Reviewing Studies and Comparisons

There continues to be ongoing studies comparing the different biometric characteristics and modalities and their use in various industries including in healthcare and public health programs. Reviewing these resources can help when deciding which biometric characteristic(s) and modality(ies) to implement.

For example, Simprints published and shared their A Responsible Biometric Deployment Handbook, which provides a comparison and factors to consider for evaluation for select biometric characteristics and modalities.18 The table below builds on the work Simprints presents with the addition of links to examples of in healthcare and public health programs. These links include a selection of research and new articles, blogs, and/or manufacturers information.

Unimodal
Face “Typically measures geometry and relationship of facial features.”
Ubiquity/Maturity “Widely implemented and understood in commercial applications, with a variety of consumer and other applications. Relatively well understood, and widely deployed for law enforcement and other applications.”	Drawbacks “Overlaps with Law Enforcement and may make Facial Recognition challenging to obtain acceptance for in some settings.” “In cultures in which facial covering has a cultural or religious aspect, facial recognition may not be appropriate, and introduce gendered challenges both in terms of user and subject.” “Most conducive to ‘trivial’ reuse – e.g. users may immediately be able to reuse pictures of users to recognise or identify them.” “While a robust understanding of accuracy exists in the academic community, and issues of bias are relatively well understood, they are not always solved or resolved.” Benefits “Contactless – posing fewest public health challenges (e.g. transmission of surface or airborne disease).” “No specialist hardware required, making facial recognition relatively cost-effective.” “While Liveness Detection is not embedded into all solutions it is widely available.” “Some protective techniques such as tokenisation or encryption are available to protect facial templates.”	Examples and/or Studies in Healthcare and Public Health Programs Ghana Simprints, Gavi, Arm and Ghana Health Services Simprints: Using touchless biometrics to facilitate access to healthcare - Cisco Blogs How Do We Track Vaccinations for People Who Don’t Formally Exist? | Gavi, the Vaccine Alliance Thailand NEC Thailand and Siriraj Piyamaharajkarun Hospital NEC Thailand and Siriraj Piyamaharajkarun Hospital pioneers contactless registration process United States Geisinger working with CERTIFY Health Certify Care - CERTIFY Health Geisinger makes checking into appointments easier with biometrics | News Articles | Geisinger
Fingerprint “Essentially a digital analogue of the analogue process undertaken in law enforcement, using the scientifically established near-uniqueness of fingerprint features to identify humans.”
Ubiquity/Maturity “Widely implemented and understood in commercial applications, with historic usage across law enforcement and security applications. ISO standardised, making some Fingerprint templates interoperable between solutions.”	Drawbacks “The overlap with law enforcement may make fingerprint systems less acceptable in some contexts.” “Most fingerprint systems require specialist hardware, increasing cost.” “Generally contact-based, increasing the risk of surface-borne disease.” “Some user training is required to use hardware effectively.” “May not work with seriously physically impaired subjects.” Benefits “Significant understanding exists regarding bias and accuracy, and whilst skin colour can be a confounding factor, the use of hardware which controls the capture environment offers some ability to mitigate this.” “Of available solutions, fingerprint may be the most interoperable.” “Fingerprint recognition also benefits from some of the most sophisticated techniques for template protection and encryption.” “Fingerprint recognition captures relatively little ‘extraneous’ information (e.g. medical conditions etc) once the template has been captured.” “Whilst not unspoofable, the need for specialist hardware makes replay or spoofing attacks harder to carry out, increasing resistance to fraud.”	Examples and/or Studies in Healthcare And Public Health Programs Nigeria PHIS3 Leveraging Biometrics to Scale a Patient Identity Management System (PIMS) in Nigeria Haiti I-TECH (DIGI) - University of Washington (UW) Piloting a Patient Identity Management System (PIMS) in Haiti Côte d’Ivoire CDC Contractor and SEJEN Utilizing Biometrics for Unique Patient Identification (UPID) in Côte d’Ivoire Ethiopia Ministry of Health - Ethiopia Enhancing Patient Identity Management (PIM) with Electronic Medical Record Numbers (MRNs), an Electronic Community Health Informatics System (eCHIS) with Biometrics, Antiretroviral Therapy (ART) Numbers, and a National (ID) with Biometrics in Ethiopia Nepal Simprints Simprints Puts Faces (and Fingerprints) to Names | Engineering For Change Simprints to launch mobile biometrics in Nepal | Business Weekly | Technology News | Business news | Cambridge and the East of England Biometric Fingerprint System to Enable Rapid and Accurate Identification of Beneficiaries | Global Health: Science and Practice (ghspjournal.org) Ghana Kintampo Health Research Centre Full article: The application of a biometric identification technique for linking community and hospital data in rural Ghana (tandfonline.com) Brazil NatoSafe and Center for Women’s Health (CAISM) at the University of Campinas (UNICAMP) INFANT.ID - Infant.ID (natosafe.com.br) Security at your fingertips : Revista Pesquisa Fapesp Mexico Biometric recognition of newborns and infants... | Gates Open Research
Palm Geometry “Measures the shape and size of fingers using camera or similar technology.”
Ubiquity/Maturity “Less common, but a number of solutions are available. Palm geometry has been in use in the private sector (e.g. banking) for some time.”	Drawbacks “Less interoperable and understood.” “Historically, this has required specialist hardware, although can now be undertaken via camera / with commodity hardware.” “Fewer techniques available for sophisticated protection e.g. using template protection or tokenisation schemes” Benefits “Relatively high social acceptance - captures minimal ‘extraneous’ information such as medical conditions.” “Contactless - posing fewest public health challenges (e.g. transmission of surface or airborne disease).” “No specialist hardware required, making facial recognition relatively cost-effective.” “Palm geometry captures relatively little ‘extraneous’ information (e.g. medical conditions etc) once the template has been captured.”	Examples and/or Studies in Healthcare And Public Health Programs Company Tools/Products/Reviews Biometric identification | Imprivata Hand Geometry Recognition Biometrics (bayometric.com)
Iris “Measures the eye itself, recording and comparing unique features in the iris.”
Ubiquity/Maturity “Less common, but subject to some large-scale deployment in humanitarian settings. Iris recognition has been deployed in the private sector (e.g. banking) for some time.”	Drawbacks “Less interoperable and understood.” “Historically, this has required specialist hardware, and specific capture conditions - and requires proximity to capture, increasing cost and complexity at point of use.” “May not work with seriously physically impaired subjects or individuals subject to eye surgery.” “Affected by lighting change, and requires configuration and supervision.” “Less inherently resistant to spoofing / impersonation attacks.” “Some protective techniques such as tokenisation or encryption are available to protect facial templates - but fewer than fingerprint or face.” Benefits “Relatively high social acceptance - captures some ‘extraneous’ information such as medical conditions, but less than other modalities.” “Like fingerprint, while not 100% unique, Iris patterning is extremely random and determined prior to birth, potentially giving rise to a very low false match rate.” “While proximity is required, Iris is less ‘high contact’ than modalities such as fingerprint, posing reduced disease transmission risk.” “Works with cohorts of users who use facial coverings.” “The Iris is protected and less susceptible to damage than finger or hand.”	Examples and/or Studies in Healthcare And Public Health Programs Kenya Feasibility and acceptability of an iris biometric system for unique patient identification in routine HIV services in Kenya - PubMed (nih.gov) United States Norvant Health Novant Health Uses Iris Biometrics to Identify Unknown Patient (rightpatient.com) Company Tools/Products/Reviews Biometrics for Patient Identification - Iris ID Iris ID in Patient Identification - Iris ID
Periocular Captures “the area around the eye, including eyebrow and other facial features above the mouth.”
Ubiquity/Maturity “Less common; some recent research, but relatively few commercial products.”	Drawbacks “Less interoperable and understood.” “May be confused by users with facial recognition.” “Fewer techniques available for sophisticated protection e.g. using template protection or tokenisation schemes.” Benefits “May leverage consumer hardware and therefore reduce cost.” “Higher social acceptance than full-face.” “Contactless – reducing surface-based transmission risk.” “May combine with Iris recognition to produce some of the benefits of both systems.”	Examples and/or Studies in Healthcare And Public Health Programs United States An eye for an eye-dentity – News – Array – Journal – Elsevier An Investigation of Biometric Authentication in the Healthcare Environment – ScienceDirect
Palm Vein Captures “the sub-surface veins in hands, typically using infra-red light and a specialist sensor.”
Ubiquity/Maturity “Some recent research but less common. Fewer commercial products but a number of actively innovating projects and vendors.”	Drawbacks “Less interoperable and understood.” “Requires specialist hardware - increasing cost and reducing interoperability.” “Still in active innovation - subject to change over time.” “Fewer techniques available for sophisticated protection e.g. using template protection or tokenisation schemes.” Benefits “High social acceptance. “Some medical data is captured, but relatively little extraneous data (e.g. facial image) which can trivially be reused.” “Contactless - reducing surface-based transmission risk.” “Vein patterns are relatively unaffected by age, disease, or physical damage, increasing accuracy over time.”	Examples and/or Studies in Healthcare And Public Health Programs United States University of Utah Health Care Imprivata Partners with University of Utah Health Care to Implement Positive Patient Identification Across their Healthcare Enterprise | Business Wire BayCare Health Using Palm Vein Technology to Accurately Identify Patients (hfma.org)
Voice Recognition Captures “the voice using an audio sensor.”
Ubiquity/Maturity “Relatively wide use, but fewer products targeting users in the Global South.”	Drawbacks “Less interoperable.” “May be more susceptible to confounding accuracy factors with populations with languages and dialects who solutions have not been designed for.” “Fewer techniques available for sophisticated protection e.g. using template protection or tokenisation schemes.” Benefits “Higher social acceptance than other solutions.” “Relatively no extraneous data is captured.” “Contactless - eliminating surface or airborne transmission risk.” “Leverages widely available commercial hardware.”
Multimodal “Combination of multiple techniques or modalities.”
Ubiquity/Maturity “Less widely deployed, but a number of products are integrating multimodal support. There are some systems at large scale using multi-modal biometrics.”	Drawbacks “Depends on the schemes used.” Benefits “Depends on the schemes used - but potentially multimodal biometrics presents the opportunity to combine and trade benefits and disadvantages of multiple schemes.”	Ethiopia – Iris and Fingerprints Enhancing Patient Identity Management (PIM) with Electronic Medical Record Numbers (MRNs), an Electronic Community Health Informatics System (eCHIS) with Biometrics, Antiretroviral Therapy (ART) Numbers, and a National (ID) with Biometrics in Ethiopia Senegal – Face and Fingerprints Innovatrics Biometric Tech Used in World Bank-Funded Health Care Healthcare Biometrics: Credence ID Uses Innovatrics Algorithms for Patient ID in Senegal (findbiometrics.com) A National Medical Information System for Senegal: Architecture and Services - PubMed (nih.gov) Face and Gestures A Multimodal User Authentication System Using Faces and Gestures - PMC (nih.gov)

Members from the Data Use Community shared chosen biometric systems, and insights learned when researching biometric systems to implement.

For example, as mentioned previously, Nigeria, Côte d’Ivoire, Haiti, and Ethiopia’s eCHIS implement unimodal biometric systems that utilize fingerprint biometrics.13,14,15,16 Ethiopia is looking to implement a multimodal biometric with fingerprint biometrics and iris biometrics for the national ID16, and Simprints worked with countries utilizing unimodal and multimodal biometrics systems.14

In addition, after setting up a patient identification management system, Zimbabwe identified implementation of a biometric system as a next step. Zimbabwe shared considerations and comparisons from their research of the use of fingerprint biometrics and/or iris biometrics. Their findings yielded the following advantages and disadvantages of biometric system implementation in Zimbabwe: advantages - improving patient identification, time savings, accessibility, scalability, and a prototype already being developed; and disadvantages - implementation and maintenance costs, and infrastructure limitations.19