BIOMETRIC-ASSISTED UNIQUE PATIENT IDENTIFIER

ABSTRACT

Over the years, healthcare institutions have relied on one or a combination of medical record number (MRN), demographics and issued documents such as name, sex, date of birth, social security number, and identity cards as patient identifiers. But all those have been proven unsuitable and inefficient as patient identifiers due to one or more of the following drawbacks: non-uniqueness,  possessiveness,  inability  to  establish  the  true  identity  of  a  patient,  and limitedness of applicability to referencing of patients across healthcare systems. This project is geared towards solving the drawbacks of the earlier methods of patient identification by adopting a hybrid solution: a combination of a unique 15-digit numeric identifier and a patient’s biometric feature. A patient is expected to enroll their palm vein, with other basic information such as bio data and contact at an accredited healthcare facility, on their first visit and be assigned a unique

15-digit numeric identifier.   The data are stored and maintained in a Master Unique Patient Identifier Index (MUPII). On the patient’s subsequent visits to any accredited healthcare facility, the unique code (called the unique patient identifier) is used to make an identity claim and verified by matching the patient’s palm vein pattern against the template in the MUPII. Furthermore, the identifier  is  useful  for filing,  labeling of laboratory specimens,  recording, transferring and referencing of patients. In situations where the identifier is not handy (as a result of incapacitation or unconsciousness of the patient), the patient could still be identified, using just their palm vein feature alone. This solution will eliminate patient misidentification and identity theft in healthcare or, at least, reduce them to the minimum.

CHAPTER ONE

INTRODUCTION

1.1     Background of Study

The era is gone when the healthcare needed by a patient was provided by a single physician who could correctly identify their patients by name. In contemporary healthcare systems, a team of healthcare professionals from different disciplines and perhaps healthcare institutions are responsible for providing a patient’s healthcare [1]. Consequently, a system is developed in healthcare  organizations  to  establish  and  maintain  the  identity  of  a  patient,  through  the acquisition of some identifying information from the patient. Such identifying information or a value  assigned  to  an  individual  to  facilitate  positive  identification  of  that  individual  for healthcare purposes is known as the patient identifier [2]. It is the responsibility of the healthcare organization to carry out this task. Hence, it should be an absolute right of any patient to be correctly identified by the healthcare provider, matched to their medical record and directed to correct care pathway such as healthcare professionals, facilities and procedures within the healthcare organization [3]. Therefore, a correct (and immediate) identification of a patient is crucial  and  indispensable.  In  this  light,  in  2012,  the  (American)  Academy  of  Orthopedic Surgeons set the improvement    of patient identification accuracy as her number one national patient safety goal [4]. Similarly, the Joint Commission (an American organization that accredits and certifies healthcare organizations and programs) has set patient identification accuracy improvement as her 2016 number one goal for patient safety [5]. All around the healthcare landscape, medical facilities, professional organizations, governmental regulatory agencies and even  patients  are  increasingly tuned  in  to  the importance  of  ensuring  patient  identification accuracy to maintain quality healthcare level and medical record data precision.

At the core of patient identification is the patient identifier. It is the patient identifier that a healthcare organization uses to identify her patient. An example of such identifier is the patient’s name. Healthcare organizations require the use of patient identifiers for their day to day operations, such as the delivery of care, administrative processes, support services, record keeping,  information  management,  and  follow-up  and  preventive  care.  Furthermore,  the

functions of the patient identifiers have been widened by the technological revolution in the healthcare delivery system and advancements in computer and telecommunication technologies. In another sense, patients’ mobility has been enhanced such that patients visit multiple providers and get treated by multiple organizations. Therefore, to support the continuum of care, it is necessary to uniquely identify patients across multiple providers and access their information from multiple locations[2].

1.2     Statement of Problem

Over the years, healthcare institutions have relied on one or a combination of Medical Record Number (MRN), demographics such as name, sex, date of birth and issued documents such as social security number, and identity card, as patient identifiers. But all those have been proven unsuitable and inefficient as patient identifiers due to one or more of the following drawbacks: non-uniqueness,  possessiveness,  inability  to  establish  the  true  identity  of  a  patient,  and limitedness of applicability to referencing of patients across various healthcare systems. Therefore, patient identification can sometimes be a source of a significant operational problem in healthcare. Take for example, a patient who got registered with a care provider but provides a different credential (e.g. name, address) from the one provided earlier. This scenario creates multiple identifiers and thus spawns an array of issues. Similarly, what if the patient gives the name and insurance details of another person? This too can pose serious consequences. Consider also  a  genuine  case  of  a  non-responsive  unidentified  patient  who  requires  treatment.  This presents yet another challenge to the care provider. Consequent to identification errors, in the U.S., health care organizations lose about $30billion annually to patient misidentification incidents [6]. Similarly, in the United Kingdom, huge amounts up to £5billion (about $7.2billion) are lost annually to healthcare fraud, part of which accrues from patient misidentification [7]. Altogether, these pressures could have a negative impact on both the patients and healthcare organizations as they (the organizations) strive to maintain patient safety, efficient operation, quality service, and good reputation. Although there is no patient identity fraud or misidentification report existing in the literature for Nigeria, there is also no proof that Nigeria is free of the challenge.

1.3     Objectives

To solve the problem of misidentification and the consequent adverse events, this work seeks to proffer a solution to the challenge of timely and accurate patient identification, by proposing a unique patient identifier model that is assisted with biometric technology for the Nigerian National Health System. Nevertheless, the model will be scalable and may be adapted to any nation.

1.4     Methodology

This work will adopt the following approach towards achieving the set objectives:

    Review of existing unique patient identifiers (UPIs);

    Environmental scan of existing patient identification systems in Nigeria;

    Information elicitation in Nigerian hospitals via questionnaire design and analysis;

    Proposal of a suitable UPI for Nigeria;

    Proposal of a suitable biometric for patient authentication;

      Proposal   of   suitable   conceptual   model,   physical,   communication,   and   logical architectures of a national electronic-based, biometric-assisted unique patient identifier system.

1.5     Scope

This work will be limited to the conceptual formulation of UPI, conceptual modeling of the physical and communication architectures for the national electronic-based, biometric-assisted unique patient identifier system. The unique patient identifier shall consist of a 15-digit decimal number (or 13-digit alphanumeric hexadecimal number). Each citizen of Nigeria will be assigned this unique number. Palm vein biometric, because of its non-intrusiveness, high distinctiveness, stability and permanence, will be used to verify the identity of the individual. The essence is to ensure that no individual will be able to make a false claim of an identifier. Through that, each patient will be uniquely identified and possible health care identity theft and fraud will be highly mitigated.

In this work, issues related to patient identifiers such as encryption and access control to patient identifier index will not be considered.

This work does not include the actual development or implementation of any algorithm. It is limited to the proposal of a suitable conceptual framework, which will form the basis for the development of an algorithm and implementation of a biometric assisted unique patient identifier and UPI index for Nigeria.

1.6     Significance of the Work

This research work will be highly relevant to health organizations such as hospitals, the National Health Insurance Scheme (NHIS), all Nigerian citizens, the government, and health regulatory agencies (such as the ministry of health) in developing an integrated national health service, being that accurate patient identification will:

          prevent duplicate medical records and lower language barriers;

     lower hospital or healthcare system liability risks by ensuring the right care is delivered to the right patient;

          eliminate patient fraud;

          streamline the patient identification process for increased efficiency;

          reduce patient check-in times per visit, thereby increasing satisfaction;

          reduce drastically the amount of deaths that result from patient misidentification;

     lead  to  huge  financial  savings  for  individuals,  health  care  organizations  and  the government.

1.7     Thesis Outline

This work is organized and presented in five chapters. Chapter One gives the fundamental understanding  that  informs  the  research  effort.  The  review  of  patient  identification,  unique patient identifier and related works is provided in Chapter Two. Chapter Three presents the detailed research methodology, while Chapter Four provides the design model of the unique patient identifier system.  In Chapter Five, the conclusion and recommendations for further work are made.

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