Washington – Representatives of electronic health record initiatives in the United States, the United Kingdom and Canada disagree on the need for a national patient identifier within the context of an EHR/national healthcare information infrastructure program.

At the 76th National Conference and Exhibit of the American Health Information Management Association, the issue was a key point of dissension among HIM professionals. At a general session featuring Richard Alvarez of Canada Health Infoway, Peter Drury, MD, of the United Kingdom's Department of Health, and LeRoy Jones of the U.S Office of National Coordinator of Health Information Technology, there was little evidence that the political hot potato of a national identification number could be avoided.

In the United States, where the issue is still in play, Jones denied that the Bush administration has ruled out an ID number. But it was clear that opposition to an identifier was holding sway.

"There are several in-house debates," Jones said. "Will we [for example,] have a national patient identifier or not? But as long as we allow these barriers to stop us, we won't get to the goal of implementing EHRs within 10 years."

Jones insisted that a single ID number for each patient was not necessary. "If you look at some of the regions that have implemented an interoperable system, it has been done without a single identifier... It's not impossible to do."

He noted a Markle Foundation report that recommended a federated identifier, and said an EHR could be compiled using sophisticated algorithms that combined demographic data and other kinds of identifiers. "It's still a debate," Jones said. "We haven't arrived at a decision, and we're still seeking public input."

Canada's Alvarez said that while Infoway did not have, strictly speaking, a national identifier number for each patient, a national ID was created from a unique provincial patient identifier.

Drury was unequivocal. After trying to avoid the political ramifications that would come with a national patient identifier, "We came to a conclusion in 2002. I don't think you can do it (create an electronic health record) without a national identifier."

Drury noted that while conspiratorial fears about such a number and its implications for privacy and security were initially strong in the United Kingdom, the British got over those fears by responding to the specific benefits that come with an EHR. They thought that patients ought to be able to e-mail their physicians. They backed the concept of electronic transmission of prescriptions. They wanted physicians to have the most up-to-date health information.

From there, Drury suggested, support for the identifier was merely an outcome of a considered cost-benefit analysis.