Tim and all,
Let me first point out the Medicare in fact has 3 identifiers. The first is the family based Medicare No, and there are then two internal identifiers one of which is called the Consumer ID and another, even more robust one. These internal identifiers are the ones Medicare Australia (formerly the HIC) use to do their data mining, fraud prevention etc. under the controls of various bits of privacy legislation. One possibility for a quite cheap Patient ID is to upgrade and make public one of these numbers.
The problem with all this is where one places one's risk / safety profile. As a simple, untrustworthy ID I frankly would use the drivers license - its way more secure than the medicare card - BUT - I believe that unless you use a purpose designed and constructed patient identifier you run significant risk of mix up, confusion, clinical harm and fraud. The old adage "If its worth doing, its worth doing well" applies in my mind.
Also for an identifier to be of much use you need to make it available to those who need it - so you probably need an identity service of some sort - or 1/10 of the time the number wont be available at the point of care etc and you probably need a token (card or whatever) with some biometric (photo, fingerprint, eye scan etc) so the link between number and ID can be established at the point of service etc.
To set up, manage and make available all this costs lots (as I said look at the costs of the proposed ID card - 3Billion is the number I have seen).
If you use compromise identifiers - you get a compromise and risk. NEHTA seems to have decided their approach (as yet undescribed as far as I know) - at $40ish million over 3 years will do. I will wait and see but I am prepared to say I will be amazed if the benefits of records linking of individual records sought by the use patient identifiers will be delivered at any thing near this cost.
Any identifier that can't be trusted and widely accessible will only add costs - not reduce them - in the delivery of care and all the other uses of an identifier.
Cheers
David
---- Dr David G More MB, PhD, FACHI Phone +61-2-9438-2851 Fax +61-2-9906-7038 Skype Username : davidgmore E-mail: [EMAIL PROTECTED] On Sat, 11 Feb 2006 23:08:19 +1100, Tim Churches wrote:
> Horst Herb wrote:
>> On Sat, 11 Feb 2006 21:37, Oliver Frank wrote:
>>> unique number assigned to each of us, within Medicare Australia, that does uniquely identify
>>> each of us, at least to the limits of the evidence of identity currently sought by Medicare
>>> Australia.
>>>
>>
>> only to some degree, and only useful to those who actually hold a medicare card, which is only
>> a subset of Australian residents and a subset of our regular patients.
>>
>> An identification system would begin being useful if it would at least encompass all Australian
>> residents; would cause enough trouble and exceptions already dealing with tourists.
>>
>
> Yes, all of which I mentioned...
>
> David More keeps saying that a national healthcare identifier is vastly expensive. All I am
> saying is that we already have one which is 80% of the way there. OK, Pareto's rule applies, and
> closing the remaining 20% gap will cost more than the first 80%, but it can be done. As Horst has
> pointed out, Norway does it, as do several other countries.
>
> Tim C
>
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