Here’s an imaginary scenario, unfortunately all too real for some families. A girl aged 15 is hit in a car accident. She is rushed to the local hospital, unconscious with internal bleeding. The only form of identification is her mobile phone. But since she was texting on it while she was crossing the road, the phone was smashed.
But what if, at 13, when the girl had her BCG jab, her parents asked for an iris photo ID picture? With a photo taken of her iris and her NHS ID number is encoded on it, things could be much different. When the paramedics arrive on scene, they could scan her eye using a portable iris reader.
The result is sent back to the A&E, her patient record is accessed and her name, address, blood type, drug allergies and emergency contact numbers are sent to the medical team on the site. Life-saving clinical decisions can be made because the hospital knows the patient.
The information barrier
Any paramedic will tell you that the first hour of treatment – “the golden hour" – is the most critical. In June 2004 the Department of Health published its bulletin of ambulance response times in the UK, which showed that 24% of category-A, serious 999 calls were reponded to between 8-19 mins of the initial call. This means that in a busy metropolitan area it could be 30-40 mins before the patient rolls in to A&E. To combat this, we have to enable faster clinical intervention by sending paramedics and mobile doctors to the accident site.
But since the medical records of this teenage girl are not available to the paramedic, the A&E department have to observe and make educated guesses about this patient. In some cases, just knowing the name of the patient and having quick conversation with a relative could speed up the clinical decision process.
The NHS ID Number could be key to unlocking the information barrier in the golden hour. We know that every patient will have their own unique ID number; the Clinical Advisory Board made this a mandatory standard from June 2004. What is more, every baby born since 30 October, 2002 has been issued with an NHS Number under the NHS Number for Babies programme (NN4B). Around 18m people have an NHS number – but most of them were issued before the new 10 digit number became the standard.
Taking control of NHS ID
“I discovered two different patients with the same name, same date of birth whose records had been merged into one"
— Cellular pathology office manager
When the NHS Number gets confused, potential danger arises. Professor Peter Hutton, chair of the academy of Royal Colleges, once protested that he had anaesthetised a patient “who had four sets of notes and six ID numbers”. An other example comes from an office manager in cellular pathology: “I discovered two different patients with the same name, same date of birth whose records had been merged into one. One patient had suspicious cells on a recent smear test and was due to be recalled, but I couldn’t tell which one."
If NPfIT is to create a framework for better clinical accuracy, it needs one basic requirement – a validated unique NHS ID number for each patient.
This is where the trust hospitals can start to make significant progress and support the NPfIT. They are already running programmes to improve the accuracy of the NHS ID Number. If there were a national audit today, how many trusts would report a 95% accuracy in verification?
Assuming a trust hospital achieves 95% accuracy, what technology is available to validate the patient? How will a paramedic know this number if the patient is unconscious, has no ID, or simply forgotten it? Several options are available: iris scanning, biometric scanning and RFID tagging.
An iris scan results in a unique digital code, describing the shape of the iris. The Government are installing iris scanners in airports to combat terrorism. The technology is mature, and non-invasive. Most importantly it is fast, and can search millions of records in around three seconds.
- The human iris settles at twelve months old and never changes after that.
- It is unique; even identical twins will have separate iris identities.
- The eye is one of the most protected organs in the body.
- The hand-portable iris scanners on the market tend to be quite cumbersome. They need to be the size of a PDA to be useful for ambulance crews and A&E staff.
- Not much data is available on scanning an unconscious patient.
This method is already in use in some places in the NHS. Several successful trials of fingerprint recognition in the NHS have taken place, for instance, at Wells Park Surgery, south London. This site logged 8,500 patients on a local system.
- If we are unconscious, our fingerprint can tell someone who we are.
The GP surgery could act as the collection point for prints.
- The critical factor is the speed of recognition; a typical catchment area of a London hospital may have 900,000 patients on file. But the scan recognition technology is not yet fast enough to identify a person any faster than three seconds.
The first human-implantable RFID tag, from Verichip, was approved for medical reasons by the US Food and Drug Administration on 13 October 2004. The size of a rice grain, it is injected in the muscle of the arm and is a passive device requiring no moving parts or power source.
- The digital code is instantly displayed on a special RFID scanner.
- Paramedics can read the tag even if the patient is unconscious.
- It is an invasive procedure and needs a local anaesthetic to inject the chip.
The technology is maturing fast. The NHS is starting to create the unique patient record. We already have child vaccine programmes like the BCG Jab. There is an established process to identify these children. There’s a golden opportunity to record their biometric data when they are having their jab. Why not offer them the chance?
Medical IT Strategy Manager, Future Labs Group