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An HIT Moment with … Liddy West

November 17, 2008 Interviews 1 Comment

An HIT Moment with ... is a quick interview with someone we find interesting. Liddy West is a principal with West Consulting and is working on the VUHID project.

What is GPII, who’s involved, and why is it a non-profit?

liddy Global Patient Identifiers Inc. is the company started by Dr. Barry Hieb and myself to manage the Voluntary Health Identifier (VUHID) project. Barry, who left Gartner’s healthcare consulting group in August to work on VUHID full-time, has been focused on this effort part-time for a number of years, beginning with the work he led on two ASTM International standards that describe how to achieve unambiguous patient identification and improved privacy of clinical information.

As a medical doctor and a computer scientist, and through his wide network of industry leaders, Barry has thoroughly vetted the VUHID concepts and design from both practical and technical perspectives.

And, to your question as to why we’re a non-profit, one of our basic beliefs is that a universal patient identifier can neither be mandatory nor managed by any government. Nor can it be commercial in that neither patients nor providers can be asked to pay for it. That is, we believe that such an initiative should take costs out of the system, not add costs.

Citizens push back hard every time someone brings up the idea of a government-sponsored healthcare ID number, yet a RAND study advocates spending billions to create such a system. What are the benefits of an ID number and why does it have to cost so much?

We wholeheartedly agree with many of the objections to creating a massive, expensive, government-controlled national identification system. And based on our estimates, it simply doesn’t have to cost so much! That’s the beauty of the VUHID approach: cheap to develop and operate, no big software engine or data base of identifiable patient information, and no government agency to oversee it (lots more details at www.vuhid.org).

So, not only vastly cheaper to implement, but essential to making the healthcare delivery system more efficient. The RAND report (warning: PDF) estimates that savings running to tens of billions of dollars annually can be achieved if effective electronic clinical information exchange is implemented. Errors in current patient identification techniques estimated to be 8% or higher represent a major barrier to achieving these economies. And the benefits?

  • The ability to accurately link patient records among participating providers for a dramatic reduction in duplicate registrations and more convenience for patients and staff.
  • Reduced costs and medical errors. Fewer duplicate or unnecessary tests because patients are identified correctly and providers have access to clinical information from encounters across an HIE.
  • Enhanced privacy protection. With VUHID, patients can elect to protect certain aspects of their clinical information based on data type and provider type.
  • VUHID also reduces the risk of medical identity theft since no patient information is associated with the VUHID identifier.

He’ll blush to see himself referred to as the leading authority on the topic, but you’ll note that Barry’s work is cited no less than a dozen times in the RAND white paper.

We’ve only recently worked through the ROI model for VUHID and believe it will be vastly cheaper than the RAND estimates — by a factor of 500! In fact, one of our advisors who is involved with an emerging HIE project has reviewed our model and agrees that proposed VUHID pricing represents a “no brainer” decision for HIE executives based on savings and benefits described above.

How do you get around the inherent layperson fear of a government-controlled health ID number?

Again, it’s our intention to keep government out of it. We’re working with HIEs and EMPI vendors, taking a ground-up approach vs. a top-down, government-driven approach.

Now, if the government, state or federal, would like to sanction what we’re doing, we’d be happy to talk! Barry has presented VUHID to Rob Kolodner at ONC who is very supportive, but as you know, Congress specifically prohibited spending federal money on this effort several years ago.

We’ll continue to work with organizations such as HIMSS, NAHIT, IEEE, AMIA, JCAHO, Liberty Alliance, and the RAND Corporation, all of which have public statements supporting the need for more accurate patient identification methods. VUHID has good visibility with these organizations, as well as physicians’ groups, patient advocacy groups, and HIEs. We’re working to gain more traction as initial deployments are accomplished and real-world experience with the system is gained.

Some high-powered and well-funded groups surely have a strong opinion about the health ID concept. GPII is a tiny nonprofit. How will you get your message out and convince people that there’s no hidden agenda?

Well, as I mention above, we’ve been heavily involved in outreach efforts for some time. But, there’s a lot to do. This is really our biggest challenge, as we’re trying to raise funding to complete development and testing of the VUHID Web server, develop outreach and education programs, and build momentum with HIEs and EMPI vendors. Right now, it’s missionary work, with a little funding for technical work, getting the company set up and bare necessities (thanks again, Judy, for the grant from Epic).

As to hidden agendas, no one has ever come away from a discussion with Barry on this topic with any such suspicions. His dedication and our business model leave little room for doubt that we sincerely believe that this is the right thing to do and a necessary part of the infrastructure of a reformed US healthcare system.

Now that you’re out on your own as a consultant, what are the most interesting trends you’re seeing?

I’m seeing renewed interest in revenue cycle … or maybe that trend just comes back around every 10 years or so. But if you look at the age of the applications that are running the business side of most healthcare organizations, and the kludge of interfaces and bolt-ons that have been added over the years to keep them going … well, I’ve always thought there’s opportunity in this area. The current economic environment might just be the incentive for these organizations to finally take the risk on newer technology.

Also, I’m one of those people who believe that RHIOs or HIEs — whatever the acronym evolves to — are quietly taking hold, will persist and expand … with or without government mandate or funding. Maybe more successfully without government intervention! So, I believe systems integrators with infrastructure, tools, and the ability to “herd the cats” are companies to watch.

And relative to government, I do believe they’re here to stay when it comes to HIT. Many of the people I’ve talked to in Washington and here in Arizona who make or influence policy really do understand the benefits and challenges. The work of ONC has been important and hopefully will be continued under the new administration.

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