10 conversion. Wolters Kluwer Health sells a suite of point-of-care products and services, including evidence-based clinical disease and drug information knowledge platforms, clinical documentation software, and clinical surveillance and pharmacy software. Wolters Kluwer Health, 301-223-2300 The standards development organization Health Level Seven International will make its standards and much of its intellectual property available at no charge during the first quarter of next year. “Making our standards and selected IP freely available is an important step toward wider adoption of our standards,” HL7 reported on its Web site. “Charging for standards is a barrier to widespread adoption by physicians, nurses, and other healthcare providers who are working to increase data sharing to improve care and reduce costs.” The decision was also driven by increasing government demand for standards that are available at no cost, HL7 added. The standards and intellectual property will be available under a free licensing agreement, but HL7 will retain the copyright. HL7 will also retain control of the development and maintenance of HL7 standards and products. The health care analytics and business intelligence firm Viewics has announced that the reference laboratory PAML has extended its use of Viewics Health Insighter business intelligence products by adding Viewics’ solutions for toxicology and anatomic pathology. Viewics Health Insighter, a cloud-based software-as-a-service offering, provides data mining and dashboarding functionality and can extract, mine, and analyze information from laboratory information systems and from finance/billing, outreach, payroll, and other enterprise systems. PAML is a full-service reference laboratory in Spokane, Wash., that is owned by Providence Health & Services and Catholic Health Initiatives. Wolters Kluwer Health, 301-223-2300 Dr. Aller is director of informatics in the Department of Pathology, University of Southern California, Los Angeles. He can be reached at raller@usc.edu. Hal Weiner is president of Weiner Consulting Services, LLC, Florence, Ore. He can be reached at hal@weinerconsulting.com. |
VUHID validated, but patient identification system progressing slowly