HHS wants feedback on a new identification system

The Health and Human Services Department, which Congress has charged with
creating a health care identification numbering system, wants to get the public’s
view of a new national ID.

In its 1996 Health Insurance Portability and Accountability Act, Congress directed HHS
to come up with what it called Unique Health Identifiers for all citizens. The UHI numbers
would let the government, health insurers, hospitals, doctors and health researchers track
peoples’ medical histories from birth to death.

The program is the first comprehensive ID numbering effort since the debut of Social
Security numbers in 1935, federal officials said.

Proponents of UHI said the standard numbering effort would replace the disparate
numbering systems insurance agencies and health care providers now use. A single permanent
number for each citizen would simplify record-keeping and lower medical costs, HHS
officials said.

The UHI numbers would also make it easier to track major disease outbreaks, measure
trends in workplace health and monitor the quality of care patients receive, HHS spokesman
Campbell Gardett said.

But opposition to the system, from privacy advocates who fear the numbers could fall
into the wrong hands or be used inappropriately by health providers and insurance
companies, led HHS to hold public hearings around the country, he said.

“The biggest deadline is getting the consensus nationally,” Gardett said.
“We’re focusing on the process … by holding hearings in different parts of
the country.”

HHS held the first hearing last week in Chicago; the department will hold more hearings
in the next several months.

After the hearings, HHS’ National Committee on Vital and Health Statistics will
make a final recommendation to HHS Secretary Donna Shalala. HHS will publish a proposed
rule in the Federal Register after Shalala approves a UHI plan, Gardett said.

If the national outcry against creating a national UHI system is too great, “we
could theoretically go back to Congress and ask them to legislate it if we don’t see
a national consensus,” he said.

HHS is considering four possible approaches. In an initial report, the department
outlined the proposals and the drawbacks of each:

But there is no way to easily verify Social Security numbers. Some people do not have
them. More than one person sometimes use the same number erroneously.

HHS officials said a new numbering system would likely assuage concerns about linking
health information to other information already tied to Social Security numbers, such as
school records, credit and financial histories, and court records.

A new numbering system would require creating an oversight organization for the ID
infrastructure, adding complexity and cost.

People might be afraid to request the alternate numbers if they thought insurance
companies perceived them as trying to hide something, HHS officials said.

The downside to this approach is securing the algorithm against tampering, which would
be difficult because the algorithm would be widely distributed. Also, the government would
need to create an organization to manage the program.

The society’s number system can create IDs of up to 29 characters. As to the
biometric IDs, HHS is considering applications that can identify people from their
fingerprint, retina, iris and voice patterns.

HHS posted its UHI report on the Web at http://aspe.os.dhhs.gov/ncvhs.


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