In 1996, Congress passed the Health Insurance Portability and Accountability Act, which included mandates for the creation of identifiers for healthcare providers, plans and patients. But when drafts of a federal rule proposed a national patient identifier, it was shot down in 1998 by then-Vice President Al Gore over privacy issues.
"Because the availability of these identifiers without strong privacy protections in place raises serious privacy concerns, the administration is committed to not implementing the identifiers until such protections are in place," Gore said at the time.
Congress followed up with legislation banning expenditures on development of a patient identifier for similar reasons.
This is not the first effort by healthcare IT interests to resurrect the patient identifier scheme, nor the first by HIMSS.
There were several concerted efforts in 2006, including one by HIMSS and another by the now-defunct National Alliance for Health Information Technology, which was created with HIMSS support. NAHIT organized a daylong forum that aimed "to break the stalemate on patient identification for electronic health records."
In its recent statement, HIMSS notes that in 1999 and in subsequent appropriations bills since, Congress has inserted language saying, "None of the funds made available in this Act many be used to promulgate or adopt any final standard … providing for, or providing for the assignment of, a unique health identifier for an individual … "
Three successive presidential administrations have interpreted that language to mean, "no study, no standard and no criteria, i.e., not addressing the issue at all," the HIMSS statement said.
Meanwhile, HIMSS said, "Others believe that the language simply means no attempt to finalize a rule or solution until HHS reports to Congress on how any proposed solution will protect patient privacy and security."
HIMSS said the "lack of clear congressional intent" on the repeated legislative language "poses a huge impediment to the optimal adoption of health information exchange." The group asked Congress to "direct an appropriate study of a nationwide patient data-matching strategy." In another policy brief (PDF) issued this month, HIMSS called on Congress to "support the harmonization of federal and state privacy laws."
Meanwhile, an update to the HIPAA privacy rule necessitated by more stringent privacy provisions in the American Recovery and Reinvestment of 2009 has remained in bureaucratic limbo since March.
