The Implementation and Impact of Federated Digital Identifiers (FDIs) in Healthcare: An Environmental Scan (Preprint)

BACKGROUND Federated digital identifiers (FDI) have been cited to improve the interoperability of data and improve information management while enhancing privacy of individuals verifying their identity online. FDIs could improve the experience of accessing healthcare, but they have only been introduced in a few jurisdictions and their impact remains unclear. OBJECTIVE The main objectives of this environmental scan was to describe how FDIs have been established and implemented within healthcare. METHODS We conducted an environmental scan consisting of an academic and grey literature search. The academic literature review was conducted through a database search of MEDLINE and EMBASE which generated a list of countries and their services that use FDIs within healthcare. This list was then used to conduct a targeted grey literature search using the Google search engine. RESULTS A total of 93 references from database and targeted Google searches were included in the environmental scan. FDIs were implemented in healthcare in 11 countries (Australia, Belgium, Canada, Denmark, Estonia, Finland, Iceland, Norway, Singapore, Sweden, and Taiwan) and almost exclusively used with a Patient Accessible Electronic Health Record system via a single sign-on interface. The most common FDIs were implemented nationally or provincially and establishing them usually required an in-person visit to a bank or government office. FDIs in healthcare can facilitate the amalgamation of health information from different data sources into one platform. Despite this, the adoption of most healthcare services that use FDIs remained below 30%. CONCLUSIONS This environmental scan highlights key features of FDIs across regions, and elements associated with higher adoption in a few countries, like opt-out registration. Although FDIs have been reported to facilitate the collation of data from multiple sources via a single sign-on interface, there is little information on their impact on patient experience. If FDIs are used to their fullest potential and implemented across sectors adoption rates within healthcare may also improve.