One wrong digit in a date of birth can set off a chain reaction, extra calls, record clean up, claim edits, all before a patient ever sees a clinician. That is why identity proofing matters for access, throughput, and staff workload.
Identity Proofing, within the NIST Identity Assurance Level framework, is the set of controls and checks that determine whether a claimed identity maps to a real person. NIST defines three Identity Assurance Levels, IAL1 for some confidence, IAL2 for high confidence, and IAL3 for very high confidence. “Identity Proofing, NIST IAL” refers to the enrollment and verification guidance in the Digital Identity Guidelines, specifically the document that covers identity proofing and enrollment. You will see requirements for acceptable evidence, validation steps, and verification methods for each level. For current definitions and terms, see the NIST Digital Identity Guidelines at NIST SP 800 63A 4.
If you run an outpatient practice, you live at the crossroads of speed and safety. You want patients to get answers fast, you also need confidence that the right chart, payer record, and message thread follow the right person. Duplicate or mismatched records drain time and goodwill, and they muddy quality metrics. Industry surveys in the United States have linked patient matching problems to adverse events, the eHI national survey reported that more than a third of organizations saw an adverse event related to matching within two years, which underscores the operational risk of loose identity practices, see the survey summary at The State of Patient Matching in America.
NIST gives you a way to calibrate assurance to risk. IAL1 is often enough for low risk informational access. IAL2 is a practical default for standard onboarding when a patient will interact with protected information or start transactions. IAL3 is reserved for situations that demand very high confidence, and it typically involves supervised or in person verification. The point is not perfection, the point is right sizing, so your front office and clinical teams are not overburdened.
Identity proofing generally follows three moves, collect evidence, validate evidence, verify and bind the identity to an account or credential, then record what you did.
Start with risk. What can the person see or do after onboarding. If they will view protected information, schedule or pay, or authorize clinical actions, IAL2 is often the right target. If the scenario carries higher impact, consider IAL3. Avoid aspirational controls that add friction without measurable benefit.
Gather identity evidence, for example government issued identification or authoritative records. In remote settings, you may add a live liveness check or biometric comparison to the ID photo. The exact mix must align to the chosen IAL, and you should document what you accept to remove guesswork for staff.
Check that the evidence is genuine and unaltered. Automated document checks, database corroboration, and human review for edge cases are common. Higher assurance means tighter validation, but keep it purposeful. Over collecting creates delay without improving confidence.
Confirm that the person presenting the evidence is the person described by it. Methods include visual comparison of ID to a live image, supervised video sessions, biometric match with liveness, and corroborating attribute checks, for example control of a known phone number. IAL2 allows remote or in person methods when controls meet the standard. IAL3 typically requires supervised verification and stronger binding.
Log the evidence categories, validation outcomes, verification method, IAL achieved, and dates. Keep the record lean and auditable, your future self will thank you when you need to explain an exception.
When clinics centralize communication and intake, identity steps become repeatable. A unified inbox keeps calls, texts, secure messages, and portal notes in one place, which reduces missed information and improves follow through. EHR inbox integration moves verified data into the chart without duplicate data entry. EHR PM system integration helps demographics and schedules stay aligned. referral intake and patient onboarding articles outline how pre visit steps connect to proofing and throughput. If you want to correlate calls and intake, see call queue analytics, and for message workflow norms, see patient messaging. The through line is the same on Solum Health, a unified inbox and AI intake automation platform for outpatient facilities, specialty ready, integrated with EHR and PM systems, focused on measurable time savings.
What is the difference between IAL2 and IAL3? AL2 targets high confidence and can be achieved with remote or in person proofing when evidence is validated and the applicant is verified. IAL3 targets very high confidence and typically requires supervised verification, remote with supervision or in person, with stronger controls and documentation.
Can clinics use remote proofing to meet NIST IAL2? Yes. Remote proofing can meet IAL2 when evidence quality is sufficient, validation is sound, and verification binds the person to the evidence, for example biometric comparison and liveness, followed by a clear account binding.
Are biometrics required for IAL2 or IAL3? No. Biometrics are permitted, not required. The IAL focuses on the overall strength of evidence, validation, and verification. Clinics can reach the target level with non biometric methods if the combined controls are strong enough.
How should a clinic pick an IAL? Start with risk. Map what a person can see or do after onboarding. Informational access often maps to IAL1. Access to protected information and transactions often maps to IAL2. High impact actions may warrant IAL3. Balance confidence, patient friction, and staff effort.
Where can I find the official NIST guidance? See the current Digital Identity Guidelines, including identity proofing and enrollment, at NIST SP 800 63A 4, and the overview page at NIST SP 800 63 which notes the revision history.
Identity proofing is not a hurdle to care, it is a quiet control that keeps records, payments, and messages aligned with the right person. When you right size it, the front office moves faster, the care team trusts the chart in front of them, and patients feel seen.
