At Bronx clinic, the eyes are windows to medical records

CNN | March 15, 2010
By Madison Park

(CNN) -- Rafael Fernandez walks into the Bronx, New York, medical clinic, with his eyes wide open.

Checking Fernandez in, a clinic employee scans his eyes using a handheld camera. Within seconds, the camera reads his iris patterns, and a computer locates his medical record. 

Such iris identification technology is usually seen in international airports to allow registered passengers to fast-track through passport checks and immigration.

But far from the sleek European airports, the South Bronx clinic that receives federal funding and operates in one of the most impoverished U.S. areas uses the instruments to prevent medical record mishaps.

Fernandez, a patient of five years at the Urban Health Plan clinic, said the iris scanning makes his visits more convenient.

"It's a shorter wait," said the 72-year-old. "I wait less, and it's more efficient. Everything is on computers. It's faster, and I don't have to stay too long. It's in and out."

Urban Health Plan, which serves mostly the uninsured and underserved, fully integrated iris identification to match patients to their medical records in 2009.

With a heavily Hispanic client base, where some of their 37,000 patients speak limited English and only a few provide Social Security numbers, the clinic encountered cases of mistaken identities.

It had 50 Maria Hernandezes, 66 Maria Gonzaleses, 55 Jose Gonzalezes, 83 Carmen Rodriguezes and 103 Jose Rodriguezes, according to the clinic. 

If a health worker is "busy and doing a couple different things, it's easy to click on the wrong one," said Alison Connelly-Flores, the clinical system administrator at Urban Health Plan. There were ways to check the patient's birth date, but "it was still possible to make a mistake."

"There are many patients with similar names and you want to make sure you get the right patient," said Dr. Samuel De Leon, the chief medical officer at Urban Health Plan. "In health care, risk management is an important thing. You want to avoid medical errors. You want to make sure you treat the right patient. You don't want to give the wrong medication."

With growing concerns about such errors, medical identity theft and insurance fraud, health technology experts say more hospitals are looking for better identification tools.

So how do you solve a problem like too many Marias?

A few hospitals use biometrics such as palm, eye or vein pattern readers, which are methods to recognize a person based on unique biological characteristics, according to companies that create the technology.

By using the eye scanner at Urban Health Plan, Maria Hernandez would get her specific medical record and not get mixed up with another person who has the same name.

"We are in the poorest congressional district in the country," Connelly-Flores said. "Being able to use this kind of technology is impressive."

In 2006, De Leon contacted a small iris identification company in Chantilly, Virginia. He was looking for ways to reduce errors at the clinic.

The clinic photographed its patients, but that was imprecise. De Leon didn't want to use fingerprints, because some patients associated that with the police and crime. He didn't want to use palm readers that required physical contact because that would easily spread germs. So he set his sights on iris scanners; it didn't require touching and didn't carry the negative connotations.

But the iris technology back then was bulky and too expensive for the health clinic -- as De Leon described, "cool but impractical." 

The clinic formed a partnership with the company Eye Controls to develop a more user-friendly model, consisting of a handheld iris camera and software to reduce identification errors.

"The acceptable error rate is zero, because we're talking about people's lives here. People can get hurt and die," said Evan Smith, Eye Controls' chief executive officer. 

The iris, which is the colored ring of the eye, is unique for every human being. The company tested the iris scanner with simulated IDs and found zero errors in 8 million transactions, Smith said.

The acceptable error rate is zero, because we're talking about people's lives here.

--Evan Smith, Eye Controls' chief executive officer 
Science and Technology 
The Bronx 
Health Care Policy 
Eyesight and Eye Health 
Using a New York Department of Health grant, Urban Health Plan purchased the newer iris scanners in 2008 and fully integrated it the next year.

It immediately changed the clinic, De Leon said.

"You don't have to worry so much about having the right chart and making the mistake of continuing to use that chart," he said. "It's safer for the patient. It's much, much harder to make a mistake."

"We've also prevented duplicate records from being opened," Connelly-Flores said. "A lot of times, patients forgot they were here, and we would open another chart for them, so we would have two charts for them at our facilities, or four or five.

"It makes sure we're using the same records for the same patient. We've been able to prevent benefits fraud."

The clinic's efforts won recognition from the Healthcare Information and Management Systems Society this year.

"I'm surprised they're using iris," said Anil Jain, a computer science professor at Michigan State University about the clinic's use of the scanners. "It's very accurate, but the system is a little more expensive than a fingerprint reader or palm print reader."

Jain, who researches biometrics, said there are additional issues for the clinic.

"How long will they keep the data?" he asked. "How will they protect it? Will they share it with authorities if they demand it? There are privacy issues."

So far, patients have been very receptive to the scanner. Rarely does anyone decline having a picture taken of his or her eyes, De Leon said.