Congress Getting Real About Interoperability – Kills Paul’s Unique Patient ID Gag Rule

Posted on December 22, 2014 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

Correction: Brian Ahier looked at this post and made a better search through the legislation. When I searched, I used the same words that had been in use since 1998, which mentioned HIPAA and a national ID. As you can see in his post, the new language does not. I did not use the health ID language. I apologize for the error and thank him for his correction.

Sometimes what Congress leaves out is as important as what it puts in. The CRomnibus Act has an example for HIT. In its hundreds of pages, Congress took three actions to promote HIT interoperability. Two have been widely reported: It ordered ONC to report on interoperability data blocking and to spell out other impediments.

The third action, which I haven’t seen reported, was an omission. Ron Paul’s unique patient ID gag rule is no more.

In 2000, then Representative Paul (R-TX) put a rider on HHS’ appropriation blocking HIPAA’s call for a unique, patient ID. It prohibited, “planning, testing, piloting, or developing a national identification card.” Given Paul’s statements, this meant no patient ID development. By making it impossible to even think about a unique patient identifier, ONC could not assess the full range of interoperability options.

Each spending bill since 2000 has had the rider, until now. Noting remotely similar is in the bill. I’m still trying to find out who and when this was dropped.

What’s clear, though, is that Congress is serious about interoperability and has given ONC a clear field to develop a real plan. A bad gag rule is gone.