Comment: The road to a national health care identifier

By John D. Halamka, MD
12:40 PM

What’s the likelihood the United States will create a national health identifier system for individuals similar to those in use in Canada, Norway and the United Kingdom?

Many people do not know that Congress has put a hold on any funding to plan or implement such a system since 1998. Under its terms, the Health and Human Services Department cannot even discuss the issue.

So compulsory national identifiers are unlikely. However, personal health records (PHRs) might prompt development of voluntary identifiers to facilitate continuity of care. And that could ultimately sway Congress to re-evaluate its prohibition.

Health care providers use different schemes for numbering medical records, making it an informatics challenge to combine an individual’s records from hospitals, physicians, labs, pharmacies and payers. At CareGroup Health System, we use a statistical, probabilistic algorithm that incorporates name, gender, date of birth, ZIP code and other demographic information to link multiple medical records into a single PHR. This works great for John D. Halamka, male, 05/23/1962, 02481, but not so well for John Smith, Boston.

A voluntary patient identifier would add another element to the matching algorithm and significantly increase the ability to accurately link the demographic information of patients with common names.

The benefit to the patient is clear. With new PHR products, such as Microsoft’s HealthVault and Google’s rumored offerings, patients would be able to more accurately link all their data so they could maintain lifetime records. And because the identifier would be voluntary, only interested patients would opt in, ensuring that their privacy preferences would be respected.

How long would it take to create such a system? This year, many doctors will start using electronic health records that will provide enough clinical data to add value to PHRs. By the following year, PHRs will be more popular, but they will require manual linking of information because patients will have to establish accounts with each provider to access their data.

I predict that some vendors and institutions will implement a voluntary health identifier by 2010.

If patients gain confidence in the security of a health care information exchange system they control, it is conceivable that Congress would revisit its ban on a secure national identifier within the next decade.

Until then, having a national identifier is not a prerequisite for getting started with PHRs. Indeed, I will fully enable any patient to retrieve his or her health records from Harvard University’s Beth Israel Deaconess Medical Center with their consent via the new generation of standards-based, employer-sponsored and payer-based PHRs using manual linking methods.

Halamka is chief information officer at the CareGroup Health System, CIO at Harvard Medical School, chairman of the Healthcare Information Technology Standards Panel and a practicing emergency physician. His blog, Life as a Healthcare CIO, can be found at