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    Point-Counterpoint: Should Every Patient Have a Unique ID Number for All Medical Records?

    At the Wall Street Journal, two experts answer the question: “Should Every Patient Have a Unique ID Number for All Medical Records?” “Proponents say universal patient identifiers, or UPIs, deserve a serious look because they are the most efficient way to connect patients to their medical data. […] Privacy activists aren’t buying it. They say that information from medical records already is routinely collected and sold for commercial gain without patient consent and that a health-care ID system would only encourage more of the same.”

    First, Michael F. Collins, a board-certified physician in internal medicine and chancellor of the University of Massachusetts Medical School in Worcester, Mass., argues that universal patient IDs are needed:

    A UPI system, using one number that seamlessly connects a person to all of his or her records, could be the safest and most efficient way to manage health-care data. It would guard against misidentification and make it much easier to pull together a patient’s records from disparate providers. Using today’s best technologies and practices, UPIs could help dramatically improve the quality of health care, lower costs, accelerate medical discovery and better preserve privacy. […]

    Currently, health-care providers and administrators struggle daily to match patients to records organized by disparate systems that rely on names, addresses, birth dates and sometimes Social Security numbers. Names can be presented in numerous formats, leading to duplicative records that cost money and lead to errors. As our population grows, the number of people with the same name and other similar personal data multiplies. Research cited by RAND Corp. indicates patients are misidentified at a rate of about 7% to more than 10% during record searches. As databases grow, the problem will only worsen. UPIs can correct this situation.

    What about data security? It is difficult—especially without being able to study UPIs—to know what the safest approach is. Admittedly, no IT system is immune to breaches.

    That said, patients with UPIs hold a distinct and important advantage in that their medical information is compiled and stored according to that unique identifier, separate from financial data typically coveted by thieves. UPIs can even be set up so that patients could choose to have no identifying data in their record, making it completely anonymous. […]

    Problems related to misidentifying patients and accessing their health information in a timely manner have eroded trust in the current low-tech system, which is why we need a new approach. Building an efficient records system that is more secure and offers better coordinated care can only enhance trust between patients and providers.

    Deborah C. Peel, a psychiatrist and health-privacy expert in Austin, Texas, is the founder of Patient Privacy Rights and leader of the bipartisan Coalition for Patient Privacy. She argues that universal patient identifiers are not necessary and will harm patient privacy:

    Yes, assigning everyone a universal patient identifier, or UPI, would improve doctors’ ability to share information and make it easier for hospitals to differentiate one John Smith from another. But a universal health ID system would empower government and corporations to exploit the single biggest flaw in health-care technology today: Patients can’t control who sees, uses and sells their sensitive health data.

    Searching for sensitive patient information would take just one number, not dozens of account numbers at professional offices, hospitals, pharmacies, labs, treatment facilities, government agencies and health plans. […]

    What’s more, any benefits associated with UPIs would be erased when patients, knowing their doctors have no control over where health-care data go, refuse to share sensitive information about their minds and bodies. This is a very real issue: Without privacy, patients won’t trust doctors. In 2005, a California Healthcare Foundation survey found that due to the lack of privacy, one in eight patients lies, omits critical details, refuses tests or otherwise keeps sensitive health information private. […]

    We are in the midst of an unprecedented data-privacy crisis. Changes to federal regulations in 2002 eliminated patient control over who sees personal health information and led to explosive growth in the data-mining industry. Pharmacies, health-care IT vendors, insurers and others routinely sell and commercialize prescription records, genetic tests, hospital and office records, and claims data to drug companies and any willing purchasers. Even with names and key identifiers stripped off, it’s simple to reidentify patients. […]

    If a single ID number isn’t the answer, what is? The best way to share sensitive health information is to build electronic-records systems where patients are in control of their own medical records, not government and industry. Health professionals should seek permission to see personal data, but only patients should release or link it. This is how it works with paper records systems, and there’s no reason we should be less concerned about privacy in the digital age. […]

    Decentralized systems with smaller data sets protect privacy because if any account is broken into, only some information is compromised. More important, they require mediation by the patient.

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