IMPORTANCE OF UNIQUE IDENTIFIERS AND PLATFORMSregist2.virology-education.com/2017/INTEREST/76_de...

IMPORTANCE OF UNIQUE IDENTIFIERS AND PLATFORMS

JLI Session at INTERESTIan de VegaLilongwe, Malawi

19 May 2017

© Western Cape Government 2012 |

Outline of the presentation

2JLI Session at INTEREST 2017

Unique Identifier in Western Cape

Benefits realised by the Western Cape

Roadmap on how to get started

PMI

© Western Cape Government 2012 | 3JLI Session at INTEREST 2017

A unique number linked or assigned to a single patient so that

all healthcare services is captured against this unique number

to be used at all healthcare service sites including prevention

not just treatment or care

What is a Unique Identifier?


Unique Identifier structure in the Western Cape


Primary Identifiers:1. Provincial Unique Client ID2. National SA ID number3. Passport number

Additional Identifiers:1. WCG Health Account Number2. Medical Aid Number3. Invoice Number4. Pension Number

Additional Identifiers:1. Facility Folder Number

Lookup, Search & Merge Facilities Across Province

Client

Patient Debtor

The person responsible for

paying the account


Patient Information linked to Unique Identifier

5

Names, Date of birth, Sex, National ID #, Passport #

Addresses (Geocoding in progress)

Contacts

Folder locations

Meta data (e.g. # folders registered, last activity dates)

Family relationships

Births

Mortality

JLI Session at INTEREST 2017

Presenter

Presentation Notes

Also known as the Patient Master Index Directory of patient information stored in a database One unique number per patient that can be used in multiple contacts and source systems


Basic functions of the Unique Identifier


The ability to identify individual patients;

Ability to link a variety of data fields needed to deliver healthcare;

Ability to aggregate information across institutional boundaries;

Protect the privacy, confidentiality and security of personal health information;


Background to the Western Cape Unique Patient Identifier

7

Hospital system(Present in 53/54 hospitals, including all in metropolitan area)

Provincial Unique Patient Identifier (PMI)

Primary care (Patient registration systems in all 307 clinics)

Clinical systems recording electronic data against shared registration number (PMI)

Radiology• Laboratory• Pharmacy• ART registers• TB registers• New systems

Individual-level data repository

PMI

Mortality and birth surveillance• Province-wide mortality surveillance system for all deaths and stillbirths• Province-wide birth registration system

Clinical audit tools• Perinatal (PPIP)• Child Health (CHIP)PMI

PMI

PMI

PMI

PMI

PMI

PMI

PMI

PMI

PMI


Presenter

Presentation Notes

Unique Patient Identifier is online for clinics and hospitals Other systems might use the number in a variety of ways But all ultimately can be consolidated into a single data environment Important to note is that there are two different primary care systems both transacting, showing it is multi-purposable This has created the potential to track patient encounters across the platform over the life course of the patient This is a key ingredient of the health information exchange that enables an integrated picture for clinical care


Current Status of Unique Identifier in Western Cape


400+ Facilities has ability to register patients with Unique Identifier

All core systems are linkable via the Unique Identifier - allowing patient care records to be viewed irrespective of treatment centre

Electronic dispensing covers 83% of all issues & expanding rapidly

All laboratory data are available electronically

90% of Radiology images and reports are done electronically

Individual-patient-level health data centre create true intelligence and system independence

Complete electronic data for HIV, TB, and good progress being made on other chronic diseases, pregnancies and births


Single view of patient records


Presenter

Presentation Notes

Prototype of the Single Patient Viewer Broadly, it presents the clinician with all the relevant information on one page: Patient demographic Episode of care Encounters within the episode Lab result Medicine or drugs issued Link to: Radiology images and reports Electronically scanned records


An example of an integrated episode summary-HIV

10

1

1.5

2

2.5

3

3.5

4

4.5

5

5.5

6

0

100

200

300

400

500

600

d4TTDFAZT

3TCFTC

EFVLPV/r

Pregnant

Tuberculosis

Clinic visit

Admission

OPD visit

CD4

Viral load (Log10)

ART Start

VL 400 copies/ml


Presenter

Presentation Notes

Bottom of graph – medication that only a person living with HIV would get Next level up – highlights the type of visits that the client has over time 2008 and 2013 TB episode and in 2010 Pregnancy episode 10/11 the viral load started climbing (possibly due to pregnancy) Changed to another drug and then virally suppressed


Performance of treatment cascade (90-90-90): 2015/16Further compromised by vertical measurement in National ART System

Viral Load

Suppressed

Viral Load Completed

Still in care

Started ART11 275

Nat

iona

l ART

Sys

tem

3 740 (42%)

3 466 (93%)

8 947 (79%) 9 475 (83%)

7 925 (84%)

6 851(86%)

11 369with valid PMI #

Integrated reporting (Province)


DE VEGAIAN EDWARD GSH 109230 034

CONSTANTIA DOB: 19/05/1982CAPE TOWN, 7880 Sex: MTel No: 0763551515 GEOHD/94G004

0 1 2 3 4 5 6 7 8 9

Filing of patient folders (STICK IT, FILE IT, FIND IT)


BIN numberSub-BIN number

Presenter

Presentation Notes

Bar-coded labels the glue which holds the clerical system together Digitize registry and use barcoded labels extensively on all forms, can be selectively digitized later


The Unique Patient Identifier has also enabled us to track patient journeys across the service delivery platform and determine:

Loss to follow up

Treatment adherence

Fragmented care

Hospital re-admissions

Infer health conditions and co-morbidities from routine laboratory data, pharmacy dispensing data and type of facility/clinic/ward e.g. HIV, TB, Pregnancy, Mental health conditions, chronic diseases of lifestyle, etc.

Continuity of Care


Western Cape Unique Identifier Journey


Envisaged Projects Plan

Real Projects Plan


Types of facilities



Initial steps to developing a Unique Identifier System (PMI)


Detailed situational analysis

Technicalleadership

Plan to address issues from assessment

POLITICAL WILL Legal

changes

Staged deployment & system integration according to plan

Continuous training

Develop Unique ID, content-free, linkable, verifiable, also support

paper clinic needs

Data stewardship guides appropriate use of data. Ensure the individuals’ privacy, confidentiality & security of personal health information


Many of these solutions for better access to care areavailable right now, the challenge is to get them

implemented and not accept the constraints

imposed by the status quo

Concluding remarks


Acknowledgement


July 2016 Unique Identifier Workshop Participants:Eduard J. Beck, Mark Shields, Ian de Vega, Gerrit Henning, Gail Andrews, Kim Marsh,Jesus Maria Garcia Calleja, Philippe Boucher, Lionel Benting, Mary Mahy, John Cutler,Whitney Ewing, Gaurang Tanna, Peter Ghys, Boonchai Kijsanayotin, Stephen Watiti,Tapiwanashe Kujinga, Keith Sabin, Keletso Makofane, Chujit Nacheeva, Jinkou Zhao,Noma Rangana, Mary Felissa Reyes Vega, Olga Varetska, Steven Macharia Wanyee,Daniel Low-beer

Thank you

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