skip to main |
skip to sidebar
In my November 17 post, I began a discussion of the [proposed] unique patient identification numbers by looking at a de facto proxy, the Social Security number (SSN). In the present post, I will continue with a look at a few of the technologies available for getting information such as someone's identification into or out of a computerized system such as, but not limited to, those used to implement electronic health records (EHR).
Biometric Applications
Biometric verification is a technology which uses unique characteristic features of an individual to automatically identify a person. There are several biometric technologies including fingerprint, hand geometry, and retinal scan. Each of these verification techniques claims to provide positive identification of individuals. What's more, these forms of ID cannot be transferred, forgotten or lost. Anywhere personal identification is required (such as PIN numbers at financial institutions), biometric verification can be used.
The hardware needed for biometric verification is frequently installed at the entrance of a building or secured area and are the "keys" for entry. Fingerprint verifiers, for example, generally allow any finger on either hand to be used for positive identification. Usually an alternate finger is also chosen as a backup in case of injury (cut, scrape, etc.) to the first. Multiple fingerprint templates can be stored locally inside the fingerprint terminal or through a network on a host computer (e.g., in a database). Most vendors also include software that supports common security access features such as unauthorized overtime or early clocking in. In addition, many of these systems can be integrated with existing software packages. Therefore, usually, separate systems do not have to be maintained in order to record and restrict access.
Biometric applications are highly specialized and costly to install when compared to card recognition and other access systems. In addition, if a biometric unit such as a terminal goes down, the manufacturer is often the only source for replacement or repair. With other technologies, such as magnetic stripe, input devices are readily available and can be purchased from a variety of vendors. Biometric Identification, however, does have its benefit. When ultimate security is vital, biometric identification is sometimes proven to be the best solution. But, caveat emptor: as shown later in this post, errors do occur.
Voice Recognition
Although technically, voice recognition is part of biometric verification, its widest application is to convert speech into text and not principally for security or access control. Voice recognition has many advantages, most notably allowing people to keep their eyes and hands free while "voicing instructions" to the computer. Voice recognition is used in many professional fields including healthcare.
For a discussion of using the human voice for verification, see my article "Speech Authentication Strategies, Risk Mitigation, and Business Metrics" in the bibliography at the bottom of this blog.
http://www.developer.com/security/article.php/3684921/Speech-Authentication-Strategies-Risk-Mitigation-and-Business-Metrics.htm
For readers with a background in mathematics and statistics, see the papers
"Comparing Human and Automatic Face Recognition Performance" at
http://myslu.stlawu.edu/~msch/biometrics/papers/adler-schuckers-Human-Automatic-FR.pdf
and
"Statistical Evaluation and Estimation of Biometric-based Classification" at
http://myslu.stlawu.edu/~msch/biometrics/papers/SchuckersTIFSCorrelationStructurev3.pdf
Among the topics discussed here are
(1) false accept rate
(2) false reject rate
(3) false match rate
(4) false non-match rate
(5) biometric authentication,
(6) effective sample size
(7) confidence intervals
Note 1: A video in the right-hand column of this blog presents a brief introduction to confidence intervals.
Note 2: If 99.9% were good enough
• There would be a major plane crash every 3 days
• 12 babies would be given to the wrong parents each day
• There would be 37,000 ATM errors every hour
Nonetheless, technology-based systems in use today do yield the expected outcome less than 100% of the time.
So, it's important that you understand that, like their human counterparts, technologically-based methods are error prone. At the same time, it's also important that you know the cost of these errors to you (and those you serve) in the methodology you choose to use.
Optical laser Cards
These cutting-edge cards transform CD-ROM technology into a credit card form, capable of securely storing megabytes of personal information. For example, a patient ID card could hold an image, health care history, vaccination record, X-rays and more.
Card Based Access System
Controlling entry security to your facility (or computer system) is of vital importance, whether your facility is a high security area such as a hospital, airport, or bank, or even if it is an everyday situation such as an insurance office, school, or department store.
Visual Identification
The simplest access control systems use portrait ID or membership cards, which rely on a receptionist or colleagues at work to recognize interlopers by the absence of a valid, matching portrait card. Such systems require the printing of clear, easily visible, portrait cards. Unfortunately however, that alone is not enough, because with current PC and scanner technology, creating fake or counterfeit cards is all too easy.
Even simple door entry control systems need to use an anti-counterfeiting system which provides an overall security "watermark" feature which is proof against all attempts to copy it.
This type of access control is extremely cost-effective, and it may be all that many facilities need to achieve the security level they require.
Swipe Card Door Access Control Systems
If you need controlled access without relying on the presence of guards or reception staff, you may need to add swipe card readers and electronic locks to your controlled entrances. A higher level of security can be achieved by using mag-stripe readers.
Proximity Cards / Prox Card Access Control Systems
Proximity Cards, or "Prox" as they are often called, are standard size plastic ID cards which contain a coil antenna and a pre-programmed micro chip containing a unique code. When the prox card is within a foot or so of the Prox reader, the radio signal from the reader is picked up by the card antenna and used to power-up the micro chip which then replies with its own unique code.
The reader and its associated processor compare the code with a list of authorized entrants, and if it's OK, the door is opened and a record of entry is logged.
Prox cards must always be "personalized" with a portrait ID to eliminate the misuse of "loaned" or stolen cards.
Reference Books
For a good summary of the sources of problems (errors) and biometric performance, see
This book includes very readable material on
(1) Legal aspects of biometric technologies
(2) Selected technology error rates
(3) Resistance of the system to forgeries
(4) RFID applications
(5) Economics
and much else.
For a comprehensive introduction to RFID, see
Click here for a preview look at this book.
RFID and Bar Codes
For a discussion of the pros and cons of using RFID and bar codes for the identification of patients, staff and medications, in different use cases, see
http://geekdoctor.blogspot.com/2007/11/bar-codes-rfid-and-patient-safety.html
You will find there a summary of early work at Beth Israel Deaconess Medical Center in Boston to establish positive patient identification:
"For identification of most patients, we believe linear and two dimensional bar codes on wrist bands is robust, cost effective and standardized. For staff badges, linear bar codes work well. For NICU babies passive RFID enables scanning of swaddled infants without disturbing them.
For identification of medications, we believe linear bar codes of NDC numbers on heat sealable plastic bags provides a practical means to positively identification medications.
For identification of equipment, specifically for tracking location in real time, active RFID works well. Because of the size and expense of tags, we do not believe active RFID should be used for patient identification at this time.
Thus, a combination of bar codes, passive RFID and active RFID is working well in our various pilots. No one technology meets the needs of all use cases. Although we favor bar codes over passive RFID in the short term, we do expect to eventually replace bar codes with RFID once the technology is more robust, standardized and cost effective."
Creating a unique patient identification number for every person in the United States would help reduce medical errors, simplify the use of electronic medical records, increase overall efficiency, and protect patient privacy, according to a recent RAND Corp. study.
Creating such an ID system could cost as much as $11 billion, but the effort would likely return even more in benefits to the nation's healthcare system, said researchers from RAND Health, a nonprofit research organization.
As adoption of health IT expands nationally and more patient records are computerized, there have been increasing calls to create a system that would include such an ID.
So, as segue to an upcoming post here on the challenges presented by an electronic health records system based on a unique patient identification number, let’s take a brief look at the closest thing to it in the U.S.: The Social Security Number.
Introduction
The Social Security Number (SSN) was created in 1936 as a nine-digit account number assigned by the Secretary of Health and Human Services for the purpose of administering the Social Security laws. SSNs were first intended for use exclusively by the federal government as a means of tracking earnings to determine the amount of Social Security taxes to credit to each worker's account. Over time, however, SSNs were permitted to be used for purposes unrelated to the administration of the Social Security system. For example, in 1961 Congress authorized the Internal Revenue Service to use SSNs as taxpayer identification numbers.
In response to growing concerns over the accumulation of massive amounts of personal information, Congress passed the Privacy Act of 1974. Among other things, this Act makes it unlawful for a governmental agency to deny a right, benefit, or privilege merely because the individual refuses to disclose his SSN.
Section 7 of the Privacy Act further provides that any agency requesting an individual to disclose his SSN must "inform that individual whether that disclosure is mandatory or voluntary, by what statutory authority such number is solicited, and what uses will be made of it." At the time of its enactment, Congress recognized the dangers of widespread use of SSNs as universal identifiers. In its report supporting the adoption of this provision, the Senate Committee stated that the widespread use of SSNs as universal identifiers in the public and private sectors is "one of the most serious manifestations of privacy concerns in the Nation." Short of prohibiting the use of the SSN outright, the provision in the Privacy Act attempts to limit the use of the number to only those purposes where there is clear legal authority to collect the SSN. It was hoped that citizens, fully informed where the disclosure was not required by law and facing no loss of opportunity in failing to provide the SSN, would be unlikely to provide an SSN and institutions would not pursue the SSN as a form of identification.
Large amounts of personal information, including tax information, credit information, school records, and medical records, is keyed to your Social Security Number. Because this data is often sensitive, you should keep it private.
The Structure of the SSN
The SSN is not entirely randomly-generated. Although the procedures for issuing SSNs have changed over the years, a SSN can reveal an individual's relative age and place of origin. The first three numbers (area number) are keyed to the state in which the number was issued. The next two (group numbers) indicate the order in which the SSN was issued in each area. The last four (serial numbers) are randomly generated.
The SSN and Privacy
Today, the Social Security Number plays an unparalleled role in identification, authentication, and tracking of Americans. Because the identifier is used for many purposes, it is valuable to those who wish to acquire credit, commit crimes, or masquerade as another person.
The SSN has been increasingly used in the private sector. The SSN is the record locator for many private-sector profilers, credit bureaus, and credit card companies. It is also used extensively outside the financial services sector. And, while some businesses use the SSN to identify individuals, others use the SSN as a password. This means that the SSN is widely used both as an identifier and as an authenticator. Serious security problems are raised in any system where a single number is used both as identifier and authenticator. It is not unlike using a password identical to a user name for signing into e-mail. Or like using the SSN as a bank account number and the last four of the SSN as a PIN for automated teller machines.
The SSN as National Identifier
The issuance of a single, unique number to Americans raises the risk that the SSN will become a de jure or de facto national identifier. This risk is not new; it was voiced at the creation of the SSN and has since been raised repeatedly. The SSN was created in 1936 for the sole purpose of accurately recording individual worker's contributions to the social security fund. The public and legislators were immediately suspicious and distrustful of this tracking system fearing that the SSN would quickly become a system containing vast amounts of personal information, such as race, religion and family history, that could be used by the government to track down and control the action of citizens. Public concern over the potential for abuse inherent in the SSN tracking system was so high, that in an effort to dispel public concern the first regulation issued by the Social Security Board declared that the SSN was for the exclusive use of the Social Security system.
In passing the Privacy Act of 1974, Congress was specifically reacting to and rejecting calls for the creation of a single entity for the reference and storage of personal information. A 1977 report issued as a result of the Privacy Act highlighted the dangers and transfer of powers from individuals to the government that occur with centralization of personal information:
In a larger context, Americans must also be concerned about the long-term effect record-keeping practices can have not only on relationships between individuals and organizations, but also on the balance of power between government and the rest of society. Accumulations of information about individuals tend to enhance authority by making it easier for authority to reach individuals directly. Thus, growth in society's record-keeping capability poses the risk that existing power balances will be upset.
Many medical providers are using the SSN as a patient identifier, thus hardening the number as a de facto national identifier. As David Miller noted in testimony before the National Committee on Vital Health Statistics:
"It should be noted that the 1993 WEDI [Workgroup for Electronic Data Interchange] Report, Appendix 4, Unique Identifiers for the Health Care Industry, Addendum 4 indicated 71% of the payers responding to the survey based the individual identifier on the Member's Social Security Number. However 89% requested the insured's Social Security Number for application of insurance. Clearly the Social Security Number is the current de facto identifier..."
But individuals and companies are resisting such use of the SSN. Acting on employees' suggestions, I.B.M. has requested that health companies stop using the SSN on insurance cards. According to IBM, fifteen insurers, which cover about 30,000 of the company's 500,000 employees worldwide have either not responded or indicated that they will not comply with the request.
The SSN and Identity Theft
The widespread use of the SSN as an identifier and authenticator has lead to an increase in identity theft. According to the Privacy Rights Clearinghouse, identity theft now affects between 500,000 and 700,000 people annually. Victims often do not discover the crime until many months after its occurrence. Victims spend hundreds of hours and substantial amounts of money attempting to fix ruined credit or expunge a criminal record that another committed in their name.
Identity theft litigation also shows that the SSN is central to committing fraud. In fact, the SSN plays such a central role in identification that there are numerous cases where impostors were able to obtain credit with their own name but a victim's SSN, and as a result, only the victim's credit was affected. In June 2004, the Salt Lake Tribune reported: "Making purchases on credit using your own name and someone else's Social Security number may sound difficult -- even impossible -- given the level of sophistication of the nation's financial services industry. But investigators say it is happening with alarming frequency because businesses granting credit do little to ensure names and Social Security numbers match and credit bureaus allow perpetrators to establish credit files using other people's Social Security numbers." The same article reports that Ron Ingleby, resident agent in charge of Utah, Montana and Wyoming for the Social Security Administration's Office of Inspector General, as stating that SSN-only fraud makes up the majority of cases of identity theft.
Because creditors will open new accounts based only on a SSN match, California has passed legislation requiring certain credit grantors to comply with heightened authentication procedures. California Civil Code § 1785.14 requires credit grantors to actually match identifying information on the credit application to the report held at the credit reporting agency. Credit cannot be granted unless three identifiers from the application match those on file at the credit bureau.
