Unique Identification Number and its utility in Healthcare

Dr Rajeev Joshi, MBBS, MD(Pediatrics)Shree J Hospital, Pune, Maharashtra, INDIA 411037

Member, Indian Association for Medical Informatics

Acknowledgement

Some of the contents of my talk are part of the deliberations of the UID group of Indian Association for Medical Informatics and I thank them for allowing me to use the same.

One man who is the identity of INDIA

An identity so powerful that . . . .

even this picture is enough..!!

but others are not so Unique…

and need some sort of identification

• Voters card• PAN card• Driving License• Bank Passbook• Passport• Fishing permits • Border area id cards

Documents for identification

• Basis of Identity– Photograph

– Birth Certificate

– Reference

– Affidavit

• Proof of residence– Electricity Bill

– Telephone Bill

– Insurance Policy

– Police Verification

– Ration card

– Domicile Certificate

– Affidavit

Multipurpose National Identity Card

• NDA : Vajpayee Government 2002• Continued by UPA : Manmohan Government• President Abdul Kalam 2006 speech• Pranab Mukherjee approved decision 2008• 26 November 2008 events in Mumbai• Allocation in 2009 interim budget• UPA Government re-elected in 2009• Approval of Chairman position for UIDAI

Identification card will contain

• NUMBER • Name • Sex• Address • Marital Status• Photo• Identification mark and • Finger biometrics

Unique Identification Authority of India• Established in February 2009• Have the responsibilities to lay down plans and policies to

implement the Unique Identification Scheme (UID)• Shall own and operate the Unique Identification Number

database• Will be responsible for its updation and maintenance on an

ongoing basis• A provision of Rs. 120 crore has been proposed for this

project.• IAS officer Ram Sevak Sharma has been handpicked as the

director of the Unique Identification Authority of India (UIDAI) to assist its first chairman…..

Nandan Nilekani Appointed as Chairman, UIDAI

Nandan Nilekani

• Co-founder, Infosys

• Bids adieu to Infosys

• Cabinet Minister Rank

• Wants ‘Best talent‘

• For finger print scan during 2011 census

Nilekani to give numbers, Ministries to issue cards

• Provide enrolment and verification services across the country.

• Will identify the targeted groups for various flagship programes

Will help address

• The rigged state elections,

• Widespread embezzlement that affects subsidies and poverty alleviation programs

• Illegal immigration into India

• Terrorist threats

Would it be compulsory?

• Citizens will not be obliged to get a number.

• But those that don’t will find it very inconvenient:

• They will not have access to facilities that require you to cite your ID number.

Connecting around the world.!

Hon’ble Prime Minister, Manmohan Singh in a meeting with Dr. Zerhouni, Director National Institute of Health ..Medline Plus

For a Global Health System..

..Medline Plus

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Release

Nu

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of

Case

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Symptom OnsetSevere Illness

Early Detection of Large Outbreaks

Days..Rita Kukafka

• Day 1- feels fine• Day 2- malaise, abstains from school/work• Day 3- headaches, fever- buys Paracetamol• Day 4- develops cough- visits family doctor• Day 5- Referred to consultant: “flu”• Day 6- Worsens- calls ambulance

seen in ED• Day 7- Admitted- “pneumonia”• Day 8- Critically ill- ICU• Day 9- Expires- “respiratory failure”• Epidemic declared when many such deaths reported

ED Logs

Pharmaceutical Sales

General Practitioner

Absenteeism

Ambulance Dispatch (EMS)

Consultant’s records

Syndromic Surveillance Data Sources

Traditional Surveillance

Manmohan Singh Forms UID Council

The council is expected to advice the UIDAI on the programe, methodology and implementation to ensure coordination between ministries, departments, stakeholders and partners

Members of the newly appointed council• Finance Minister Pranab Mukherjee • Agriculture, Food and Civil Supplies Minister Sharad Pawar • Home Minister P. Chidambaram • External Affairs Minister S.M. Krishna • Law and Justice Minister M. Veerappa Moily • Human Resource Development Minister Kapil Sibal • Rural Development & Panchayati Raj Minister C.P. Joshi • Labour and Employment Minister Mallikarjun Kharge • Communications and Information Technology Minister A. Raja • Planning Commission Deputy Chairman Montek Singh Ahluwalia and • UIDAI chairman Nandan Nilekani.

Ministry of Health & Family Welfareis missing from UID council ? ?

• Family Planning • Antenatal Care• Anemia control• Perinatal problems• Birth intimation

• Immunization• Tuberculosis control• Leprosy control• Malaria Control• Death intimation

UID Should be issued at birth

• Healthcare provider registers birth under confinement number

• Birth related information essential for national statistics

• Health related issues start from birth of a individual

This is to certify that

Mrs xxx yyy zzz

Wife of yyy aaa zzz

Delivered a Male/Female

Child in this hospital

At hh.mm AM/PM

On mm/dd/yyyy

And is registered under

Confinement no *******

Submitted on mm/dd/yyyy

Will Death Certificate have UID?

• Death certificate issued by healthcare provider.

• Death certificate will have to be issued for still birth.

• Death certificate will have to be issued for abortion after 20 wks.

Recording of patients sex

• Male / Female• Unknown

– for unborn child if treated in-utero

– Cannot be determined

• Change of sex medically possible, to be recorded by healthcare provider?

Healthcare Provider should be able to

• Generate UID– Unborn child

– Abortus > 20 wks

– Still birth

– New Born Child

– Any Patient

– Death Certification

• Access information

In case of Medical Emergency

• Attending physicians will be able to access medical record of any patient so as to save his / her life

• Treatment of unidentified victims of accidents

• Natural calamity

Partners

• Immunization is given to child even if born at home

• Patients will take treatment from healthcare provider at least once in two/three years

• Patients not having UID can be issued one

• Reduce burden off government agencies

Healthcare Provider must Record UID

• Patient registration• OPD treatment• IPD treatment• Laboratory tests• Radiological tests• Pharmacy• Electronic or paper

based

Need for Lifetime EHR

• Personal health record– Google health

– Microsoft health vault

– Other organizations

More than one healthcare provider

• Family Physician• Consultant• Pathology Laboratory• Radiology Clinic• Hospital• Home Care

Transfer of medical information

• One doctor to another doctor• One hospital to another hospital• One city to another city• One State to another state• One software to another software

Health Information Network

• PHC• District Hospitals• Medical Colleges• Directorate of Health• DMER• Medical Colleges• ICMR• Ministry of Health

Utility of UID in Healthcare

• Epidemiological Database

• Disease Prevalence• Data mining• Preventive measures• Improvement in

immunization • Health of the Nation

Government may decide policies for

• Encryption• Security• Sharing• Standards• Storing UID as

secondary key• Access control

Medical Tourism

• Revenue• Nationals of other

countries• Mechanism of

registration needed• Modification of

software required

• Change Management

– Software developers• Upgrading software

• Installation

– End user / provider• Implementation

• Training

Stakeholders• Healthcare providers• Insurance companies• Government healthcare organizations• NGOs• Research Institutes• Drug Distribution

Let us pay our tribute ..

Healthcare IT in “search” of identity !!