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 dont will find it very inconvenient: They will not have access to facilities that require you to cite your ID number.

Connecting around the world.!

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

For a Global Health System..

..Medline Plus

Early Detection of Large Outbreaks

Symptom Onset

Number of Cases

Severe Illness
Relea se

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

Days
..Rita Kukafka

Syndromic Surveillance Data Sources

Day 1- feels fine Absenteeism Day 2- malaise, abstains from school/work Day 3- headaches, fever- buys Paracetamol Pharmaceutical Sales Day 4- develops cough- visits family doctor General Practitioner Day 5- Referred to consultant: flu Consultants records Day 6- Worsens- calls ambulance seen in ED Ambulance Dispatch (EMS) Day 7- Admitted- pneumonia ED Logs Day 8- Critically ill- ICU Day 9- Expires- respiratory failure Traditional Epidemic declared when many such deaths reported 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 Welfare is 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 This is to certify that registers birth under Mrs xxx yyy zzz confinement number Wife of yyy aaa zzz Birth related Delivered a Male/Female Child in this hospital information essential for national statistics At hh.mm AM/PM On mm/dd/yyyy Health related issues And is registered under start from birth of a Confinement no ******* individual 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 !!