December 26, 2007

Biometrics Coming of Age
By Carolyn P. Hartley, MLA, CHP, and Stanley Nachimson
For The Record
Vol. 19 No. 26 P. 8

Biometrics—using our human biological characteristics to identify ourselves—is no longer limited to movies and television. Widely adopted by several government agencies, biometrics is about to make a house call in your front office.

The technology is also on the Office of the National Coordinator’s agenda for 2009 antifraud measures and in the 2007 Deficit Reduction Act antifraud requirements, which means it also will show up in the Certification Commission for Healthcare Information Technology measures. Electronic health record (EHR) vendors hoping to continue certification guidelines will need to show how they interface with biometric devices.

The reason is embedded in the Centers for Medicare & Medicaid Services’ goals of reducing fraud and abuse by verifying that the patient receiving treatment is actually the beneficiary. The method of identification through biometrics is still wide open, from facial recognition to fingerprint and retina identification.

Let’s examine a few examples of how you already include biometrics in your everyday life. Voice recognition is the mainstay of directory assistance and customer service call centers. Legislators seeking opinions can poll constituents using voice recognition software. Some automobiles use voice recognition to turn certain functions on and off, tune the radio, or, in the case of voice destination entry, find an address by saying the telephone number.

Fingerprint readers and finger image readers are now being used to identify individuals. Today, many laptops include a fingerprint reader to allow the owner to control access to their laptop. Disney World uses finger scanning to ensure that patrons with multiday passes do not share them with others. The efficiency of the finger-scanning technology allows lines to move quickly into the park.

Facial recognition software is used in relatively sophisticated applications for several purposes. Some are used for gaining access to buildings, offices, etc. Other applications include comparing live video feeds to facial databases to identify criminals and search for missing persons, giving us the ability to pick a person out of a crowd. Essentially, the faces are compared against a database of known faces to “recognize” an individual, much as we do ourselves.

Whether you learned about DNA matching techniques from television or a textbook, it’s likely you also learned that your DNA is unique—a match usually means an individual can be identified. This technique, widely used in law enforcement, is no longer accessible to only the government and the wealthy. It is now available in healthcare for under $1 per transaction.

Starting at the Front Desk
As IT becomes more pervasive in healthcare facilities, biometrics can play a bigger role in allowing access to information and guaranteeing that patient data is correct. Biometrics can also be used to protect the privacy of information collected and stored.

Let’s start at the front desk. When a patient arrives at the facility, it is imperative that he or she is accurately identified and the correct person’s records are available for use in both administrative and clinical processes.

Instead of relying on names (which can be misspelled, mispronounced, or changed through marriage or divorce), healthcare professionals can use biometric technology to establish an identity. Once identity is established, a link to the patient’s administrative information and EHR can be created. Phone calls can also use voice recognition technology to positively identify a caller. Practices devoting staff to eligibility calls to verify health benefits eliminate hours on the phone by using fingertip verification.

A Competitive Bragging Point
Mark McLaughlin, executive vice president and chief technology officer of eMedicalFiles, a former chair of the Workgroup for Electronic Data Interchange, and former commissioner of the Electronic Healthcare Network Accreditation Commission, says healthcare will see its fastest growth in biometrics in the next two to three years, driven largely by widespread use in other industries, as well as healthcare’s need to overcome costly inefficiencies in patient identification and duplicate record management.

In a Medicaid integrity pilot initiated by the Texas Health and Human Services Commission (HHSC), five biometric products were tested in an independent study performed by the International Biometric Group. The HHSC’s goal was to ensure that the state’s limited resources were provided only to eligible recipients but also to ensure that it did not pay for services that were not rendered, so-called phantom services. “A study like this gives assurances needed for positive patient identification at enrollment and encounter,” McLaughlin says. “Since IntelliFinger [an eMedicalFiles biometric product] has the embedded logic to perform an eligibility check, the verification of the patient’s eligibility happens automatically and without further computer interaction.”

Physicians trying to remember constantly changing passwords may find relief in BIO-key’s secure fingerprint access to patient records. Doctors currently use the company’s technology to establish their identity when they sign in to an EHR to process daily functions such as documenting patient visits, prescribing medications, and ordering and viewing lab tests.

“Fingerprint identification guarantees that each patient’s private medical information remains private because while passwords can be shared, a doctor’s fingerprint cannot,” says Praveen Toteja, chief information officer for the George Washington University Medical Faculty Associates in Washington, D.C. “Our physicians are focused on patient care, and they complain about the inconvenience of constantly resetting and remembering passwords. Using their finger to access information is not only considerably more convenient but also more secure than passwords, allowing us to ensure that only authorized staff can access patient records.”

True Gains
Using biometric techniques in an office setting can improve workflow. For example, placing a finger image reader at the front desk would make registering patients easier and free a receptionist or administrator to deal with new patients or those needing more specific attention rather than pulling records. The biometric identification will also increase the accuracy of the pulled records—no need to search through all the John Smiths to figure out which is the correct record.

As the treatment process progresses, biometrics can also be used to alleviate identity concerns involving patients and their records. Nursing homes can use finger image readers to access resident drug orders so that staff provide the correct medication to the correct individual. In hospital operating rooms, a final verification of the patient can be accomplished through biometric identification to ensure the right patient is getting the right treatment.

Community settings, where patients may visit a series of clinics, can also benefit from the technology. If the clinics can share the patient database, each facility can instantly identify an individual if they have visited at least one of the clinics and registered their biometric (eg, a finger image). Any clinics with a finger image reader can then identify the patient and obtain their records.

As providers begin to share more medical records through health information exchanges, accurate identification of the individual and matching him or her with the correct medical record becomes more critical. Current efforts at creating master patient indexes using demographic information, name matching, etc, enables matching to a fairly accurate degree, but it also requires that the data be gathered, validated, and updated. On the other hand, biometric information linked to an individual generally does not change over time.

Within an enterprise record system, biometrics can help prevent common record-keeping errors. It should reduce duplicate records (two or more records for the same person) and merged records (one record for two or more people). The unique biometric identifier can be used to determine if a record has already been created for the patient and ensure that the information is going into the right person’s record.

Risks of Using Biometrics
Biometrics can help improve records accuracy, registration processes, patient safety, and security and privacy. However, there are some risks and costs associated with using the technology.

Equipment: There are purchasing, installation, and operation costs to consider. Before implementing the technology, decision makers should compare these costs against the technology’s value.

Patient reaction: There may be patients wary of their finger being imaged or their voice being recorded. Privacy concerns must be addressed up front, ideally through advanced notice and education. Any change in procedure will likely be met with resistance.

McLaughlin explains that IntelliFinger creates a digital image, which—unlike a fingerprint image—cannot be reverse engineered, a security feature appealing to patients. “A police officer cannot come into the practice with a set of fingerprints and say, ‘Tell me who this is.’ eMedicalFiles’ patent-pending system creates a one-way pointer with several layers of security encryption to the patient’s medical record,” he says. “The finger then becomes the patient’s personal identification number. In an emergency, it directs the physician to the record, even if the patient is traumatized or unconscious.”

Staff resistance: Advance discussion and staff involvement in the decision may help alleviate this problem.

Usability: There is a risk that biometrics won’t be appropriate for all patients. For example, finger imaging cannot be used if fingers are amputated, bandaged, or afflicted with particular diseases. In those cases, alternate techniques would need to be employed.

Small World and Getting Smaller
Watch for handhelds, laptops, and wireless devices to ride the biometric train. Companies to watch include Atmel Corporation, developer of a thermal fingerprint sensor that fits on Hewlett Packard’s iPAQ handhelds; AuthenTec, creators of TruePrint, a sensor the size of a cough drop that fits into a handheld; and Panasonic, developers of Authenticam, a camera the size of a small jewelry box that captures the iris.

HIPAA compliance, security issues, Joint Commission auditing requirements, and the push toward electronic medical records are all driving the price of biometrics into a competitive structure. Add national security, border patrol, and transportation concerns to help drive the price points down, and healthcare is in a position to take advantage of the digitization of the human body.

— Carolyn P. Hartley, MLA, CHP, is the president and CEO of Physicians EHR in Cary, N.C., and coauthor of Technical and Financial Guide to EHR Implementation.

— Stanley Nachimson is a former senior technical advisor for HIT activities at the Centers for Medicare & Medicaid Services and founder of Nachimson Advisors, LLC, in Baltimore.