Biometric scanner used for hospital security
Fingerprints and photo IDs can deter fraud
Catholic Health Systems (CHS) in Buffalo, NY, is deterring insurance card fraud and taking a step approach to cleaning up its master person index (MPI) through the use of a fingerprint scanner for patient identification. The process is in place in the admissions area of two CHS hospitals, Sisters of Charity and St. Joseph, with plans to expand soon to the two remaining facilities, Buffalo Mercy and Kenmore, says Jeffrey Baughan, vice president of information technology.
By April 2005, about 16,200 patients had been registered using the TouchLink fingerprint scanner from Ultra-Scan Corp., which also is in Buffalo, he notes. The compliance, or adoption, rate was at 92%, even though the process still is voluntary, adds Baughan.
How it started
CHS began fingerprint scanning more than two years ago at its inner-city methadone clinics using a stand-alone system "to positively identify that the patient is who he says he is," but which did not interface with the medication dispensing cabinet, he explains. "There were issues with it," Baughan says. "Some had to do with the support staff not using the equipment properly, but most were with the clientele. These are recovering drug addicts, so they were saying things like, Why am I using this? Is this Big Brother? Is this FBI?’"
Those who had been finding ways to abuse the system to get multiple doses weren’t happy with the institution of a method of positive identification, he adds. Later, the same type of stand-alone scanner was put in one of the health system’s neonatal intensive care units, to positively identify those seeking access to the unit, Baughan notes. No particular problem was being addressed, but rather the scanner was installed as a preventive measure to enhance quality of care.
Six months before the biometric process was put in place in the admissions area at Sisters of Charity, CHS went through a test phase, setting up a single database and installing a scanner at common areas in each of its four hospitals and encouraging employees to scan, Baughan says. The goal was to validate bandwidth requirements and make sure a person would be identified correctly systemwide.
That two-month test phase was followed by several months of monitoring and tracking the system, and the process was rolled out in the registration area in June 2004, he adds.
Although the fingerprint scan was mandatory for clients of the methadone clinic, "we wanted to manage it a little differently" with regular hospital patients who, if disgruntled by the process, "can always go somewhere else," Baughan points out.
To make introduction of the fingerprint scanning system as seamless as possible, CHS launched a media campaign four weeks in advance of the installation, issuing press releases that explained how the process would improve patient care, he notes.
For six weeks before implementation, CHS had kiosks in the hospital lobby with television monitors running a continual DVD loop describing the new process, Baughan says, adding that the health system won the 2005 award for achievement in education innovation from InfoTech Niagara, a consortium of business, government, and education entities. "It was professionally done and well-scripted. The CEO appears on the DVD, as do [images] of the elderly, of young people, of physicians and nurses." A voice-over, he notes, explains the reasoning behind the fingerprint scan, pointing out that it will help ensure patients receive the right treatment and the right medications.
"That was a great communication tool, along with the press releases, to soften the what the heck are you doing’ effect," Baughan adds. "Advance communication to the public is important."
Cleaning up the MPI
The beauty of the fingerprint scan process is that as patients make return visits, it provides a gradual — and much less expensive — method of cleaning up the health system’s MPI. An MPI cleanup, he notes, can cost anywhere from $500,000 to $1.5 million, and putting in an enterprise MPI is a $5 million solution. Installing the Ultra-Scan system costs less than cleaning up the MPI and significantly less than putting in an enterprise MPI, Baughan says.
The health information management (HIM) systems for the four acute-care CHS hospitals have an MPI component with 2 million people in it, including — as is true of most such systems — some duplications, he explains. "Our issue is compounded because we came together in a merger and didn’t standardize on the same platform. So we don’t have an enterprise MPI," Baughan says.
Two of the CHS hospitals use one type of HIM system, and two use another. "There are two distinct databases, implemented differently. If I walk into any of our four hospitals and present, there might be four records with [different variations of] my name — and I have a straightforward name, and I’m being honest," Baughan points out.
With a foreign name that is difficult to spell, or in the case of a guy who is trying to fraudulently get coverage for his cousin, the situation is even more problematic, he adds.
To increase patients’ comfort level with the fingerprint scanner, admissions staff ease them into the process, he notes, ensuring them that the information isn’t used for government purposes, and when it comes time to take the person’s photograph, using that step to lighten the moment.
Simple procedure takes little time
The whole process takes two or three minutes, "so there’s not a line forming" as a result of the scan being done, Baughan explains. It begins with the registrar asking if the patient has been registered in the system. If the answer is "No," the patient is asked to sit down and has the index finger of both hands scanned. When the finger is placed on the scanning device, the registrar sees an icon representing the right or left hand, he continues. "When that [icon] becomes green, you know you have a good scan."
At that point, the patient is asked for an insurance card, and then for a secondary insurance card or another form of identification, such as a driver’s license, Baughan says. Then the cards are scanned, and the registrar confirms with the patient that all the information is correct.
The next step is to ask the patient’s birth date, and if a photo can be taken, he says. "At this point, we give patients the [Health Insurance Portability and Accountability Act] HIPAA-related documents and information, and a signature block they can sign so the information is captured electronically."
After a message asking if everything is correct comes up on the screen, and the registrar hits "yes," he adds, the HIM system assigns an index number to the patient, and then transitions into the registration flow.
The next level
If a patient arrives whose fingerprint has been scanned into the system during an earlier visit and identified to the higher-level Ultra-Scan index, Baughan explains, the scenario proceeds as follows:
The person puts a finger on the scanner, and the system pulls up his or her picture. In some cases, two near-hits are made and two images — this person’s and someone else’s — might appear, in which case the registrar can confirm identity with a visual check, comparing the person with the web photos.
Using both the scan and the person’s date of birth makes the process faster.
Once the registrar hits "yes" on this return visit, the process goes into another screen of the Ultra-Scan system that displays an index of the existing medical record numbers for the subsystems in which the patient has been previously registered, Baughan explains. "It will link through that higher-level index the disparate medical record numbers" that are associated with the individual because the person has been registered in different locations or with different versions of the same name, he notes.
As for the occasional appearance of two web photos when a person’s finger is scanned, "no biometric measure is 100% accurate," Baughan says.
In fact, adds Ultra-Scan founder John K. Schneider, PhD, "no technology in the world is 100%. If someone tells you that, turn and run away." However, the Live Scan Ultrasonic Identification System (LUIS) technology his company developed 15 years ago gives TouchLink the ability to reduce the search of a large database to one or two individuals, he points out. "At worst case, you use a digital photograph" for final identification, Schneider explains. The accuracy rate for LUIS is "high — 99%," sometimes referred to a "99-plus%."
Traditional optical fingerprint readers, which take a digital picture of the finger, have extremely poor accuracy, which has precluded their use for large databases made up of diverse individuals, he adds.
Future applications abound
"This is exciting technology that will really help us as we move forward to positively identify our patients," Baughan says. "If we fast-forward, I can see more value as we continue to roll out [use of the fingerprint scanner]."
"In the future, I can see a nurse walking to a medication-dispensing cabinet, and the system confirming this nurse’s identity and that she is on shift right now," he says. The nurse enters the information that patient Mary Mays in Room 302 is there and should get a particular medication, "and a wireless version of the [scanning device] goes into that room and positively identifies the patient," Baughan points out.
CHS already has a freestanding laboratory site with two phlebotomists drawing blood and no receptionist, but with a fingerprint scanner at the door, he notes. A sign instructs arriving customers, many of whom come in for frequent blood work, to sit down and, if they’ve been there before, to use the fingerprint scanner, Baughan continues. "The phlebotomist, who is with someone, sees on the screen that the person who has just arrived is ready for a blood draw."
His advice for those considering installing a fingerprint scanner — in addition to plenty of advance notice to the public — is to train extensively and make staff part of the planning process. "We are very sensitive to [the registration employees] and made them part of the work flow design," Baughan says. "Everybody says the system is fairly intuitive, so there was not a long training curve," he points out.
"We found that making them part of it and keeping them informed, was key to the success of the implementation," Baughan adds. "As we were testing the system, we worked closely with two or three admissions people to get the feel of it. When we went live, there were people available from Ultra-Scan, and I had folks from the IT department on hand to ensure the network was up and stable," he concludes.
(Editor’s note: Jeffrey Baughan can be reached at [email protected], and John Schneider can be reached at [email protected].)
Catholic Health Systems in Buffalo, NY, is deterring insurance card fraud and taking a step approach to cleaning up its master person index through the use of a fingerprint scanner for patient identification.
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