Wednesday, April 13, 2016

Patient ID is critical to Enabling Privacy

A very short article this week really brings the problem of Patient Identity to a point. Specifically this:
Dr. Charles Jaffe, CEO of standards development organization Health Level Seven International, said Tuesday at the 13th annual World Health Care Congress in Washington that Kaiser Permanente Southern California had records of 10,000 people named Maria Gonzales. Ten thousand.
That is 10,000 opportunities for a FALSE match, aka a false-positive. That is where the data of the wrong person is being used to treat someone. From a Medical Practice, and Medical Safety perspective this scares me to no end!

But that is not my focus in this article. Privacy Enabling is.

I know that the people in Healthcare really want this problem resolved. However in the USA we are up against a forbiddance of USA Government funding of a national patient ID. There was concerns that it would present a Privacy risk. I however think that by not having a national patient ID we have a much worse Privacy risk. As today we are forced to expose all the demographics that we know about the patients we know, so that hopefully a match can be made. That should be enough of a Privacy violation to change the attitude. With a strong identifier, we would need only communicate that identifier (should include some other demographics for safety reasons).

But there is more Privacy violations, given that we don't have a solid identifier we can't have solid Privacy Consent Directives. We can within a realm that has a solid identifier, but that breaks as soon as one moves out of that one controlled environment.

More Privacy violations as we can't then give patients deterministic access to their own data, or control of their own data, or even an accounting of uses or disclosures of their data.

Privacy Principles would be enabled by a strong national patient identifier.

We are reverse engineering a national patient identifier by correlating poor-quality but highly sensitive demographics. We have made a central database of stuff that is very valuable to the black-market. I point out that our Patient Matching problem is the same solution as the black-market uses when they re-identify a de-identified dataset- Patient Matching as a Science. We have the worst of all worlds.

Note however, we will still have false-positives and false-negatives and john-doe; but the problem shrinks significantly.

I covered this very topic back in 2012. Universal Health ID -- Enable Privacy. In this article I go much deeper into the Privacy ‘risk’ and the Privacy ‘solution’. We can’t have stalemate.

Patient Privacy is enabled when we have strongly assured Identifiers. We don't even need to invent a new system. We just need to use the identifiers that we have already. It would not hurt to have a new system of trustable opaque identifiers that support federation.

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