Healthcare Meets Minority Report, and Patients Like It

Using technology associated with a Tom Cruise movie to identify hospital patients is an actuality at one Louisiana hospital, where it saves time at check-in, reduces chances for patients to receive the wrong care, and has already paid for itself.

At Terrabonne General Medical Center, a 325-bed acute care hospital in Houma, Louisiana, patients check in by having their photo taken by a greeter at the door to the waiting room.

Technology behind the scenes scans the unique markings on each patient's irises, matches these patterns up to previous registration data, or flags the patient as being new. The whole iris-matching process takes a couple of seconds. Even identical twins have unique patterns, and the whole thing works with patients as young as nine months old.

According to John Sonnier, manager of patient access services at Terrabonne, the only time a patient has to be reenrolled with the iris-scanning technology from RightPatient is when the patient has cataract surgery. "The surgery distorts the iris, so they have to be reregistered," he says.

Once the camera at the front desk takes that photo of a registered patient, RightPatient consults a master patient index and pulls up the patient's medical record, which is stored in McKesson STAR, and the patient is checked in.

This workflow replaced one all-too-common at healthcare check-ins nationwide: asking patients to present a government-issued photo ID, dates of birth, and, most irritatingly to some patients, all or part of their Social Security number.

Since going live with RightPatient in December 2014, nearly 17,000 individuals have checked in at the at Terrabonne's hospital, its radiology areas, the outpatient ambulatory surgery center, and at the emergency department.

"There's only one person that I know of that did not want to have their picture taken," Sonnier says. "Once we went through all the standard questions; once we finished, and I explained, 'now if you would have allowed me to take a picture of your iris, it would have pulled you up within two seconds, and I wouldn't have had to ask all that information from you.' And that person allowed me to take a picture at that point."

The Simpler, the Better
Needless to say, the time saved at check-in, and the reduced chance for patients to receive (intentionally or unintentionally) the wrong care, mean Terrabonne's system has already paid for itself.

It also meets the criteria I set four years ago—the simpler the technology, the better. What could be a simpler biometric than taking a photo, crisp enough to capture unique iris patterns?

As it turns out, for patient experience, it can hardly get any simpler. It also plays out a science-fiction scenario described in the 2002 movie Minority Report, where Tom Cruise's character, and all others in this fictional world of 2054, are recognized by digital sensors. All manner of welcome and unwelcome personalization is present (personalized advertising being the most unwelcome-looking).

It's a bargain the healthcare industry may be preparing to make, in order to once-and-for-all overcome the persistent lack of widespread patient ID technology that has us still reaching for our driver's licenses, dates of birth and Social Security numbers. Not to mention Congress' continuing ban on a national patient identifier.

But will this country as a whole have the kind of acceptance Terrabonne has seen?

Will others be so willing to essentially submit a high-tech mug shot upon every check-in? Like many technologies, here it is wise to remember that one size does not fit all.

"While it might work for the majority of us, if you're in parts of Pennsylvania and you're Amish, that's not going to work," says Catherine Schulten, director of product management at LifeMedID, another healthcare digital ID solution provider. "If you're in parts of Michigan and you're Muslim, and you wear a full face covering, that's not going to work."

But in some parts of the country, such as Homer, Louisiana, getting mug shots taken all over town is already a normal thing. "With our community, you go to the doctor, they take your picture," Sonnier says. "You go to the dentist, they take your picture. You go to the optometrist [they take your picture]. So we're used to having our picture taken."

In other words, put the solution in an area of the country where identity theft is rampant, where hyphenated names are commonplace and commonly misspelled on ID cards, and the face as a biometric token is an attractive option. And it presents none of the hygiene concerns of asking patients to have their palms scanned, or fingerprints taken.

From my vantage point in the San Francisco region, it seems like another world. I've never (knowingly) had my mug shot taken for any of those purposes. I posed the question on my Facebook page, and my friends' sentiments ran heavily against the idea, with many Big Brother concerns. One notable exception: one friend said his kid had received some other kid's medications, and had the clinician been looking at a photo of his kid in the process, the mixup might have been caught.

For more perspective, I turned to Adrian Gropper, MD, chief technology officer of Patient Privacy Rights, a nonprofit dedicated to restoring patient control over personal health information.

"I personally don't have any problem with a photo at registration as long as that photo is considered PHI like your address or phone number," Gropper told me in an email. "I welcome the idea, and there's some actual research to support [it], showing a thumbnail alongside any patient record screen. It actually seems to improve the empathy of clinicians and it is a safety measure."

Privacy Concerns
This technique, a way of helping verify a patient's identity during the actual clinician encounter, is made possible as an optional feature in many EHRs, but it is unclear how many providers actually employ it. Terrabonne does not; although the photo makes the medical record match, Terrabonne's implementation of McKesson STAR does not store any patient photo for such purposes, Sonnier says.

Gropper adds, however, "it would be evil to send a photo to an HIE or other directory service for matching because that would be a coercive match that a patient cannot control," he writes.

So does Terrabonne's implementation qualify as a coercive match? Is it in Minority Report territory? Or is this just a clever way to solve the vexing problem of patient ID, one which patients can opt out of in time to avoid becoming part of the big photo-matching database?

Coming off the massive healthcare data breaches of 2016, the thought of patient photos in criminal hands, matching our stolen medical records to all the many other photos of us on the Internet, and captured by ever-more cameras in public, is disquieting.

The ultimate judges of biometric patient ID methods, for solutions from RightPatient, LifeMedID, and others, is likely to be the panel convened by the College of Healthcare Information Management Executives (CHIME), whose year-long National Patient ID Challenge competition launched on January 19.

"We want you, [and] every single place you've gotten care, to be correctly identified at the right time at the right place for the right care," says CHIME president and CEO Russ Branzell. The competition will see many different solutions vie for the top prize. Mug shots will be only one of several biometric identifiers in competition.

But one thing is also clear to me: there will not be palm vein sensors available in mobile phones, now or any time in the foreseeable future. This matters because there is no reason that check-ins such as those that are occurring at Terrabonne couldn't use the patient's own selfie photo, taken with the camera on their mobile phone, for an even more self-service patient check-in experience.

Minority Report concerns or not, cameras are easy, simple, and powerful biometric sensors. My money is on mug shots as the biometric token to beat.