Tuesday, December 13, 2016

Unique Health Identification and Aadhar: A case for mandatory linkage

All India Institute of Medical Sciences (AIIMS) has requested the Ministry of Health for a mandatory linkage between Unique Health Identification (UHID) and Aadhar. This seems like a simple and a straightforward suggestion but deep down it has major implications for delivery and democratisation of healthcare. I would argue that this linkage should be mandatory for all hospitals, both public and private primarily because it empowers the patients to have access to their own medical records.
As part of the digital initiative, AIIMS issues a UHID to each patient, who visits the hospital for the first time. In subsequent visits the patient is expected to reproduce this number. The UHID plays an instrumental role in documenting the patients entire journey in the hospital. With this it is possible to track, the date and time of the patient visit, the departments where the treatment was offered, the tests and the sub-tests that were undertaken and their results, if the patient was admitted (in-patient) then date and time of the ward in which the patient was admitted, the procedures performed, date and time of discharge, the release description (such as cured, expired etc.) and the diseases codes. Within AIIMS, availability of this data helps the doctor to develop a more accurate medical history of the patient. Also, this significantly reduces the burden on the patient to either produce past medical records or recall all the necessary treatments or procedures done. This has significant impact on quality of care by reducing the risks of medical errors and negligence, better patient management, avoiding unnecessary investigations, etc. In practice, however, there are many patients that are either unable to produce records of their previous visits to the hospital or do not recall the UHID number, as a result of which a new UHID is issued and in the process, precious medical history of the patient is lost. Aadhar has a potential to resolve this issue. Aadhar is a nation-wide unique identification which is used for multiple purposes, therefore, significantly easier for patient to reproduce and if this is linked to the UHID then it is much easier for the doctors to access the medical history without putting any burden on the patient. Moreover, the patient has cheap and reliable access to his own medical records.
A medical record is the property of the patient and just like any property its value depends on proper identification, accurate documentation, easy transferability and the rights to access it. If all hospitals UHID are linked to Aadhar then it has the potential to create a universal health records for the patient. With Aadhar the patient can request the hospital to transfer his medical records to his digital locker which he can access from anywhere at any time. This will lead to democratisation of healthcare delivery.
Let me illustrate this with an example. Consider a patient from a village in Bihar who is visiting a district hospital for an ailment. Under the Digital India initiative, the District Hospitals are expected to maintain a Hospital Management Information System (HMIS) that records the details of patient visits, disease, treatment offered and outcomes (cured, referred, expired, etc.).  If this information was linked to the patients Aadhar, then this could potentially be stored in the patient’s digital locker. Now suppose the patient is referred to a tertiary healthcare such as AIIMS (more than 50 percent patients in AIIMS come from UP and Bihar). With easy access to the digital locker at any time, the patient can transfer all the past medical information to the doctor in AIIMS who will have a far more accurate medical picture than a scenario in which he has to rely only on the testimony and the records of the patient. Such a portability of medical records has significant impact on the quality of care that the patient receives by reducing the risks of medical errors and negligence, better patient management, avoiding unnecessary investigations, etc.
Perhaps in the future it would be possible to link all medical visits, from the primary health centres, community health centres, secondary hospitals to the tertiary care hospitals, to the Aadhar. This will help in the development a comprehensive health record of the patient that is accessible anywhere at any time.
As a first step in the development of a comprehensive health record of the patient it is important that the government makes it mandatory for all the hospitals to link their UHID to Aadhar and give digital access to the patient to their own medical records which can be stored in the digital locker. To achieve this the government must take steps to ensure that basic data on each patient is collected in all hospitals:
1.     Date and time when the patient was admitted.
2.     Vitals of each patient: Weight, Height, BP, Hypertension, Diabetic.
3.     Disease code using the ICD-10 codes.
4.     Date and time stamp when the patient was discharged.
5.     Discharge outcome: Cured, Death, LAMA, etc.

In conclusion, linking UHID to Aadhar allows for the development of the comprehensive health records of the patients. It empowers the patient with the right to access his own medical records anywhere at any time. An important step in the democratisation of healthcare delivery.

1 comment:

  1. this is exactly what we are working on in private and independent GP level as Swasthaadhaar. the only diff is to not create a UHID but use only Aadhaar as the identity of the patient. we would like to connect with you Mudit. request you to please share your coordinates at info@swasthaadhaar.com