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Background  In many low and middle-income countries (LMICs), difficulties in patient identification are a major obstacle to the delivery of longitudinal care. In absence of unique identifiers, biometrics have emerged as an attractive solution to the identification problem. We developed an mHealth App for subject identification using pattern recognition around ear morphology (Project SEARCH (Scanning EARS for Child Health). Early field work with the SEARCH App revealed that image stabilization would be required for optimum performance.    Methods  To improve image capture, we designed and tested a device (the ‘Donut’), which standardizes distance, angle, rotation and lighting. We then ran an experimental trial with 194 participants to measure the impact of the Donut on identification rates. Images of the participant’s left ear were taken both with and without use of the Donut, then processed by the SEARCH algorithm, measuring the top one and top ten most likely matches.    Results  With the Donut, the top one identification rate and top ten identification rates were 99.5 and 99.5%, respectively, vs. 38.4 and 24.1%, respectively, without the Donut ( P  < 0.0001 for each comparison). In sensitivity analyses, crop technique during pre-processing of images had a powerful impact on identification rates, but this too was facilitated through the Donut.    Conclusions  By standardizing lighting, angle and spatial location of the ear, the Donut achieved near perfect identification rates on a cohort of 194 participants, proving the feasibility and effectiveness of using the ear as a biometric identifier.    Trial registration  This study did not include a medical intervention or assess a medical outcome, and therefore did not meet the definition of a human subjects research study as defined by FDAAA. We did not register our study under  clinicaltrials.gov .    Electronic supplementary material  The online version of this article (10.1186/s12911-019-0833-9) contains supplementary material, which is available to authorized users.

bmc medical informatics and decision making

Ear biometrics for patient identification in global health: a field study to test the effectiveness of an image stabilization device in improving identification accuracy