Patients embrace palm scan ID process with roots in Japanese banking industry
Patients embrace palm scan ID process with roots in Japanese banking industry
Technology 'huge win' for NC health system
Carolinas HealthCare System (CHS) is using palm scan technology originally developed for the Japanese banking industry to ensure accurate patient identification at its five hospitals in the Charlotte, NC, metropolitan area.
The process currently unique among health care delivery facilities in the United States was easy to implement and has been accepted by patients in a way that has surprised health system leadership, says Chris Johnson, FHFMA, vice president for patient financial services.
"When we started down this path, we said we would consider it a success if we could get 50% of patients to enroll and cooperate," Johnson adds. "Today the participation rate of patients who are offered enrollment is running at about 97%."
For a variety of reasons, he explains, it is not appropriate to offer enrollment to all patients.
As with other health care organizations, Johnson says, one of the problems CHS deals with is the creation of duplicate medical record numbers. With 3 million names in its master person index (MPI), he notes, there can be pages and pages of people with identical first and last names.
While a patient's identity can be verified in other ways, such as date of birth, Johnson says, "the thinking is that if you're not 100% sure you have the right person, you create a new medical record. We'd rather have a duplicate record than connect someone with the wrong record."
When CHS leaders began looking at ways to refine the patient identification procedure, he says, they drew on the organization's information systems (IS) support to do the market research and determine what tools were available.
Among other solutions, CHS looked at fingerprint and retinal scans, Johnson adds, deciding that the latter process was too invasive and would not be accepted by patients. While fingerprint scans are widely used in the industry, he says, "we learned that some segments of population across the world don't carry deep enough grooves in their fingerprints for that to be a viable solution in health care."
In addition, studies show that the chance of incorrectly identifying a person by fingerprint is one in 10,000, Johnson points out. "We determined that the incidence of a false positive in the fingerprint world is higher than with the palm scan."
The palm scan, he explains, doesn't take a picture or record an image, but rather measures the blood flow pattern in the palm through vein mapping and converts that information to a unique number.
"Because the biometric sensor creates a unique identifier for each scanned palm, it does not require the storage or use of an actual image or picture," adds Jim Burke, director of information services for CHS. The technology uses a near infrared light to capture the vein pattern in a patient's palm, he notes.
With the CHS process, the unique number is associated with the patient's medical record number, Johnson says. "If you present for a return visit, you place your hand over a device called a palm reader which we refer to as a 'brick' that is made of surgical-grade plastic, the same kind of plastic that is used for hip replacements."
The hand is guided to the right place and the device reads the vein mapping and searches the MPI, he continues. "It will pull up only the record associated with that number. There could be 12 pages of Chris Johnsons, but it will only find one person."
To speed the process, registration staff ask the person for his or her birth date, Johnson notes. "The reason is that as the database grows, we don't want [the device] to have to search through hundreds of thousands of names, so it will just search for people with that birth date."
Still, even if there are 100 people with that name and date of birth, it will bring up only the record associated with that palm print, he emphasizes. "Vein mapping is unique across the universal population. At this point, that's proved true."
Success rate tested 'over and over'
When CHS began implementing the process, the IS team tested it on a number of employees, Johnson says. "They would try to enroll the same person multiple times to see if it would tell us the person was already in the MPI.
"We tested the success rate of finding a person over and over. We did a lot of that kind of testing before we rolled out the process to any of our facilities."
To gauge patients' reaction and see if this was a technology they would accept, Johnson says, the process was tested at one of the smaller hospitals in the Charlotte/Mecklenburg County area. Since October 2007, he says, it has been in place at five of the Charlotte-area hospitals, which include four acute-care facilities and one devoted to behavioral health.
"This year we're expanding on that," Johnson explains. "We have three or four outpatient clinics and we're extending the technology to them, and to our physicians network, which has 150 locations within the Charlotte metro area."
At that point, he continues, patients will be able to enroll at their physicians' office and their information will already be in place at the CHS hospitals, if and when they need to be admitted.
"[The palm scan technology] already is a win, but it's going to be a huge win as we get more people enrolled," Johnson says. "At last count, we were up to just over 100,000 in less than a year. Once we deploy to those physician practices, I expect that number to quadruple very quickly."
Safety aspect attractive to patients
Registration employees explain the procedure to patients from the perspective of public safety and identity theft prevention, he notes, and point out that once enrolled, the patients won't be asked for their Social Security number.
Staff further emphasize that no one else will be able to use their account, and that if they ever present at the ED or any other Charlotte-area CHS facility their information already will be in place, Johnson adds.
Only a small number 2% to 3% of patients decline to participate, usually citing religious concerns or what they say is the "Big Brother" nature of the technology, he says.
The palm scan process being used at CHS is a unique technology, Johnson notes, and is the result of a partnership between the health system and Fujitsu Computer Products of America, located in Sunnyvale, CA. It incorporates the Fujitsu PalmSecure biometric authentication sensor into a solution developed by CHS and its partner, HT Systems, he adds.
The CHS technology, Burke explains, runs on a Windows-based 64-bit platform, with information running redundantly on two servers. Because the digital record created from the palm scan is associated with the patient's electronic medical record, he adds, the person's existing information is automatically populated in the patient registration screens.
"The technology in Japan was developed for the banking industry, not for health care," Johnson points out. "In the United States, if you have an ATM card, you use your PIN number and there is a limit say $300 on the amount of cash you can withdraw. In Japan, they have a limit like we do with the card and the PIN number, but if you are enrolled and use the palm technology you can obtain a higher sum.
"They consider that technology so secure that if you've got the card, the PIN, and your hand, it's you," he says.
As CHS worked with IS staff to implement the palm scan, there was a small learning curve, Johnson notes. "What we learned is that at the point of enrollment, you have to place your hand on the device and hold for a second. Then you lift your hand up and we ask you to put it down again while the scanner does a second pass to validate that the two scans are consistent enough to assign an identity. Two scans are necessary only at the time of enrollment."
Training staff was easy, he adds, but at the beginning of the technology rollout, it became apparent that there was a discrepancy between the number of patients who presented and the number who were enrolled.
What was happening, Johnson says, was that when two or three people were waiting, staff would bypass doing the palm scan enrollment until the line decreased.
"It was so ingrained in staff that there should be no wait time, no bottleneck, that the wait should be five minutes and under," he notes, "and on the first visit [enrolling with the palm technology] does add time, although it is less than a minute."
It was explained to staff that being part of the palm scan enrollment was a big win for patients and in the long run also a win for registration employees because on repeat visits it eliminates the process of doing an entire MPI search, Johnson says.
"We learned that we had done a good job of training on 'how,' but we didn't do a good job on the 'why,'" he adds.
'Compliance' goals exceeded
The department established dates for attaining certain levels of "compliance," Johnson says, meaning the percentage of patients actually enrolled via the palm scan: "We set a goal of having compliance at 65% by Dec. 31, 2007; 75% by Jan. 31, 2008; and at 85% by the third quarter of 2008. Much to the credit of our staff, we exceeded every one of those goals."
By late February 2008, he adds, compliance was at between 70% and 80%, with no question that it would pass the 85% mark well before the original deadline.
As to why the goal has not been set at 100%, Johnson explains, "we've learned that there are times when it is not appropriate to try to enroll somebody; when a person is very sick, coughing and hacking, for example, there is a sensitivity issue."
Such situations are much like instances in which the admission process is streamlined for seriously ill patients, with the knowledge that staff can go back later and get more details, he says.
"Sometimes, even if a person is willing to participate, we still can't get the palm scan," Johnson notes. "We only try on children five and older, and sometimes even that group can't be still or is afraid of it or whatever. There is a certain percentage that just isn't going to get enrolled."
CHS leaders believe their palm scan solution is the best of the patient identification technology currently in use and in fact have plans to market it to other organizations at some point, he says; but there are other patient ID solutions available to the health care industry.
To those interested in initiating either the CHS program or another form of patient ID technology, Johnson offers this advice: "It was an easy implementation process, but you need to have a very good relationship with the IS department to pull this off."
Additionally, he says, it is important to educate staff as to why this is the right thing to do. "On the patient access side, the biggest gap we had was that we didn't do a good job of making the front-door people our best ambassadors at the beginning.
"They knew not being enrolled with the technology wouldn't keep patients from being treated, so rather than delay, they bypassed the palm scan," Johnson adds. "You can see their logic, but the long-term logic wasn't there. If you explain, in the long run, they're much more satisfied with what we're doing."
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