Centralized Patient Health Record Database with Integration of NFC/Datasim Cards — Its Benefits & Its Hurdles
A centralized health record system aims to better analyze and improve the healthcare system, at all levels. The value of real-time data analysis has been demonstrated in the current era of the coronavirus, whereby decisive interventions are necessary. For a government to launch an effective health care reform; evaluation of clinical care and health care delivery; administration of health plans, groups, and facilities; and public health planning, there needs to be a resource that can answer their questions and that is based on empirical data.
The Sehat Sahulat Program (SSP) is described as follows:
“Sehat Sahulat Program is a milestone towards social welfare reforms; ensuring that the identified under-privileged citizens across the country get access to their entitled medical health care in a swift and dignified manner without any financial obligations.”
The PTI’s Manifesto, released in 2018, has statements about their ideal ‘Healthcare for All’ program in Pakistan with a lot of points that have been addressed and most of them would require monitoring and knowing the real-time data to be accessible to policymakers.
In their Actuarial Report, regarding the Sehat Sahulat Program (SSP), they mentioned that by October 2018, 3.2 million families had been enrolled across 38 districts. Over the next three to five years, the SSP plans to expand coverage to a total of around 11 million families across Pakistan.
What does the Sehat Sahulat Program offer?
The SSP is an in-patient (IP)-only scheme and is cashless to the insured beneficiaries. There are no exclusions and all pre-existing conditions are covered.
Indemnity coverage for secondary IP hospital care up to 50,000 Rupees per annum per family
Indemnity coverage for priority hospital care up to 250,000 Rupees per family per annum. Priority care, as defined in the rules, is for the following conditions only
- Cardiovascular diseases, Diabetes Mellitus complications, Burns and road traffic accidents, End-stage renal disease and dialysis, Chronic diseases, Organ Failure Management, Oncology
Maternity care up to 17,000 Rupees per annum per family
- Transportation benefits for non-local beneficiaries of 350 Rupees per discharge, also available to women who are discharged from local district hospitals after receiving maternity services.
These are the services that are provided in phase-1 of the roll-out and it will have more coverage and more benefits later in coming years moving forward as mentioned in the ‘Manifesto’.
One avenue that can be explored by the healthcare sector and its stakeholders is the integration of NFC/SimCard into the Sehat Insaf cards, to establish a centralized patient health record system. Sehat Sahulat Program Card — which we can call the ‘Sehat Card’ for the sake of simplicity; can evolve into more than just another card in someone’s wallet.
The integration of the NFC/Datasim Card for a national level centralized patient health profile database would add to the ground data and help expedite this dream of ‘healthcare for all’.
How to integrate NFC/SimCard — Healthcare Record Card
A simple tweak to the card’s integrity itself can store the patient’s health profile on this card which would only be decrypted after their fingerprint authentication or passcode, just any ATM card for their privacy.
Localized bank-ups in their local district hospitals that can serve as a local database recovery centers if an individual’s card is lost. The nature of the localities common diseases and understanding the nature of drug efficiency in the region could be formulated for each district region with creating the first local effective pharmaceutical therapy guidelines, which is the norm in the developed world.
Sehat Sahulat Program Card — which we can call the ‘Sehat Card’ for the sake of simplicity; can evolve into more than just another card in someone’s wallet.
It can have an individual’s past medical history (e.g. any history diseases, surgery, vaccination, details, etc.) and their medications prescriptions details inscribed into a data chip (Sehat Card). Which is like the data sims that we put in our phones being cost-effective.
It would validate and gather real-time data and make analyzing from tertiary or secondary sources redundant and would not require third party reliance. There will be no need to dig through retrospective databanks which are not reliable because of its variability.
Benefits for the ‘Patients’ & their ‘Doctors’
Lesser explanation on patient’s part — no communication gap and there are no misunderstandings, that we have lately seen. The patient’s attendant is not the primary source of history of the disease of the patient.
Efficient delivery of emergency treatment — time saved in knowing the past medical history can save crucial intervention time and can avoid potential drug interactions.
No Medication Bags or Files required — Patients will only need the card for their past medical history, no need for carrying huge documentations, past multiple laboratory investigations, and bags of medications. They will only require the card, which will have all the data stored on it and will have backups in his district hospital from where it can be issued. Forming a sort of primary to tertiary care triage as well.
Medical history, ‘at a glance’ — Doctor’s understanding of the patient’s condition can be accelerated with a past medical history, knowing their co-morbidities/medications, can make a big difference. A simple glance by an experienced doctor, improve the consultation for the sake of the patient, the doctors will know their primary and secondary issues and will address it given their individualized context. This can curtail a symptomatic approach that is inevitable at an overcrowded setup.
A summary of the benefits of NFC/Datasim in healthcare can be read in this article (Reference Article) and the avenues that it can streamline are as follows:
Patient’s Identification, Medication’s Control, Resource Management, Data Acquisition Applications, Personal Storage of Data on the card, Past Medical History Records.
Hurdles For NFC/Datasim Cards — ‘Sehat Card’
— Incentivize — data entry by the doctors to build the databanks, with simple interfaced and drop-down and no free-text base entry to ensure clean data collection.
— Cost infliction — mass scale manufacturing costs for making the cards exactly as required and will need quality control assurance. providing all the existing hospital set up with proper internet connections and IT infrastructure to have widespread access. Creation of network systems and warehouses for storage of personal data that must have layered security systems.
— Installation of required NFC/Datasim Readers — at all hospitals to ensure mass scale implementation for it to incur proper data recovery.
— Regulatory bodies — to ensure proper access abilities and mass scale workshops to teach the individuals that will be interacting with the system.
For the government to launch an effective health care reform; evaluation of clinical care and health care delivery; administration of health plans, groups, and facilities; and public health planning, their needs to be a resource that can answer their questions and that are based on data analysis of population-based studies.
Nowadays, they are achieved by research conglomerates which use grants and then push NGO’s, to do this at a price but the best alternative to all of this would be to build a comprehensive individual health profile centralized database; which can comprise of the following domains (suggestions based on research):
- Demographic data — consist of facts such as age (or date of birth), gender, race and ethnic origin, marital status, address of residence, names of and other information about immediate family members, and emergency information.
- Health risks and health status — Health risk information reflects behavior and lifestyle (e.g., whether an individual uses tobacco products or engages regularly in strenuous exercise) and facts about family history and genetic factors (e.g., whether an individual has first-degree family members with a specific type of cancer or a propensity for musculoskeletal disease).
- Patient medical history involves data on previous medical encounters such as hospital admissions, surgical procedures, pregnancies, and live births, and the like; it also includes information on past medical problems and possibly family history or events (e.g., alcoholism or parental divorce). Again, although such facts are significant for good patient care, they may also be important for case-mix and severity adjustment.
- Current medical management — includes the content of encounter forms or parts of the patient record. Such information might reflect health screening, current health problems, and diagnoses, allergies (especially those to medications), diagnostic or therapeutic procedures performed, laboratory tests carried out, medications prescribed, and counseling provided.
- Outcomes data — encompass a wide choice of measures of the effects of health care and the aftermath of various health problems across a spectrum from death to high levels of functioning and well-being; they can also reflect health care events such as readmission to hospital or unexpected complications or side effects of care. Finally, they often include measures of satisfaction with care. Outcomes assessed weeks or months after health care events and utilizing reports directly from individuals (or family members), are desirable, although these are likely to be the least commonly found in the secondary databases under consideration here.
Control, Ownership, and Governance.
Whether a given database has been established by the public or the private sector (or is some hybrid) will have important implications for inclusiveness and access. So, consideration can be that its ownership is government based so it can regulate the access and have certain types of restrictions on the availability of segments of the data to only concerned professional individuals.
Hospitals, pharmacies, physicians’ offices, insurance companies, public program offices, and employers should be able to generate systematic inputs to this database that are interconnected throughout.
If an extensive and rigorous understanding of the subject of health databases is required one can do their research or go through a summarized version in this article (here).
How to ensure if the data is correct, a committee can be formed that ensures data quality on an ongoing basis and take affirmative steps to ensure:
- The completeness and accuracy of the data in the databases for which they are responsible.
- The validity of data for analytic purposes for which they are used.
A centralized portal (website) will be regulated with access limitations to the amount of information that is accessible and can be tailored to the job description of the individual accessing it. Only a designated number for the patient would be required which can be linked to the national identity card number (NIC) which is already present.
This pathway of this integration between technology and healthcare will only bare fruition if the expectations are realistic. It will reap benefits for the generations to come and there is always a starting point and each step is taken at the right time to understand and learn the nature of the progression.
Shortcuts are not the way forward; they can only get you to a place that is unfamiliar by skipping the necessary learning curve.
