Saturday, 6 February 2016

Health ID as Patient IDs unifier in India

Health ID as Patient IDs unifier



06.Feb.2016, Bangalore, India

Overview
The post discusses how a Health ID can be linked to Aadhar Number

Unique Identifiers, Health ID & Aadhar Number

A unique identifier from a database technology standpoint, is the ability to create a primary key and link all the data in the database using a primary key (parent record) & foreign key (child records) concept.
Keeping this concept in mind using Aadhar Number as a Health ID offers a very compelling opportunity to uniquely identify a patient across multiple episodes and visits, in a single facility or across multiple facilities (that may be located in same geographical location or multiple geographic locations)
In most Health Information systems, the records of a patient are tied to a Unique Patient Identifier, a Patient ID or a UHID.
Let's consider what are the various use cases of the Aadhar Number and a Patient ID.

Aadhar Number

The Aadhar Number has been planned to be used by the government for various welfare and direct benefit transfer schemes. There have been many instances that the Information that has been recorded in the Aadhar ID may or may not have the latest information of the person carrying the Aadhar Card. The purpose for which the Aadhar Card has been created is to identify a person for various government schemes and also has been deemed to be used to be provided at the time of opening of a bank account. Hence there are quite many financial transactions that might be linked to the Aadhar Card.

Patient ID or UHID Number

The Patient ID in various Healthcare information systems, is generally used to uniquely identify a patient so as to deliver various services for the patient at the right place and the right time and to the right person. And also link all the healthcare information about the patient to this unique identifier.
Keeping in mind the need to uniquely identify a patient and to avoid duplicates becomes a very important factor in the Hospital Information Systems.
In a specific system ( and these obviously vary from one HIMS to the other) the Patient ID is utilised to keep track of various types of patient related information or healthcare events. In addition to the Patient ID, there is the Episode ID and the Visit ID information that is used to store specific visit related and diagnosis based information in the Health Information System. In these systems, the Episode ID and the Visit ID are used as the child records of the Patient ID.
Most Health IT systems employ an algorithm to identify patient duplicates based on various data points creating a complex key.

Using Aadhar as a Health ID

In various countries around the world, the use of a single identifier as a universal identifier has never been successful due to the complexity & security concerns of the various use cases.
Take for example the case of the SSN (Social Security Number) in the US. The SSN is recorded for the patients in the Healthcare Information Systems but is never utilised to uniquely identify a patient due to the issues of Security and Identity theft. There are a lot of instances in which the SSN has been stolen and leads to the person suffering from stolen identity.
Healthcare Information systems have been hacking targets and currently the losses estimated in every hacking incident runs into millions of dollars.
Now take the example of Aadhar ID as a Health ID. We might land up having similar issues of the healthcare information system at a hospital/ clinic being hacked into and the Aadhar information being misused by the hackers.
Obviously, the security levels of an IT infrastructure at a hospital or clinic will not be as superior as the competent authorities security and IT infrastructure.
The government agency will be able to ensure the security of the Aadhar number, by providing robust and secure systems, but the same may or may not be expected of the Hospital Information System vendor or the hospital or a clinic that has implemented the solution or for that matter a Health Information Exchange authority. 
Suggestion
  1. Use Aadhar to validate the Identity of the Patient, Only

The Aadhar number must be used only and only to validate and authenticate the Identity of the person who has come to the hospital. Aadhar Authority could provide a service that could be called to authenticate a person.
  1. Use Health ID to be the Primary Key, Patient IDs to be the Secondary Key

In the absence of standards as to how the Patient information is to be stored within a Healthcare Information Management System or EHRs, it is more advisable to maintain the Health ID as a Primary Key, the ownership remains with the Health Authority. However, each visit that a patient makes into any healthcare facility, the HIMS/EHR/EMR vendor generates a care summary record (using Patient ID) as a “Secondary Key” information for the patient.
This is akin to how each bank might have different banking information systems, but the PAN number is a unifying information to understand how many bank accounts a tax payer might have (since PAN number is mandatory for every transaction done).
In this bank scenario, the PAN is the Primary Key, and every transaction done against the PAN card is the secondary key.
The authentication of the PAN is done by the competent authority who develops robust systems to safeguard the PAN card information of the PAN Card holder.
  1. Patient ID/ Health ID should be maintained by the Health Authority (e.g., the National Health Portal)

We propose the Health ID should be maintained by the Health Ministry in the government and the various aspects of Health Information should be defined by this authority. Since the Health Information of the patient needs to interoperate between the Hospitals/ clinics (which comes under the Health Ministry) and the Insurance Companies (which is another government department), maintaining a separate Health ID with its own security and interoperability guidelines is an appropriate approach.
The interoperability between the various government departments is more easier than any other third party vendor implementing such a interoperability system. The government therefore becomes an enabler of interoperability between various consumers of the healthcare information (in this case, the insurance companies and the Hospitals)
For instance, the Health ID could have a one-to-one relationship with the Aadhar Number. But the contents of the Health ID related information can be dictated by the Health Ministry or the National Health Portal Authority.

In Conclusion

  1. Health ID should be used to maintain a persons’ Health Record across the care continuum.
  2. Health ID can derive the Demographic information from the Aadhar ID and use the Aadhar ID for Identity matching, duplicate check and person authentication services.
  3. There should be a one-to-one relationship between Health ID and Aadhar ID.
  4. Each time a patient makes a visit to a healthcare facility, the Health ID information regarding the patient will be updated. Mechanism to be worked out if the current and latest information gathered from the patient regarding the demograhics should be updated back to the Aadhar Information.
  5. For Healthcare Related information, Healthcare Information Exchange purposes, Health Insurance purposes; the Health ID should be the unique and Primary Key.
  6. The Patient ID or UHID captured in each of the system should be treated as the Secondary key or the child records that will help put together the patient visit related information.
  7. We can now move to a National Level Health Information Exchange to store health data for the Patient’s clinical events across healthcare facilities, against a Health ID

References:

  1. Limiting the Use of the Social Security Number in Healthcare - http://library.ahima.org/doc?oid=104465#.Vz_5EJN95E4
  2. Patient Identification and Matching - Final Report - http://ow.ly/2ZAE300qT1Z
  3. National Patient ID System: Debate Stoked - InformationWeek - http://www.informationweek.com/administration-systems/national-patient-id-system-debate-stoked/d/d-id/1109314?
  4. HIMSS Asks Congress for Patient Identity System--Again - InformationWeek - http://www.informationweek.com/healthcare/patient-tools/himss-asks-congress-for-patient-identity-system--again/d/d-id/1106498?
  5. National Patient Identifiers | Practice Fusion  - http://ow.ly/XwfTj
  6. Identity Crisis: An Examination of the Costs and Benefits of a Unique Patient Identifier for the U.S. Health Care System | RAND - http://ow.ly/Xwg2I 
  7. Creating Unique Health ID Numbers Would Facilitate Improved Health Care Quality and Efficiency | RAND - http://ow.ly/Xwg6v 
  8. Patient Identification in Three Acts - http://ow.ly/Xwgab
  9. National patient identifier struggles for life | CIO - http://ow.ly/Xwgd5 
  10. White Paper on Unique Health Identifier for Individuals http://ow.ly/XwgfI
  11. The Imperative of a National Health Identifier | HL7 Standards - http://ow.ly/Y0KHz
  12. Are we ready for national patient IDs? | HIMSS Future Care - http://ow.ly/Y0KSn

    Suggested Reading

    1. Unique Identification Authority of India - https://uidai.gov.in/faq.html
    2. Aadhar: A number to facilitate the lives of the next billion | Dr. Pramod Varma | TEDxBangalore - YouTube http://ow.ly/pX4K300AsO8
    3. Linking Aadhar to better Healthcare - http://www.thehindu.com/news/cities/mumbai/news/linking-aadhaar-to-better-healthcare/article8288043.ece
    4. Authenticating Indian eHealth System through Aadhar: A unique identification - http://www.ijser.org/paper/Authenticating-Indian-E-Health-System-Through-Aadhaar-A-Unique-Identification.html
    5. A secured model for Indian eHealth System - http://www.softcomputing.net/ias27.pdf
    6. The Aadhar for mass health insurance - http://www.thehindubusinessline.com/opinion/the-aadhaar-of-mass-health-insurance/article4644193.ece

     

    Author: 

    Manish Sharma


    Founder HCITExperts.com, Digital Health Entrepreneur.


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