Biometrics entering a new era in healthcare
Biometrics technologies such as fingerprint scanners, palm vein readers, facial recognition tech, iris scanners and others, have long held promise to tighten up identification of patients and employees.
This would help reliably verify that patients are who they say they are, guarantee caregivers are working with the proper medical and demographic information, and ensure only the proper employees have access to the right information.
But biometrics technologies have been slow to catch on in healthcare. Sure, many hospitals and clinics have implemented some basic tech, but biometrics is not yet fully in the mainstream of healthcare practices. And it will still take some time and effort on the part of healthcare CISOs and biometrics technology vendors to get the tech swimming in the mainstream.
The future portends a new era of biometrics. Advances to the technologies will make them more attractive to healthcare organizations. Decreasing costs will make biometrics a more palatable move. Other technologies like artificial intelligence will, in turn, also give biometrics a boost.
But mainstreaming biometrics faces a variety of challenges. These include privacy, people, cost and interoperability.
There’s a lot of ground to cover in so experts at biometrics technology vendors, consulting firms and healthcare provider organizations shared their views on the road ahead.
Let’s begin with a look at what’s happening in the here and now.
A hospital’s view of the new era
Northwell Health in New Hyde Park, N.Y., is using iris scanning biometrics technology from RightPatient. It selected iris scanning because the high-resolution photo that is taken also can support facial recognition. It also intends to push the picture to all downstream EHRs where clinicians will have access as another step in assuring the correct identity. And by having a picture for every enrollment, this can also support the revenue cycle teams in the event of fraud or refusal to pay.
Keely Aarnes, IT director at Northwell Health, explained how the provider organization is using the biometrics technology in innovative ways that could lead into a new era of biometrics.
“There are a couple innovative areas; first, we see a lot of duplicate medical records created during the scheduling process,” she said. “We want to drive an identification process where perhaps a selfie is taken as another verification to ensure the appropriate record was located. There is also opportunity in our digital patient experience initiative to have facial recognition drive the workflow for linking a patient to their record. We intend to test these use cases in our Innovation Center where we have setup a mock-patient patient experience environment.”
Northwell Health envisions every patient encounter beginning with taking a picture. The picture will be used to identify and link a patient to his or her record.
“We intend to also pilot and test opportunities through AI that can identify indicators from changes in appearance, pointing to clinical indicators,” she said. “With a longitudinal view of the patient’s pictures, there are many opportunities to create alerts to the patient’s care team.”
How a picture leads to clinical uses
By starting workflow with taking a patient’s picture, there is an opportunity to expand to urgent care situations such as in the ambulance, in the field or in the emergency room, Aarnes said.
“If the patient is enrolled in biometrics, the patient’s record can be accessed immediately,” she explained. “Today we depend on a ‘quick reg’ process that often does not have enough information to link to the patient’s enterprise master patient index number. The clinician then does not have access to the history and continuum of care. If the patient is enrolled into biometrics, then that process happens upfront where time is of the essence.”
Aarnes also sees facial recognition having many opportunities to support the patient experience.
“If we can embed the technology into CCTV and identify the patient when they arrive, we can welcome them through the digital patient application and/or check them in,” she said. “We can then notify them where to go, wait times, introduction to their care team, links to education material, etc. Biometrics has more use cases then just identification – it can drive the entire patient experience.”
"When millions of smartphones use thumbprints and iris recognition, it makes the technology a whole lot more affordable for a lot more applications"
Mark Clifton, Princeton Identity
Where biometrics tech is headed
Nontraditional biometric modalities such as behavioral, EKG, finger vein and iris/retina are showing promise, but they face stiff competition from established modalities such as fingerprint, face and voice biometrics, which also are going mobile, said Merritt Maxim, a principal analyst at Forrester Research.
“The reality is that we will continue to see new biometric approaches introduced in coming years as vendors seek to commercialize any physiological approach that is unique,” he said. “And while things such as DNA are used more for forensic purposes, a scenario that uses real-time verification of DNA using saliva is certainly theoretically possible in the next five years.”
Something that matters for biometrics is the need for mandatory tuning. As healthcare organizations strive to provide patients with a frictionless registration and authentication experience, ensuring that the technology performs at scale with an acceptable level of false positives and negatives is essential.
“And privacy of the biometric samples will make or break biometrics in all industries, including healthcare,” Maxim said. “To ensure user acceptance and compliance, healthcare organizations will need to reduce the likelihood that biometric samples will suffer a compromise. This will likely mean relying on technology that stores only a subset of encrypted mathematical characteristics and parameters of biometric samples.”
Being able to identify patients with 100 percent accuracy is imperative in healthcare, so clinicians can provide the correct diagnosis and treatment based on that individual’s medical history. Biometric technologies get healthcare closer to 100 percent than any other medium or manual process.
“Healthcare organizations today assess different biometric modalities such as palm vein, iris, fingerprint against criteria such as accuracy, permanency, applicability – can all or most patients use the modality – and adoption – will patients use it,” said Sean Kelly, MD, chief medical officer at Imprivata, a healthcare IT security company whose offerings include biometrics. “As these technologies develop, other criteria or components will become table stakes.”
One modality versus multiple
The tools will need to be scalable, consumer-friendly, touchless and interchangeable. For example, today, health systems typically deploy only one modality to ensure that data capture is consistent and retrievable at all facilities within the system, even if multiple modalities may be desired, Kelly added.
“All of these modalities could continue to improve if combined with or enhanced by advances in fields such as AI or machine learning,” he explained. “As one example, palm vein scanning is a more established biometric modality but the current form factor presents some limitations for digital use-cases.”
If, though, it’s really more a question of when palm vein patterns might be reliably captured with another media, the use-cases will expand significantly, he added. Another example is facial recognition. Currently, facial recognition is great for 1-to-1 matches, but not nearly as accurate when it comes to the 1-to-many matches it must make to correctly identify a patient within a healthcare organization’s patient database, he contended.
The issue of cost could be changing in the years to come, too. Biometrics technologies are becoming less expensive, more compact and easier to integrate within a wide range of devices.
“Five years ago, thumbprints went mainstream courtesy of the iPhone,” said Mark Clifton, president and CEO of Princeton Identity, a vendor of iris scanning and other biometric technologies. “Similarly, millions of smartphones now use iris recognition, which once required expensive, specialized, bulky readers. Now it’s built right into a tiny screen. It’s easy to see how this trajectory will lead to integration of biometrics into many more products, including a wide range of medical devices.”
Clifton said that accuracy is also improving.
“This is of the utmost importance in healthcare,” he added. “Biometrics can’t be generating false matches. Using iris recognition, if scanning both eyes, the chance of getting a false reading is 1 in 1.4 trillion.”
"We envision a world where an individual’s personal biometric signature will eventually be under their own control, rather than under the control of the organization or software vendor."
Joe Artime, MedicFP
All biometrics will advance in effectiveness
Broadly speaking, all of the various biometric technologies will continue to advance in their effectiveness, but certain modalities, such as palm vein scanning, facial recognition and voice recognition, will exhibit the greatest promise, either as standalone biometrics or in applications that combine multiple biometrics, said Joe Artime, interim CEO at MedicFP, a fraud prevention IT vendor that uses facial recognition and palm vein scanner biometrics technologies.
“Generally speaking, we envision a world where an individual’s personal biometric signature will eventually be under their own control, rather than under the control of the organization or software vendor, and the individual will determine the extent to which this identity data is to be shared, with whom, and for how long,” Artime said.
Michael Trader, president of RightPatient, an iris scanning biometrics technology vendor, has seen increased adoption of biometric technology in general across many markets and use-cases. Algorithms and hardware for contact-dependent modalities like fingerprint and palm vein will continue to improve; however, RightPatient’s philosophy has been focused on what is practical for a given use-case and what will best position organizations for the future.
“This is especially important for patient recognition since it takes some time to build up a useful data set of enrollments,” Trader said. “So, for example, a fingerprint reader is inexpensive but does any contact-dependent modality make sense for patient recognition since it’s less ideal for hygiene and infection control? What about the impact on patient acceptance due to the negative stigma it may carry or a technology’s inability to scale? What if the technology locked customers into a single, proprietary device or a system that doesn’t offer any mobility or versatility?”
These are some areas that healthcare providers should be seriously considered before making any decisions, he added. Moving forward into a new era of biometrics, they should also be looking at what vendors have been recommending over the years to evaluate their expertise, commitment and vision, he said.
Challenges to biometrics moving forward
While it appears that biometrics will be covering a lot of ground in getting to a new era of advancements and use, there are challenges to getting there. A variety of challenges.
Privacy is a major potential inhibitor of biometrics, said Forrester’s Maxim.
“Much of biometric information is not resettable — causing a lot of customer pushback in the area of privacy,” he explained. “Storing the entire fingerprint or facial image is not only insecure but also requires huge storage capacities for large user populations.”
Forrester expects that biometric solutions will provide: 1) Server-side storage of only a partial biometric sample or only encrypted characteristics of a sample; 2) Better rotation and management of encryption keys protecting samples; and 3) Further improved replay attack mitigation capabilities.
“Any biometric solution must also separate out the enrollment process from ongoing use,” Maxim said. “The former is where you link the user biometric to an identity, possibly using document verification of a government ID to verify the identity. The ongoing authentication process is usually straightforward, but a poorly designed enrollment process can sap adoption and usage, and even introduce the potential for fraudulent sign-ups.”
Some of the biggest hurdles in the integration of biometrics technologies in healthcare are related more to people than to technology.
Getting the right people within continuously expanding health systems to recognize the problems associated with patient identification is the first hurdle, said Kelly of Imprivata. The “right” people could be clinical, financial, IT or risk management leaders who bear the burden of responsibility for population health management or value-based care; in other words, they own the management of patient identities and insist that their organizations attempt solutions, Kelly said.
"By configuring a smart environment and passive awareness of patients, providers can leverage their existing infrastructure and patients can use their own devices for personalized interaction."
Michael Trader, RightPatient
Patients need to be engaged
Naturally, the second group of people that needs to be engaged is patients.
“Many of us take more precautions around our financial identities than our medical histories, even though studies show health information can be even more valuable if it falls into the wrong hands,” Kelly said. “As part of the trend toward consumerization of healthcare, patients will become more aware of the value of and importance of protecting their medical identities.”
While costs of biometrics technologies are coming down, they remain a challenge to a new era of biometrics.
One of the challenges is indeed cost, or more accurately, perceived cost, said Clifton of Princeton Identity.
“Healthcare facilities often operate on a tight budget and, until recently, some biometrics technology solutions were relatively expensive,” he added. “Fortunately, that has changed a great deal as economies of scale have had an impact on the market. When millions of smartphones use thumbprints and iris recognition, it makes the technology a whole lot more affordable for a lot more applications.”
Also, hospitals should evaluate the cost of investments in biometrics over time, and not just for the one-time, upfront expense. Most biometrics technologies operate flawlessly for years, once installed, and can reduce administrative, IT, insurance and other expenses, making the total cost-of-ownership much lower than one might think, Clifton said.
Artime of MedicFP sees two challenges faced by biometrics within the healthcare context: the need for interoperability and the resistance of individuals to consent to biometrics data collection and storage.
“To address these challenges, biometrics-based software must be constructed in a modular manner that enables simple integration with as wide a variety of external systems as possible using industry-standard data-sharing conventions,” he said. “Modularity should also allow for easy interchange of biometrics tools to provide the flexibility to update the biometrics that are used as technology advances and to enable the use of multiple modalities as a way to accommodate resistance to individual biometric collection methods.”
"Healthcare organizations will need to invest in appropriate data security mechanisms to protect biometrics data as well as user education and training materials."
Merritt Maxim, Forrester Research
The new era of biometrics
Today, there already is use of biometrics such as fingerprint in clinical settings for doctors to log into workstations. Such approaches provide a convenience and productivity value as doctors and nurses can usually get faster access to healthcare apps by not having to enter complex passwords.
In the future, for consumers, for instance, they will be able to check-in using a biometric as well as the possibility of connected wearables being able to provide real-time data on medical conditions that provide better decision support to clinicians to take action, such as identifying irregular heartbeat, said Maxim of Forrester Research.
“As with any biometric, data privacy and user acceptance will remain barriers to adoption,” he said. “This means that healthcare organizations will need to invest in appropriate data security mechanisms to protect biometrics data as well as user education and training materials to explain how to enroll and use specific biometrics modalities.”
Trader of RightPatient said he believes his company’s use of artificial intelligence is pushing forward a new way of managing biometrics for the future.
“Our AI platform recognizes patients and personalizes their experience,” he said. “This occurs by configuring a smart environment and passive awareness of patients. Providers can leverage their existing infrastructure and patients can use their own devices for personalized interaction. Patients have an experience that exceeds their expectations with the reassurance that they are being kept safe and secure because medical record mix-ups and other adverse events are mitigated.”
Making AI ubiquitous
Healthcare providers improve patient safety, satisfaction, data integrity and revenue cycle while receiving predictive insights and preventing readmissions, Trader added. The company is working with clients to leverage its AI-based technology across all interaction points so the AI is ubiquitous.
Speaking of ubiquitous, Imprivata’s Kelly said that in a future state, biometrics identification in healthcare will be ubiquitous.
“Whether patients are being seen in a physician’s office, an emergency department, an ambulance or in the comfort of their own home, their identities are confirmed using biometrics, giving them and their caregivers the utmost confidence that they are being treated based on their entire medical history,” Kelly said. “Biometrics will be mobile, with identities managed in the cloud and accessible only to authenticated users.”
Since the pressure on provider organizations to achieve compliance, cost savings and high-quality care will undoubtedly continue, biometrics technologies will help with measurable results such as fewer denied claims, duplicate records and patient safety incidents, he said.
“The more biometrics are used, the more benefits accrue to organizations and to patients, leading to higher patient satisfaction and ideally better health outcomes,” he added.