Your Health Record Embedded in Your Arm

An article by the Associated Press last weekend points to the link between microchip implants and tumors in animals. It adds to other health concerns about subcutaneous chips described in a report released early last summer by the American Medical Association (AMA), for example, that they could become dislodged in the body, or interfere with a pacemaker (it’s CEJA Report 5-A-07 on the AMA web site). The chips, called RFID (radio frequency identification) tags, are already widely used by Wal-Mart and others for managing product inventory, and have for years been implanted in animals to help people to identify lost pets. The recent article rekindles an ongoing debate about whether they should be implanted under peoples’ skin to facilitate access to critical health information.

RFID implants in humans have been relatively rare, but they could become more mainstream. According to VeriChip, manufacturer of the only FDA approved version, more than 2,000 people worldwide now carry the chips under their skins. Some view them as a medical safeguard—a chip could convey the identity and condition of an unconscious patient to a doctor in an emergency room. For others, an implanted RFID chip is primarily a convenience or status symbol—one that lets them pay, with the wave of a hand, for drinks in certain trendy bars.

The basic concept behind RFID was first articulated in 1948, but in recent years the chips themselves have become smaller, cheaper, and more widely used. RFID is effectively the next generation of the bar codes you find on groceries. Except that RFID, because it uses radio waves, can communicate information without the line of sight required by bar code readers, and makes it possible to read multiple tags at a time. It is also more durable than a bar code—better able to withstand heat, moisture, and pressure. In humans, a tag about the size of a long grain of rice is generally implanted above the right tricep. After the surgery there is no outward sign that it exists.

While some RFID tags regularly emit data through radio waves, subcutaneous ones are “passive,” responding only to a request from an outside reading device. Because of both size constraints and privacy concerns, the tags embedded in humans contain only a reference number (as opposed to say, a list of the individual’s allergies). That number is linked to a database containing medical, financial, or other data, and it may require a password or other means of authentication for access.

One hundred and sixteen US hospitals have already signed up to adopt the technology in their emergency rooms, while others, such as Beth Israel Deaconess Medical Center in Boston, already use RFID on humans (embedded or merely affixed to a bracelet) to match newborns in the intensive care unit with their mothers’ milk or to verify that patients are taking the correct medications.

What are the potential implications of embedded RFID from a Project HealthDesign perspective? It could help solve a big challenge several of the grantee teams are wrestling with: patient identification and authentication. Several of the teams are developing devices that wirelessly transmit data, such as blood sugar levels from a glucometer, to a software program that can track and analyze it. But how do you really know who used the glucometer? What if you have two people in the same household that are using the same measuring device? Embedded RFID chips could automatically identify individual patients and keep their records separate and accurate.

But assuming the potential health dangers associated with the chips can be overcome, is society ready for embedded RFID chips? Many people are alarmed by their potential privacy implications. If information on the chips is linked to the user, theoretically anyone from law enforcement officials to criminals or terrorists could abuse it, for example by tracking an individual’s movements. Some extremists even suggest that RFID portends the end of the earth.

Dr John Halamka is the CIO of Harvard Medical School and the CareGroup Healthcare System. He’s also an emergency physician at the Beth Israel Deaconess Medical Center. His research has shown that it would be fairly easy to intercept and mimic the data on an implanted RFID chip. In part because of this vulnerability, he argues that subcutaneous RFID chips should be used only to identify people, but that they should not be used for authentication purposes. Identification confirms that a person is, for example, Jane Smith, but authentication takes identity a step further, using it as a condition to enable an individual to do something—like access a building, bank account, or anything else of value. If chips are used for authentication, they could put their “hosts” at greater risk of kidnapping or physical harm.

I asked Halamka, who is an avid mountain climber, about his own decision to have an RFID chip implanted in his arm a few years ago. “Implanted RFID is a personal choice.  For some people, such as those with cognitive or communication impairments, it offers an easy electronic pointer to a PHR which authorized clinicians can access in case of emergency. For others, such as myself, who travel to the corners of the earth, including its most extreme places, I have the security of knowing that my record is always with me. Of course, not every healthcare institution has the ability to scan RFID, so at present the technology is in the early adopter phase.”

On the topic of privacy he underscores the importance addressing the privacy and security features of implantable RFID as early as possible. As he put it, “You can’t just let the technology develop and try to correct the resulting social problems later.”

Comments

[George Ferguson]

I am not an export, but I thought I'd pass on a recent news item related to RFID tags in humans.

Associated Press: Chip Implants Linked to Animal Tumors
http://www.washingtonpost.com/wp-dyn/content/article/2007/09/08/AR2007090800997_pf.html
http://science.slashdot.org/article.pl?sid=07/09/08/1832243

George

[Dawn]

I don't consider myself an "extremist" but I agree that RFID technology is creepy as hell. We're supposed to just trust an industry that can't even deliver evidence-based care for diabetes half the time?

[Patti Brennan, Director, Project Health Design]

While Project HealthDesign is not presently studying the RFID implants as a feasible strategy, we understand that such an innovation is consistent with some of the key goals of the project. We anticipate a future in which health is broadly integrated into every-day living and the need to 'identify' oneself as the user of a specific device or data capture/ receive service is done away with.

Yet we recognize the amazing shift that might occur - people who by simply being 'near' a receiving device may in fact make themselves open to transmission about what they are doing and where they are - this portends significant benefit to helping to integrate health coaching and encouragement into the daily lives of people facing significant health challenges - yet assuring the privacy protection and awareness of the individual seems still out of reach of current technology.

RFID is one of several emerging technologies Project HealthDesign is tracking to see how it may impact our work in the future.

-- Patti Brennan, Director, Project HealthDesign

[Lygeia Ricciardi (Project HealthDesign blogger)]

Yet more support for the need to pay greater attention to privacy and security concerns in this context (this time the point was made at the Emerging Technologies Conference at MIT): http://www.technologyreview.com/blog/editors/21867/

[Evan Smith]

There's no need for surgery to implant a unique personal identifier--our creator designed us with built in "bar codes." Specifically, we all have unique physical characteristics that can provide definitive identification. Fingerprints are the best known biometric identifier, and iris, facial, hand, and vein geometries can also be used. Government studies confirm that the iris pattern offers the fastest and most accurate biometric identification.

Each human eye on the planet has a unique pattern. The core iris technology has been proven in 10 years of use in airports, border checkpoints, and military applications, but these systems were costly and not adapted for clinical applications.

Like air bags that premiered in more expensive cars and then became widespread, over the last year this high-end security technology has been ported to cost-effective commercial products that accurately match patients with the right EHR every time. These systems identify people almost instantly and without any physical contact when they look into a handheld video camera. System architecture is specifically designed to enhance privacy; for example, the new iris systems cannot identify someone without their knowledge and cooperation. As an added benefit, the systems can also protect the privacy of records by requiring biometric ID of those accessing the records.

RFID tags work, but relatively few people will consider getting one implanted. In contrast, public reaction to biometrics in airports and other applications has been overwhelmingly positive. Biometric systems have proven effective and well-liked in these other industries, and can help solve increasingly critical identification issues in the medical field.

--Evan Smith, CEO, Eye Controls