Scan Artist

Michael Fitzgerald / Boston Globe | July 30 2006

The same technology that gets a car into Fast Lane is now implanted in Dr. John Halamka's arm. Will this electronic ID make hospitals work better?

In December 2004, Dr. John Halamka became the first physician in the country to have a radio frequency identification, or RFID, chip implanted in his body. The chief information officer of Harvard Medical School and Beth Israel Deaconess Medical Center, Halamka is also an avid ice-climber and a poison-control specialist, and he's convinced that this technology is going to reduce medical errors that are made due to identification problems - though patients will wear their chips on something like a hospital bracelet, not in their bodies. Despite occasionally setting off the alarms at Home Depot, he's a fan of the small piece of circuitry he carries under his skin. At the beginning of our meeting, he scans his arm with a wand, which beeps and shows the number 37492.

So, is your name on the chip?
It's not. It's a proxy for me. The chip has identifiers on it that are simply used as a pointer to a website. As your medical history evolves over your life span, you're not going to have your chip taken in and out every time you want to add something to it. So you put identifiers on it, you go to a secure website with that identifier. The patient can decide what they are comfortable disclosing. In my case, the website has who I am, who my doctor is, who my emergency contact is, my allergies, medication history, and very basic laboratory information.

Are you sure you should be advertising all of this information?
In doing this, I have accepted the privacy risks. I recognize that everybody has a different threshold for that. What I thought was, as a physician-CIO, I could probably do a reasonably objective analysis of all the legal, medical, and privacy implications of these things.

So how is your life different since getting the chip?
If I were to arrive unconscious at an emergency department, they can scan me and find out my medical history. And this is a little science fictionish, but anyone in a crowd could scan me if they had a scanner.

Isn't the whole thing a little science fictionish?
If I go to Copley Plaza and I walk in through the scanner, they may not know who I am, but they could tie my scan to my purchases. And next time I come in, they could say, "Ah, 37492 is back. Last time he was here he bought X, and now let's show him billboards along the way that would be appealing to him."

Have you scanned yourself at a store?
I will read in some store's readers, but the likelihood that my number is one of their SKUs is basically zero, so it's not going to come up and charge me as a garden hose or something like that. I have had the experience of walking out of Home Depot and having my chip set off their security alarm.

How do you deal with that?
Security alarms often go off with a false positive, so it's not really a big issue. I don't explain to the security guard: "Yeah, I have this implanted chip." That's about like saying "I was abducted by aliens."

Does the chip come up at cocktail parties?
I talk about it at lectures I give. As people want to know what's cutting edge, there are a couple of things I'll describe to them, and implanted RFID is one. I'll talk about this not as in, "I think everyone should get one," but there are certain use cases for which having an implanted identifier makes sense. I also believe that in the future we will have sequences of our genome done at birth. What if we all had RFID smart cards - or whatever [technology] - that we'd carry around with us with representations of our genome that could be used in a diagnostic way?

You could post your genome on the Web, like Harvard researcher George Church.
George and I are co-principal investigators of the Personal Genome Project [PGP]. George, of course, is an exhibitionist. So what he said is, in the interest of really exploring this issue, he's putting his phenotype, his genotype, and everything on the Web. And I, as co-PI, have said I am also willing to contribute my genotype to research.

That was a much more challenging conversation with my wife and daughter. The RFID really has no implications for them other than that my whereabouts could conceivably be tracked. The PGP has a lot of privacy implications. . . . Somebody could leave my DNA at the scene of a crime, because they could replicate my sequence, theoretically. But the real challenge is, what if my genome, in fact, has some horrific characteristic, so that five generations from now my descendants will be affected by the consent I sign today?

What would make you take the chip out?
Imagine that my body had an immune reaction to it. Or if there was a political situation where losing your anonymity would be bad.

Will you upgrade to every new chip that's developed?
There is a new generation of chip that will measure your body temperature. And what would be the value of having a temperature sensor? One is quite macabre: Imagine that this was used as an authenticator. Wouldn't you want to know that the arm was still attached to the body? Or imagine a syndromic surveillance for something like avian flu - are you coming from Southeast Asia, and do you have a fever? So, as you walk down that corridor to immigration . . . But, as a physician, I can tell you that it's easy to insert things into the body and really hard to get them out.

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