Creating Patient-Centric

Identity Management Solutions

Mr. Michael Stahl

HSG seminar unique health identification

5th February,2018
ADB, Manila
 Outline
• Activities and output under RECAP
(Results for Malaria Elimination and Control of Communicable
Disease Threats in Asia and the Pacific)

• General findings from the ÌD mapping exercises

• Methodology of the ID mapping exercise

• Scenarios for setting up a National Health ID

• Leapfrogging to the latest digital health technology

• IT Infrastructure and disaster respond

• Linkage between digital health and eGovernment

 What has been done under the RECAP Project?

Joined ADB C P
May 2015
CONCEPT NOTE POLICY BRIEF
Why is interoperability in Dissemination of
the heath sector so a policy brief on
challenging? S Health IDs

STOCK TAKING of IDs

Country visits for stock taking
Cambodia, Laos, Myanmar

3
 TEST ENVIRONMENT FOR
INTEROPERABILTY
Set up of CAMLAB to test
open source products

T T
HEALTH ID
TOOLKIT
Development E
of a Toolkit for
health ID stock
F E-HEALTH STRATEGY
taking Supporting the
e-health strategy and
FINE-TUNING OF THE implementation plan
TOOLKIT in Cambodia
Testing the draft toolkit
during a stock taking
mission in Nepal V

SUPPORT VIETNAM
Health ID stock taking
in Vietnam
 • Policy Brief on Health IDs
RECAP
• Unique Health Identifier
KNOWLEDGE PRODUCTS Mapping Toolkit

• Experiences from setting up

OpenHIE products

• Draft brief on Unique Health

Identifier Scenarios

• Terminology Booklet for

eHealth (Khmer, Vietnamese,
English)

• Digital Health Investment

paper + tool
5
 Investment in Identity Systems
Digital technology can improve patient centric care

Health IDs allow the provision of the

Services right health service to the right
patient in a short time. It can
lead to:

Health Insurance Hospitals

• less waiting time
• no double payments
• fast reimbursements
Health Centers Private clinics • less treatment errors
• enables patient
engagement via mobile
apps
Stock taking of existing Identification
Mechanisms in different countries

Findings from our work for better interoperability

eHealth is complex
Governments need to define
their national eHealth goals
 EXAMPLE
CAMBODIA

(C) M. Stahl, 2016

Identification Silos - Laos

(C) M. Stahl, 2016

Data sharing is a
sensitive topic
Health care providers are not
necessarily interested in data
sharing beyond their own
institutions
eHealth is complex
Governments need to define
their national eHealth goals
Health Identifier is
needed
Unique health ID required to
better connect the health
sector
Limitation of Open Source
OS products are innovative
but rarely used on national
scale
 Findings from the UNIQUE HEALTH ID ASSESSMENTS

1 No focus on IDs beyond

the own organization

2 Dual registration:
Manual & Digital

3 Identification and
Authentication differs

Data entry is done for government reporting requirements 13

Mapping of existing Identification
Mechanisms in different countries

Methodology
Understand the ID Which number is a
landscape first “real unique number?

% of entire population registered?

Patient Database 1

40%

Patient Database 2

60%

Patient Database 3

35%

Patient Database 4

90%
Data Silos – Identification Silos
Multiple Health IDs not linked to a master
patient index or national health client registry

(C) M. Stahl, 2015

 Centralized vs. de-centralized identification management
Features Centralized De-Centralized
Scaling Easy to scale up Slow to deploy
Costs Eliminate redundant costs Higher project costs
Less L A O S to local needs
Data definitions
KOREA
Consistent data definitions responsive

Maintenance Easy to maintain Often ignored

Implementation skills Less intensive to implement Effort intensive
changes
T H A intensive
Change Management Leadership ILAND DataV IETN
owners andAapplication
M
top down approach owners are change agents at
grassroots
Access and Lies with central team, Dependent on the governance
Management I Nrelationship
Vendor D I A easy to and quality
CAM BODIA
tool owner
maintain
Control Central control over Decentralized control if using
TAIWAN
infrastructure distributed data systems
Country examples are referring to the updating procedure of demographic data
(the system architecture can be based on various server clusters across a country)
Let’s take a closer look to Vietnam…
 During our interviews
more than 40 information systems
were found and documented

Internal ID Number is rarely used for any data sharing

outside their clinic or clinic network

(C) S. Mellor/M. Stahl, 2017

 A person can easily receive
two National Id cards if he moves from
one province to another

It is also theoretically possible to have

two passports at the same time using
different IDs from different provinces.

Using the national ID is not a perfect

solution for patient identification
HIV Facilities
Internal ID Number is rarely used
data sharing outside their clinic or
facility network

TB Facilities

Using a vertical disease ID is not a

perfect solution for patient
identification
 Vietnam…the way forward
GOVERNMENT SERVICE
PLATFORM

Mandatory National
National Health
Unique Client
Health ID Health ID Registry

Select an
existing ID
Thailand
CENTRAL
Digitizing over 60 million records POPULATION
from paper DATABASE

But why
not `waiting
for the National
ID Number?
 Country Example: Thailand
Mandatory use of GOVERNMENT SERVICE
National Citizen ID PLATFORM

Multi purpose card:

1. Personal ID
2. Fingerprints
3. Tax CITIZEN DATABASE
HEALTH SYSTEM
STAKEHOLDERS 4. Social welfare
5. Social security numbers
13 digit number generated
6. Agricultural data
at time of birth .
7. Healthcare data ID card when they reach
the age of 7.
Considerations in Tonga Attention
DHIS2 is primarily a
data collection tool
Reporting

HEALTH SERVICE PLATFORM

National
Health Client
Registry
Unique
Using the DHIS2 primary key Health ID

as the unique health ID

 Considerations in Cambodia
GOVERNMENT SERVICE
Mandatory PLATFORM
National Health ID
National
Unique Health
Health ID Client
Registry
Checking Identity
via Health Client National
Registry ID Number
as sub key

Ministry DATABASE
CITIZEN of Interior

Health stakeholders contribute

National
to updating the CRVS System ID Number
CRVS
 Current situation in Malaysia

Health
Ministry Client
of Interior Ministry DATABASE
CITIZEN of Interior
Registry

HEALTH NO Connection National

ID ID Number
eHealth and eGovernment

&

Maturity of ICT solutions

 Education
Health Sector Health
is feeding the Driving license/
population registry Vehicle registration

via the CRVS system

CRVS
system Identity

Land
Health center Birth certificate
POPULATION registry
Home delivery Family book update
REGISTRY
Immunization
Patient ID
State benefit

International
Immigration/
Border control

eHealth eGovernment
 Countries are at different ICT maturity levels

Laos, Cambodia
…want to leapfrog
Vietnam, Myanmar are here….but…
 Leapfrogging to the latest digital health technology
Trying to implement
innovative solutions
without having the basic
infrastructure in place
Not having legal
frameworks in place
which ensure data/privacy
protection
Adding data silos instead
of consolidating, linking
and harmonizing data and
small-scale projects
No need to build on
legacy digital information
systems from 20 years ago
Threat
Develop with a patient-
centered approach
Better health information
to manage more complex
chronic diseases
Using innovative solutions
like mobile apps;
wearables…
 Develop a legal environment
for the new VN Social Security Number

Supporting the development of EMRs

Is it mandatory Who has the

to use the VSS authority to
Number? update patient
data?

Should the new Are

ID support the biometrics
idea of paperless collected?
medical records?
 RECAP

Strengthen prevention and response to

communicable diseases
IT infrastructure can speed-up disaster respond time..
 IT infrastructure can speed-up disaster respond time..

Quickly know the status

Health Facility Registry (GIS based)
of a facility after a disaster

Quick diversion
Health worker registry of resources

Inform people where to go

mHealth application + Social Media for medical services

Know your drugs in stock

Drug disbursement system and re-order quickly

Medical advice for people

Telemedicine solutions in cut-off areas

This all requires Storage

Electricity Network (disaster proof)
 Investment opportunities

CAPACITY BUILDING
GOVERNMENT
INFRASTRUCTURE
DHIS2 Training
HL7 FHIR Training Network
Business Process Design Data center
Organizational change Population Registry
Policy design and Health Registries
implementation

HEALTH FINANCING POLICY & PROCESSES

IT for national health eHealth Strategy Design
insurance schemes Business Process mapping
Linking EMRs with health Policy advise
insurance purpose
Thank you