Bhutan ehealth Action Plan Workshop - Weaving Health and Happiness with ICT

Transcription

1 Bhutan ehealth Action Plan Workshop - Weaving Health and Happiness with ICT The Role of Unique IDs in Health Paro, Bhutan June 22, 2016

2 Outline The Role of Unique IDs for health and the digital technologies that can help operationalize them Establishing and managing Unique IDs o Connectivity o Identity o Client Registry o Point of Service Applications (Immunization Registry, OpenSRP, etc) How can we begin, immediately, to adopt Unique IDs for Health Purposes

3 This is Kanya s story

4 Across multiple data databases... How do we uniquely identify Kanya s health story?

5 We need, two distinct, but complementary, things to be able to track Kanya s health story. Connectivity Identity

6 Connectivity

7 Digital Health Infrastructure Coordinated service delivery Two-way information flow Continuity of person-centred care

8 Identity

9 This is Kanya This is information about Kanya To be able to manage Kanya s health information across our health care delivery system, we must first be able to unambiguously identify her

10 This is Kanya 3 ID Factors: 1. Something you ARE 2. Something you HAVE 3. Something you KNOW Unambiguously identifying Kanya can readily be done by employing one or more of the 3 factors of identification: biometrics, wallet IDs (such as cards), or shared secrets

11 This is Kanya 3 ID Factors: 1. Something you ARE 2. Something you HAVE 3. Something you KNOW Biometrics

12 This is Kanya 3 ID Factors: 1. Something you ARE 2. Something you HAVE 3. Something you KNOW Name: Kanya Bakar Sex: F D.O.B.: Mother s name: Diah Bakar Name: Kanya Bakar Sex: F D.O.B.: Mother s name: Diah Bakar

13 Mobile phone # This is Kanya 3 ID Factors: 1. Something you ARE 2. Something you HAVE 3. Something you KNOW 4-digit PIN Date of Birth

14 Authentication This is Kanya 3 ID Factors: 1. Something you ARE 2. Something you HAVE 3. Something you KNOW For Kanya, the act of proving she is who she says she is...is called authentication Kanya authenticates her identity a number of countries successfully operate their health systems using 1-factor authentication based on a simple, inexpensive card.

15 ID# The next step is that we need an ID# that we can employ for health purposes, that will be uniquely associated with Kanya.

16 As a best practice, it will be a meaningless but unique number; an MBUN MBUN This ID# should not contain any other information It s sole purpose is to be different from every other ID#

17 How do we establish and manage identity within OpenHIE

18 Operationalizing identity management for health purposes is found in the functionality of the health information exchange, using a demographic database called a Client Registry, also sometimes called an enterprise master patient index or EMPI

19 Client Registry Master ID (the golden thread ) Local IDs Client registry is a cross-referencing database with national scope It s job is to relate local keys to a golden key an ID that is associated with Kanya s golden demographic record This golden key is used for health purposes only

20 Client Registry Client Registry creates a system-generated index key for each individual Associated with this golden key is the definitive, golden demographic record for the person which includes data such as their name, date of birth, sex, home residence, perhaps mobile phone #, etc.

21 Client Registry Local IDs Client Registry also includes a cross reference index of any other keys that may be associated with this person. These keys represent ID#s that might appear on a national ID card, or a driving license, or on a simple card issued by the health ministry. the Client Registry stores the ID# and its issuing authority

22 Client Registry Fuzzy match Exact match The cross-index of IDs allows us to do exact match search for Kanya Without the ID, we must do a fuzzy match search using a combination of name, sex, date of birth, etc..

23 the cross-index of IDs is that it allows unique identification for health purposes to be established without requiring everyone to have an ID from the same issuing authority

24 As a way to kick start the process of establishing unique records in the Client Registry, anyone presenting for care who already has an ID card can use that card to authenticate themselves Their ID# will be recorded in the Client Registry and associated with their golden key and demographic record

25 for those who do not already have IDs such as migrant workers, non-citizen residents, children under 18, and others, they can be immediately issued a health card when they present for care this health-only ID# is associated with their golden key and demographic record

26 Client Registry Shared Health Record ICD-10 code: HIV+ ICD-10 code: Pregnant Plan of care: ANC Procedure: Birth ATC codes: ARV The golden key creates a golden thread that links the disparate scenes of Kanya s health story into a single, person-centric narrative Instead of seeing healthcare activities through a silo d, program-focused lens we can see it from the same perspective as Kanya - we can see her complete person-centric health story.

27 An opportunities to expand identity management and use of Unique Ids at the Point of Service Delivery thru Immunization Registry

28 Potential Pathway To Interoperable HIS Standards-based Exchange Profiles: PIX, PDQ, XDS.b, CDA Immunization Registry Courtesy of Mark Landry, Regional Advisor, WHO SEARO

29 IZ Ideally, a baby gets its first vaccination right at birth. To safely and effectively execute the vaccination schedule, we need to immediately identify this unique child At the first opportunity, we will establish a vaccination record in the immunization registry and associate the baby s vaccination card ID with its golden key in the Client Registry.

30 IZ At the first opportunity, a vaccination record is recorded in the immunization registry and associate the baby s vaccination card ID with its golden key in the Client Registry Ideally, a baby gets its first vaccination right at birth. To safely and effectively execute the vaccination schedule, we need to immediately identify this unique child

31 Stock-outs ZERO Vaccine Inventory >30% reduction IZ an essential part of the business case for immunization registry and OpenHIE lies in the supply chain features ultimately, it enables governments to more effectively know in advance what should happen and begin capturing a child health story

32 IZ the golden demographic record in the client registry may be leveraged to improve the coverage and timeliness of birth registration data in the country s civil registration and vital statistics CRVS

33 In conclusion Unique IDs are foundational to effective continuity of care and the improved health outcomes Don t rip and replace existing systems leverage the Client Registry to extend and embrace them. we can extend the usefulness of existing ID schemes and embrace them to support care at multiple points of service...this gives us a golden thread that we can use to connect disparate care episodes into a longitudinal, personcentric shared health record

34 In conclusion Unique IDs are an Essential element for the Enabling Environment in Moving into the SDG era for Equity and leaving no one behind - improved delivery of health services in underserved communities commonly migrants, urban poor settlers and ethnic minorities initiatives to adopt Unique IDs for health purposes and engineer/deliver Digital Health Infrastructure and Health Information Exchange can make signifcant contributions toward UHC

35 Unique ID assessment in Cambodia, Lao PDR and Myanmar Breaking data silos and moving towards interoperability multi-country gap analysis to include the mapping and analysis of existing unique ID systems used (e.g. in CRVS, health, pension, unemployment, health insurance, social assistance programs); o what is needed to establish an ID registry and index before eventually unifying these systems - promoting interoperability o gaps with global standards for ID management (privacy/security) o recommendations for each country on how to develop and deploy the unique ID registry and index, global standards for ID management, etc. o development of a Unique ID training curriculum led by ADB in partnership with UNICEF, WHO, AeHIN Will provide the basis for country developed Unique Id Roadmaps

36 Strengthening Identity Management and CRVS Global and Regional Priority Strengthening CRVS is one of the cornerstones of health measurement and accountability

37 References ooks.com/

38 Standards and Guidelines Data Protection Directive (officially Directive 95/46/EC on the protection of individuals with regard to the processing of personal data and on the free movement of such data Standard guide for properties of a universal health care identifier (UHID) or ASTM E describes the properties of the health care identifier including the numerical/character representation of the patient identity Guide for implementation of a voluntary universal health care identification system or ASTM E describes a scheme for voluntary implementation of the health care identifier, realizing an opt-in mechanism that is controlled by the patient/person, not the government International Standards Organization (ISO) Health informatics -- Identification of subjects of health care or ISO/TS22220: focuses on the key personal information that is associated with the identifier, biometrics, and patient matching to link independent records belonging to the same person Health informatics Patient health card data. ISO Health informatics - Guidance on patient identification and cross-referencing of identities or CEN/TR 15872

39 A live demonstration of Kanya s health story was presented at AeHIN s general conference in Bali, Indonesia in October, More information can be found at

40 THANK YOU Lori Thorell, Regional ICT Specialist for HIV and System Strengthening, UNICEF EAPRO Mark Landry, Regional Advisor, WHO SEARO