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The New Congressional Rider: Unique Patient ID Lemonade?

Posted on January 8, 2015 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manager 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, a role he recently repeated for a Council member.

Note: Previous versions referred to Rand Paul as the author of the first congressional rider. That was in error. The first rider was authored by then Representative Ron Paul. I regret the error. CB

Last month, I posted that Ron Paul’s gag rule on a national patient identifier was gone. Shortly, thereafter, Brian Ahier noted that the gag rule wasn’t dead. It just used different words. Now, it looks as if we were both right and both wrong. Here’s why. Paul’s rider’s gone, but its replacement, though daunting, isn’t as restrictive.

The gag rules are appropriation bill riders. Paul’s, which began in 1998, was aimed at a HIPAA provision, which called for identifiers for:

…. [E]ach individual, employer, health plan, and health care provider for use in the health care system. 42 US Code Sec. 1320d-2(b)

It prohibited “[P]lanning, testing, piloting, or developing a national identification card.” This was interpreted to prohibit a national patient id.

As I noted in my post, Paul’s language was dropped from the CRomnibus appropriation act. Brian, however, found new, restrictive language in CRomnibus, which says:

Sec. 510. None of the funds made available in this Act may be used to promulgate or adopt any final standard under section 1173(b) of the Social Security Act providing for, or providing for the assignment of, a unique health identifier for an individual (except in an individual’s capacity as an employer or a health care provider), until legislation is enacted specifically approving the standard.

Gag Rule’s Replacement Language

Unlike Paul’s absolutist text, the new rider makes Congress the last, biggest step in a formal ID process. The new language lets ID development go ahead, but if HHS wants to adopt a standard, Congress must approve it.

This change creates two potential adoption paths. Along the first, and most obvious, HHS develops a mandatory, national patient ID through Medicare, or the Meaningful Use program, etc., and asks congress’ approval. This would be a long, hard, uphill fight.

The second is voluntary adoption. For example, NIST could develop a voluntary, industry standard. Until now, Paul’s rider stopped this approach.

NIST’s a Consensus Building Not a Rulemaking Agency

NIST’s potential ID role is well within its non regulatory, consensus standards development mandate. It could lead a patient ID building effort with EHR stakeholders. Given the high cost of current patient matching techniques, stakeholders may well welcome a uniform, voluntary standard. That would not solve all interoperability problems, but it would go a long way toward that end.

Congress has loosened its grip on a patient ID, now its up to ONC, NIST, etc., to use this new freedom.

EMR and Privacy

Posted on November 20, 2013 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve recently engaged Dr. Deborah Peel, Founder of the Patient Privacy Rights organization, in a number of really interesting discussions around patient privacy. For those who aren’t familiar with Dr. Peel, she’s the most passionate patient privacy advocate in the world. While I don’t always agree with Dr. Peel’s views on patient privacy, I always love to hear what she has to say and I think we need more people like her in healthcare to make the case for something they think is really important.

With this said, Dr. Peel recently told me about a Wall Street Journal Experts chat she was on where they discussed EMR and privacy. You can see the video embedded below (Dr. Salwitz had sound issues, so after the intro you might want to skip to 4 minutes):

Dr. Peel also told me about an ONC event that she’ll be attending to talk about a really important topic: Patient IDs. When you’re talking privacy, the patient ID discussion is a very important one. Here’s the info if this is a discussion that you think is important. Plus, if enough people register, they’ll stream the event for everyone to watch online.

The Office of the National Coordinator for Health Information Technology (ONC) invites organizations with an interest in improving the accuracy of electronic patient identification and matching to attend a meeting in Washington, D.C. on December 16, 2013.
The Patient Matching Stakeholder Meeting will be held from 10:00 a.m. – 3:30 p.m. at Patriot Plaza III, 355 E Street, SW, Washington, D.C. 20024.
Registration is now open –

The agenda will include:
– Updates on the recent industry environmental scan on patient identification and matching, conducted by Audacious Inquiry on behalf of ONC;
– Sharing of initial recommendations for improving patient matching rates, derived from input from a wide range of stakeholders;
– Interactive discussions around emerging ideas to improve the processes of data collection, data validation, and other ways to help ensure accurate patient identification and matching, as electronic exchange of health information increases across the country; and
– Opportunities for all sectors to provide further feedback, including: large and small health care organizations, software and hardware health IT vendors, federal agencies, patient safety and privacy advocates, associations, and state and regional health information organizations.

We are exploring the possibility of providing webinar/videoconferencing capabilities to expand participation. Please register now, even if you plan to attend remotely, and we will follow up with more information.