Increasing Accuracy In Healthcare With ID Card Systems

The U.S. Department of Veterans Affairs (VA) medical centers and outpatient clinics treat nearly 3 million veterans annually. With that volume of patients, these centers and clinics desperately needed to improve their registration process for patients.

For example, consider this scenario: a veteran goes to a VA medical center for treatment. In order to check if the veteran is registered with the VA's main computer system, a hospital clerk clerk enters the last four digits of his social security number as well as the first letter of his last name. At that point, the clerk may be given up to 10 different names with those same social security digits and last initial. Assume that the clerk mistakenly selected the wrong name from the list of possible matches. As a result, the physician would not be given the appropriate medical information for that veteran. Consequently, the physician probably would not be made aware of his health problems, like hypertension or a heart condition.

Previously, such a scenario always was possible, says Chaz Kastel, health administration officer at the Ralph H. Johnson VA Medical Center in Charleston, SC, which is one of 171 Department of Veterans Affairs medical centers. Because of the potentially serious consequences of such mistakes, Kastel says the VA knew it had to develop a better method of identifying incoming patients.

The solution? The VA installed digital identification (ID) card printing systems in all of its 171 medical centers and in most of its 200 outpatient clinics. The ID card printing systems, which were purchased from DataCard Corporation, included badge design software, ID card printers, digital video cameras and magnetic stripe readers. DataCard (Minneapolis, MN), a manufacturer of identification card printers with more than 2,000 employees worldwide, had 1997 revenues of $350 million. The installation, valued at $14 million to DataCard, encompassed VA facilities in all 50 U.S. states, as well as Puerto Rico. All told, 500 systems were implemented; some larger facilities received more than one system.

Since the system implementation began in December 1996, photo ID cards are now issued to more than 2.7 million U.S. veterans annually.

Manual Data Entry Leaves Room For Error
Prior to implementing the DataCard card printing systems, VA medical facilities did issue veterans rudimentary identification cards, according to Kastel. These cards were produced with machines that embossed the veterans' names and other demographic information on small, credit-card-sized pieces of plastic. However, these ID cards did not include veterans' photos.

Previously, upon coming to a medical center or clinic, veterans presented the embossed cards to clerks. Clerks then entered the first initial of the veteran's last name, and the last four digits of the social security number, into the system. That way, clerks could check if veterans were registered, which was necessary to ensure that certain information, primarily the veterans' address, phone number and next of kin, was up to date. Such a system was imperfect, because the clerk could be presented with up to 10 possible matches based on last initials and partial social security numbers. "Clerks sometimes got up to 10 possible matches because the VA serves almost 3 million veterans annually," Kastel says. "If clerks weren't careful, they could pull up the wrong name. We wanted to eliminate that possibility."

In addition, Kastel says the embossed cards left open the potential for fraud and misuse because they didn't include photos. He says, "If a card were lost, someone else could use it. And some veterans also knowingly gave their cards to others to use. Eliminating fraud wasn't our main motivation in adopting a new card printing system, but it was a consideration."

In addition, the embossing units were aging and becoming too costly to maintain, Kastel says. Many Veterans Affairs facilities had been using them since the mid-1980s, he says. In 1996, when the VA received funding for new equipment, it faced an important decision: replace the old embossing units with new ones or replace them with newer, more sophisticated technology. The VA chose the latter option and decided to implement the DataCard digital card printing systems. In March 1996, the VA tested the systems at six of its medical facilities. Nationwide system installations began in December 1996, and were concluded in April 1997.

Adds Kastel, "We went with this system because we wanted to keep pace and to acquire the newest technology, like digital card printing."

Readers Automate Patient Processing
The DataCard system now allows VA facilities to print photo IDs quickly and easily. ID cards are issued on a need-by-need basis. After the veteran's picture has been taken with a digital camera, the image is then transferred to a software program. There, the image is merged with a standard ID card background, or format. Then, the DataCard printer prints the card, with photo, simultaneously. This card, called the Veterans Universal Access Identification Card, includes a magnetic stripe. The veteran's name, social security number, address and period of service are encoded in the mag stripe.

Veterans present this card each time they visit a medical center or outpatient facility. A clerk then swipes the card through a mag stripe reader. The readers are an integral part of the system, Kastel says. Once a card has been swiped, the veteran's demographic information appears on a PC. That way, the veteran is positively identified, and there is no chance a clerk will pull up the wrong patient file. "Swiping the card has streamlined the process," Kastel says.

The VA is considering using the ID cards as debit cards, Kastel says. Veterans could use the cards at "canteens" located in medical centers and clinics. The cards would have declining balances; purchase amounts would be deducted from the card at the point of sale.