Unique Identification Number and its utility in Healthcare

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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

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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.

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One man who is the identity of INDIA
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An identity so powerful that . . . .
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even this picture is enough..!!
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but others are not so Unique
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and need some sort of identification

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

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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

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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

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Identification card will contain

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

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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..

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Nandan Nilekani Appointed as Chairman, UIDAI
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Nandan Nilekani

• Co-founder, Infosys
• Bids adieu to Infosys
• Cabinet Minister Rank
• Wants Best talent
• For finger print scan during 2011 census

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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

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Will help address

• The rigged state elections,
• Widespread embezzlement that affects subsidies
  and poverty alleviation programs
• Illegal immigration into India
• Terrorist threats

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Would it be compulsory?

• Citizens will not be obliged to get a number.
• But those that dont will find it very
  inconvenient
• They will not have access to facilities that
  require you to cite your ID number.

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Connecting around the world.!
Honble Prime Minister, Manmohan Singh in a
meeting with Dr. Zerhouni, Director National
Institute of Health
..Medline Plus
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For a Global Health System..
..Medline Plus
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Early Detection of Large Outbreaks
Symptom Onset
Severe Illness
Release
Number of Cases
Days
..Rita Kukafka
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Syndromic Surveillance Data Sources

• 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

Absenteeism
Pharmaceutical Sales
General Practitioner
Consultants records
Ambulance Dispatch (EMS)
ED Logs
Traditional Surveillance
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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

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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.

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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

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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
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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.

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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?

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Healthcare Provider should be able to

• Generate UID
• Unborn child
• Abortus gt 20 wks
• Still birth
• New Born Child
• Any Patient
• Death Certification
• Access information

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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

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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

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Healthcare Provider must Record UID

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

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Need for Lifetime EHR

• Personal health record
• Google health
• Microsoft health vault
• Other organizations

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More than one healthcare provider

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

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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

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Health Information Network

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

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Utility of UID in Healthcare

• Epidemiological Database
• Disease Prevalence
• Data mining
• Preventive measures
• Improvement in immunization
• Health of the Nation

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Government may decide policies for

• Encryption
• Security
• Sharing
• Standards
• Storing UID as secondary key
• Access control

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Medical Tourism

• Revenue
• Nationals of other countries
• Mechanism of registration needed
• Modification of software required

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• Change Management
• Software developers
• Upgrading software
• Installation
• End user / provider
• Implementation
• Training

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Stakeholders

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

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Let us pay our tribute ..
Healthcare IT in search of identity !!