Tuesday, April 13, 2021

Provider Working Group - Final Report

Prologue

DIGITAL HEALTH ECOSYSTEM - ACCESS HEALTH DIGITAL VISION

Over the years economists and leaderships around the world have learnt that economic growth that is gained through the hard work of a creative, healthy and productive working population; is easily lost through healthcare costs arising from disease burdens that come with ageing or other public health challenges; which could be endemic communicable, lifestyle related or pandemics as in the recent experience.

This challenge becomes even more acute in the case of developing economies and economies with very young populations which will see longer life expectancies and higher healthcare burdens in the future.

The Sustainable Development Goals (SDG) framework elicited by the world community is an attempt to ensure that economic growth translates into real change in the lives of large populations around the world, lifting up their quality and experience of life.

Universal Healthcare is adopted as the third SDG in this framework but on closer examination has profound interconnections with all the other goals in the framework, and therefore is perhaps the most important one. In fact, it is so important that it is no longer possible to leave people to fend for themselves and pay-out-of-pocket for their healthcare costs. This report describes India’s policy initiatives for Universal Healthcare, along with a detailed discussion of, and solutions for, the hurdles that India faces in it’s drive towards implementation of Universal Healthcare.

Providing Universal healthcare in a way that is sustainable for economies requires a preventive, predictive and proactive approach to healthcare that is wellness centric and is both equitable and accessible to citizens.  There are a number of paradigms that need to be understood to effectively deliver on these approaches.

Firstly, it requires Healthcare to be seen as an ‘Eco-System’ or a collective environment, rather than disjointed entities / industries making overlapping or selective efforts that fail to address the issues holistically. Healthcare is not a single industry or a set of unconnected industries. Some of the issues arising from isolated efforts are discussed as ‘Fuzzy boundaries’ in the report.

Secondly, having realized that healthcare is an inter-dependent ecosystem, even more so when an entity other than the beneficiary or patient is paying for the services rendered; it becomes critical that all members (stakeholders) of the ecosystem work together in close cohesion with minimum administrative glitches and ensure economy of effort and resources used. The Size, Scale and Speed that is required to make this work, makes it essential for information to flow amongst the stakeholders in a seamless and meaningful way that is universal and helps decision making easy, rapid, transparent and non-discriminatory to the extent possible. For this to happen, Interoperability becomes critical and lack of Interoperability - fatal

The centrality and criticality of effective Interoperability calls for universally accepted structures, rules, processes and data standards. This is the core of the work that Access Health Digital has been doing over the recent years.  Access Health Digital (AHD) has expertise across Medicine, Technology, Public Heath, Governance and Policy, Healthcare Systems, Adoption, Capacity Building and Implementation; with at least 3 if not more cross functional disciplines available within each individual team member’s multi-decadal span of experience and qualifications.  AHD has Conceptualized, Designed the Building Blocks, Minimum Viable Product Designs and other Digital Health Assets for healthcare delivery information systems. The central purpose of this document, and the efforts behind the working group initiative, is to serve the nation by releasing this body of work into opensource for Public Good and secure majority agreement with stakeholders on these. This helps create an inclusive approach to the ecosystems instead of one that threatens or challenges the smaller stakeholders with financial ruin. The exclusiveness that is possible in other sectors of business is not viable in healthcare, as it would trigger a systemic collapse. Healthcare services are greatly personalized in nature since medicine is an extremely nuanced and evolved discipline, where a clinician often needs to factor in a lot of subjective information to make the best decision for the patient.

Essentially the Healthcare Space has three broad principal stakeholder groups namely:

  • Payers – These are entities that pay for healthcare services given to a patient. These could include the patient and his family, governments schemes, insurance providers – private and public. As discussed above, Universal Healthcare is striving to ensure that this burden is minimized for the patient.
  • Providers – These are entities, public or private, that provide care – ranging from the individual medical practitioner in a remote area, to the sophisticated urban hospitals; ancillary services eg. Labs and Diagnostics, telemedicine, medicines and so on. This is a vast area running into millions of entities.
  • Patients or Beneficiaries are those receiving healthcare services.
As is obvious by now, Healthcare is a domain that is vastly different to the more orderly areas like Banking, Payments, Finance, Retail, Telecom and so on, which have a very limited type and number of stakeholders and transactions that can easily be objectified.

Thirdly, given the fundamentally unique nature of healthcare and its diversity, and its need for a truly inclusive, country appropriate approach -  it is clear that integrating this ecosystem cannot be achieved by un-boxing and applying a playbook approach to India’s Healthcare Ecosystem, either from another country or even from another sector within India.

It can also not be achieved by just ‘replicating’ paper based processes by doing them electronically ie. merely Digitizing an existing process and carrying on the same way but with computers.

It would need a fundamental change to the way data is collected, organized, shared and acted upon in a way that decision making could be accurate and fast, while scale and safety went up exponentially with accessibility and equity. It also meant leveraging publicly available infrastructure and moving away from dependence on proprietary technologies that would create dependencies that no public system can survive, especially when it is a nation of 1.3 Billion people. Moreover healthcare is continuously evolving as our knowledge of the human  body, genetics, technology changes at speeds that have never been experienced in human history ! What we can do with a simple Mobile phone today, was never imaginable just 15 years ago! Lives and economies have truly been transformed by this ‘Digitalization’.

Healthcare needs Digitalization and not just mere Digitization since nuances and speed are not just important - they are critical, and could sometimes be the difference between life and death, in terms of outcomes.

Fortunately, since Universal Healthcare has been a high priority with the current government there has been a cascade of far-reaching measures following the National Health Policy of 2017 viz. PMJAY, The National Digital Health Blueprint, The National Digital Health Mission, the NEP-2020, and so on, initiated to remove hurdles towards achieving this goal.

Fourthly, Digital Health - as the Digitalization of Healthcare has come to be known, is a transformative discipline and is a complex specialization born through the convergence of multiple disciplines, just as most cutting edge innovation in the world is, today.

It is a matrix of Medicine, Technology, Public Heath, Governance and Policy, Management, Healthcare Systems, Adoption, Capacity Building and Implementation. At the primary level it required medical professionals to develop a familiarity with technology issues and for technologists to develop an appreciation for the nuances of healthcare and medical science, as the workplaces begin to adapt and change.

The recommendations in this report reflect the work of 200+ professionals, who have made that journey despite the extreme discomfort that this change represents, to reach a state of familiarity with the intricacies and nuances of this cutting edge area. The future requires a similar effort from all of us in Healthcare and Information Technologyu, with an urgency that has never been experienced in history.

Coming back to the three groups of stakeholders mentioned earlier in this discussion:

AHD’s Payer side recommendations were already discussed with the Payer industry and submitted to the National Health Authority.

This Provider Working Group Initiative seeks to serve the nation by evolving a set of tools that will allow for integrating the Provider Community and it’s diversity into a National Digital Health Ecosystem. Give all of the above, It’s importance to Universal Healthcare can hardly be overstated.

Nations must rise to protect themselves, professionals must step across the divides of habit, if we are to meet the challenges of the future. Covid19 makes it essential to build healthcare eco-systems that are adequate to spot and address threats predictively across geographies, besides keeping large populations healthy by preventing disease.

India stands at an inflection point today quite similar to the one that she witnessed when mobile telephony arrived in the 1990s’. The bottlenecks of the old, infrastructure heavy, fixed line telephony were gone in one fell swoop; and as they say, the rest is history. It led to a transformation of the country in exponential terms, in every sphere of life.

The work done by AHD will go a long way in helping the realization of this critical national priority as the proverbial ‘stitch-in-time’. Access Health Digital as a Not for Profit, Technology Knowledge Leader has been making catalytic, India specific, design, innovation and adoption initiatives to remove bottlenecks in the healthcare domain to make it possible to adopt and implement the recommendations of the National Digital Health Blueprint.

We have sought to address the lack of Interoperability between members of this vast ecosystem, which has so far been impeding the scale and speed of data and knowledge flow, which is vital to make universal healthcare achievable.  The National Digital Health Blueprint has been the set of guiding principles to our initiatives.

We have gone further and convened extensive working group discussions in each of these areas across academic, industry and policy makers; to secure majority agreement and make sure that adoption of digital health was not obstructed, and interoperability became inherent to the Building Blocks, Minimum Viable Products and Architectures that AHD proposed and shared as open-source, digital health assets for the public good. Our intent is to help India leapfrog the current state into a bold new future in digital health and also lead the global healthcare community by example.

As a Medical, Technological Governance and Policy Maker, Management or Public Health Professional, or even as a student or educator in these diverse domains, we believe this report will help you  navigate the future and be a worthy investment of your time to read.

We earnestly submit to the Government, that this rarely seen agreement / consensus and set of recommendations across a very wide spectrum of stakeholders in healthcare, be seized upon as a ‘once in a generation’ opportunity for the country to benefit it’s citizens immediately. It would also enable India to leapfrog and lead the global healthcare community for the benefit of all patients everywhere.


Saturday, August 22, 2020

eClaims - Payer eObjects









This document presents the design specifications for electronic claim objects and associated standard processes for their exchange between Payers and Providers, through a Health Claim Platform that was recommended in the report “Common IT Infrastructure for Health Insurance Claims management” by IRDA-NHA joint working group. 

The health claim platform is intended to improve current claim processes, enforce transparency and facilitate on time provider payments for Health insurance Claims in India. Usage of Standard Electronic Claim related objects will facilitate auto adjudication of claims by both Public and Private Health Insurance Payers with reduced operational costs.



eDischarge Summary Object: Pick the eDischarge Object from Provider eObjects v2

Standard Value Sets for eClaims Objects

Standard Value Sets for eDischarge Objects

Summary of Insurance eObjects

The eObjects concept was introduced by ACCESS Health in Theme papers in Nov 2018, that became the Chapter 5 of the book ‘Health Systems for New India’, published by Niti Aayog in Nov 2019. Prof Dennis Streveler and Dr Pankaj Gupta are the Authors of the Chapter 5 in the Health System for New India book. The eObjects concept was again recommended in the ‘NHA-IRDA joint working group report’ to facilitate electronic, codified data exchange between providers and payers. The eObjects concept was then detailed out into Provider and Payer eObjects including the data standards recommended in the National Digital Health Blueprint. ACCESS Health has now released the eObjects design and code in opensource under MPL 2.0 license.

eObjects are evolving, check with us for the latest versions. Reach out to us for any help to understand or implement the eObjects. We can set up a group call with all of you to explain these eObjects in detail or even can set up one to one calls.

Thank You for your continuous association with us.

-- ACCESS Health Digital --

Contact for Clarifications:
Access Health Digital
digital.health@accessh.org

Sunday, July 26, 2020

AHD ACADEMY: DIGITAL HEALTH 101



Digital Health 101 is a basic set of webinar recordings from AHD Academy. Suitable for Doctors/Nurses/Clinicians, Public Health and Healthcare Managers, Government Administrators and Technologists interested in Digital Health. The Courses are spread across Basic, Specialist and Expert Levels. It is a video based learning model and It is free. 

Disclaimer: AHD Academy is a Library of Live Webinar Recordings from AHD on various Digital Health topics. It is opensource material meant for learning from experts at your own pace. This is Not an Academic Course material. Please do not confuse these webinar recordings with regular recognized courses run by universities/colleges. You may contact your College, University, Organization for properly moderated Lectures, Trainings, Courses on Digital Health.

Basic Course for Digital Health Enthusiasts: Suitable for Clinicians, Healthcare Managers, Govt Administrators and Technologists interested in Digital Health. Will take approximately 40 Hours to read up the material and listen-in to these 101 webinars.

LESSON 1: HEALTHCARE IT IS DIFFERENT

Reading Material Lesson 1. Note: This is a preparatory Lesson that will open your mind and help you understand the higher lessons. Reading material for this Lesson is based on white paper written by Dr Pankaj Gupta on the same topic.

LESSON 2: GOVERNANCE AND FINANCIAL LEVER

Reading Material for Lesson 2. Note: This is a preparatory Lesson that will open your mind and help you understand the higher lessons. Reading material for this Lesson is based on white paper written by Dr Pankaj Gupta on the same topic.

LESSON 3: FUZZY BOUNDARIES FOR GOVERNANCE

Note: This is a preparatory Lesson that will open your mind and help you understand the higher lessons. Reading material for this Lesson is based on white paper written by Dr Pankaj Gupta on the same topic.

LESSON 4: LINES ARE BEGINNING TO BLURR!

Note: This is a preparatory Lesson that will open your mind and help you understand the higher lessons. Reading material for this Lesson is based on white paper written by Dr Pankaj Gupta on the same topic.

LESSON 5: HEALTH DELIVERY INFORMATION SYSTEM [HDIS] MVP


Reading Material for Lesson 5

LESSON 6: CLOSED LOOP MEDICATION ADMINISTRATION

Reading Material for Lesson 6

LESSON 7: HEALTH INSURANCE INFORMATION PLATFORM [HIIP] MVP

Reading Material for Lesson 7

LESSON 8: HEALTH INFORMATION EXCHANGE [HIE]

Reading Material for Lesson 8

LESSON 9: META DATA AND DATA STANDARDS AND NDHB

Reading Material for Lesson 9

Additional Reading material: 
http://www.openbodhik.in/2020/04/india-leads-way-in-digital-health.html
http://www.openbodhik.in/2020/04/access-health-india-perspectives.html
http://www.openbodhik.in/2020/06/mdds-for-health-standards-published-in.html
http://www.openbodhik.in/2020/04/health-systems-for-new-india-eobjects.html
http://www.openbodhik.in/2020/05/blog-post.html

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Specialist Course: Suitable for Healthcare Managers wanting to Specialize in Digital Health. Will take approximately 50 Hours to listen-in to these 101 webinars. Pre-requisite is Basic Course for Digital Health Enthusiasts. Technologists can jump to the Expert level Course.

LESSON 1: HL7 AND FHIR
Reading Material for Lesson 1


LESSON 3: MICROSERVICES

LESSON 4: CLOUD COMPUTING


LESSON 7: JAVA PART 1


LESSON 9: JAVA PART 3

LESSON 10: DESIGN PATTERNS


LESSON 12: OOPS CONCEPTS

Additional Reading material:
http://www.openbodhik.in/2020/07/beneficiary-registry-recommendations.html
http://www.openbodhik.in/2020/06/doctors-registry-of-india-concept-note.html
http://www.openbodhik.in/2020/06/national-health-facility-registry.html

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Expert level Course: Suitable for Technologists aspiring for Expertise in Digital Health. Will take approximately 60 Hours to listen-in to these 101 webinars. Pre-requisite is Basic Course for Digital Health Enthusiasts. Specialist Course is not required for Technologists. 

LESSON 1: HL7 AND FHIR

LESSON 2: eObjects IMPLEMENTATION

LESSON 3: MICROSERVICES

LESSON 4: CLOUD COMPUTING

LESSON 5: Bootcamp 2 PART 1
Discussions on NDHB, Federated Architecture, HDD, Registries,

LESSON 6: Bootcamp 2 PART 2
Discussions on SNOMED,

LESSON 7: Bootcamp 2 PART 3
Discussions on eObjects, FHIR,

LESSON 8: Bootcamp 2 PART 4
Discussions on Microservices,

LESSON 9: Bootcamp 3 PART 1
Discussions on eObjects Implementation,

LESSON 10: Bootcamp 3 PART 2
Discussions on SEA Members eObjects Experience,

LESSON 11: Bootcamp 3 PART 3
Discussions on Microservices Implementation,

LESSON 12: Bootcamp 3 PART 4
Discussions on HIEAF,

Additional Reading material:
http://www.openbodhik.in/2020/07/beneficiary-registry-recommendations.html
http://www.openbodhik.in/2020/06/doctors-registry-of-india-concept-note.html
http://www.openbodhik.in/2020/06/national-health-facility-registry.html
http://www.openbodhik.in/2020/04/provider-eobjects-published.html
http://www.openbodhik.in/2020/08/eclaims-payer-eobjects.html
http://www.openbodhik.in/2020/06/hdis-mvp-microservices-published.html

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Masters level Course: Suitable for Academic Excellence in Digital Health. Content similar to Basic, Specialist and Expert level course is used in Last semester of the Masters course, but obviously with more in-person teacher-led classroom sessions.

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DIGITAL HEALTH ECOSYSTEM - ACCESS HEALTH DIGITAL VISION


Congratulations! This completes the AHD Academy's Digital Health 101 Webinars. Best of Luck for implementing the concepts on the field.

Your feedback is welcome, Write to digital.health@accessh.org

Note: All Content is released under MPL 2.0 License. It is free to use with proper attributions.

AHD Academy Partners and Collaborators for Digital Health capacity building, research, content and pedagogy: 

       





More MoU in pipeline...

Monday, July 20, 2020

Social Entrepreneurship Accelerator

Social Entrepreneurship Accelerator [SEA]

ACCESS Health Digital [AHD] is a a not for profit think tank working on NDHB Digital Health Standards for India. We run a Social Entrepreneurship Accelerator [SEA] for helping Indian HealthTech startups and vendors to implement Open Digital Health Standards that are applicable globally. #AtmaNirbharBharat #VocalForLocal

The Social Entrepreneurship Accelerator launched by ACCESS Health Digital has become an official Amazon AWS Activate Provider. AWS Activate works with accelerators, angel investors, and venture capital firms to provide startups with free AWS credits, technical support, training, resources, and more. These exclusive benefits are designed to help startups quickly get started on AWS and grow their business. Startups associated with an AWS Activate Provider are able to apply for AWS Activate Portfolio.

The new partnership with Amazon Web Services will help the Social Entrepreneurship Accelerator create new opportunities for its startups, providing them with access to Infrastructure as a service [IaaS], Platform as a Service [PaaS] and Software as a Service [SaaS]. This gives the startups entry into a Plug-and-Play integrated software development environment. Just adopt the PaaS and all startups in the accelerator can turn into SaaS companies.










SEA Objectives








SEA Cohort 1


SEA Cohort 2

In late October 2020, India's National Health Authority' Market ACCESS Program [MAP] put 12 startups under mentorship of ACCESS Health Digital's Social Entrepreneurship Accelerator [SEA] -- the second of three cohorts to join the SEA family, now home to almost 40 startups that range in sector and specialty from primary care delivery and telemedicine to electronic health records and disease management. Like the previous cohort, SEA aims to provide its newest members with mentorship, market access, and a stamp of confidence, among other basic building blocks that will situate them in the digital health landscape. Together, they're working toward a single transformative purpose: building a vibrant national digital health ecosystem.



SEA Cohort 3

Parallelly Cohort 3 has also started to take shape, mostly on reference from Cohort 1 and requests from Partner organizations.



SEA Silver Club

Silver Club has implemented the Standards and achieved our Stamp of Confidence.




SEA is an Exponential Organization (ExO) whose impact will be disproportionally large as compared to its peers because it leverages exponential technologies.


SEA implements the eObjects Interoperability framework. eObjects were first written by Prof Dennis Streveler and Dr Pankaj Gupta in a white paper in Nov 2018 that was published by Niti Aayog in the book Health Systems for New India, Chapter 5 - Reimagining India's Digital Health Landscape Wiring the Indian Health Sector in Nov 2019.



Additional Reading material:

Will update soon...keep checking this space..

-- ACCESS Health Digital --

Contact for Clarifications:
Access Health Digital
digital.health@accessh.org 


Thursday, July 9, 2020

Beneficiary Registry Recommendations for India

Since the start of the Millennium, India has been trying to overcome the problem of interoperability and fragmented healthcare delivery ecosystem across states, health policies and vertical health programs to deliver seamless or uninterrupted continuum of care. With the launch of the Pradhan Mantri Jan Arogya Yojna (PMJAY), that covers & provides free healthcare to approximately 40 % of the Indian population, it has become critical to identify each patient uniquely. The criticality for unique identification of individuals got highlighted when India was hit by the COVID 19 pandemic – when patient tracking and relevant health information on comorbidities was not available for effectively and efficiently executing surveillance. States and government could only collect aggregated data in non-standard and an unstructured format via door to door screening, which was extremely inefficient and poorly suited for response planning and to effectively combat a pandemic of this size and scale.

UHID is a critical building block from a Universal Health Coverage perspective and is also the missing link in enabling a true longitudinal health record for the patient. This is critical in providing all individuals, equal access to quality healthcare at all times. The first step towards enabling UHC for a country is to identify uniquely all individuals who seek healthcare as patients. 

Many developed countries as well as some developing countries have already implemented the concept of UHID. These can provide valuable inputs to India, in finalizing our UHID implementation policy. It was found that different countries have followed varied methodologies and approaches for UHID implementation at the National Level. In the more advanced countries with robust civil or social protection laws, UHID is generated and assigned at the time of birth and is utilized for every healthcare transaction throughout a person’s life.

India is a democratic country where health is a state subject with flexible regulations, which gives States and citizens freedom of choice to adhere to the health policies they want to adopt. In such an environment, to enable access to quality healthcare for all, it is critical to define a well thought out UHID strategy that can seamlessly encompass various use cases and scenarios specific to India. 

The recommended UHID approach is - Create a National Unique Health Identifier for every person in the country and link it with Aadhaar or with any Government verifiable ID for authentication and validation of the persons information.

The categories and recommended approaches are provided here for ready reference. 

https://drive.google.com/file/d/1FeqmVkGMLTSeWexjGx1XluA4j8lATdne/view?usp=sharing

Various use cases were identified and studied to arrive at the recommendation. The population can be divided into 5 major categories with an associated approach to assign a UHID to the identified population group. The minimum data elements recommended for the Beneficiary Registry are also provided. 

We are also publishing the recommended minimum data elements for the Health Delivery Information Systems minimum viable product for Personal Health Records [PHR].

https://drive.google.com/file/d/1HU7cf6D4MmNx9YzNO1DpX2TInRgue1N5/view?usp=sharing

NDHB has also recommended a Health Locker to Maintain the Personal Health Records of the Individuals in the Health System. The Health Locker is a standards‐based interoperability specification that can be implemented by multiple players to enable the creation of a Personal Health Record. A personal health record, or PHR, is an electronic application through which patients can maintain and manage their health information (and that of others for whom they are authorized) in a private, secure, and confidential environment. The healthlocker either stores patient’s record in digital format pushed by various providers or can store eObject pointers to the patient record or summary stored in a source system against the Unique Health ID of the patient.

The health lockers enable creation of a longitudinal health record from the various eObject links/pointers available and enables retrieval and storage of the EHR for continued clinical decision making. All the related eObject pointers and ID documents can be loaded to the Healthlocker for the PHR, giving the individuals the right to their information and control the information which they may like to share with other stakeholders.

-- ACCESS Health Digital --

Contact for Clarifications:
Access Health Digital
digital.health@accessh.org 


Monday, June 8, 2020

Health Data Dictionary Published in XSD Formats



The Public and Private Health System in India is struggling with multiplicity of information systems being used at central as well as at state level. Each of these systems is unable to exchange data and information with each other. To overcome similar challenges across ministries, the Ministry of Communication and Technologies initiated semantic standardization across various domains under Metadata and Data Standards (MDDS) project. The intent was to promote the growth of e-Governance within the country by establishing interoperability across e-Governance applications for seamless sharing of data and services. MDDS for health domain was created by adopting global standards in such a way that existing applications could be easily upgraded to the MDDS standards. 

The exercise yielded approximately 1000 data elements. These data elements were expected to serve as the common minimum data elements for development of IT applications for various sub domains of health care. The need for the CDE arose because most of the primary and public health IT applications are being developed without any standards by different agencies and vendors in public and private sector in India. Each application is developed for standalone use without much attention to semantic interoperability. Later when the thought of interoperability emerges – it becomes difficult to connect the primary and public health systems and make them talk to each other because they were never designed for that purpose. 

Even if technical and organizational interoperability is done the semantic interoperability may remain a challenge. For example – all primary and public health applications must have the same Facility Master. When application A sends the ANC data for facility 123, the receiving application B should understand ANC and uniquely identify facility 123. Another example is if a hospital application sends the insurance reimbursement bill to insurance company/government, the recipient application should be able to understand and represent the same meaning of bill information. Ministry of Health & Family Welfare has initiated development of the national health facility registry. The registry was intended to standardize facility masters used across public health information systems. 

Standardization of facility masters is required for two purposes, first when exchanging data the sending and receiving applications should be able to identify health facility similarly. For example – when application A sends the maternal health data for facility 123, the receiving application B should understand maternal health data and uniquely identify facility 123. Second, in public health, performance of each of the facility is assessed using aggregate indicators and facility master serve as the secondary data source on which primary program specific data is aggregated. For example- data from number of doctors from system A and total outpatient attendance data from system B could be analyzed to get per doctor patient load across health facilities only when both applications use common facility masters.

MDDS for Health Final Part I Report in PDF: https://www.slideshare.net/PankajGupta9/part-i-mdds-overview-report

Final MDDS for Health Full Report in PDF: http://egovstandards.gov.in/notified-standards-0

Here is the link to MDDS for Health in XSD Format in GITHUB folder. This includes about 1000 Data Elements and about 140 Code Directories in technically usable formats such as - CSV, JSON, XML, XSD: 
https://github.com/accesshdigital/mdds 

It also has a readme file for your reference.

Thank You for your continuous association with us.

-- ACCESS Health Digital --

Contact for Clarifications:
Access Health Digital
digital.health@accessh.org 



Saturday, June 6, 2020

National Health Facility Registry - Concept Note


What is a Registry?

A registry is an organized system or database that collects, stores uniformed data or information about an entity like patient, person , or facility etc and is kept updated at all times to act as “Single Source of Truth” for the entity in question. The data facilitated by the registry can be accessed as service by information technology applications or by the government for planning initiatives and governance.

How a Registry is different from a Directory?

A registry is an official record keeping database which not only identifies an entity uniquely but also proves its existence in the ecosystem in question. E.g.: ADHAAR- A person must be listed in AADHAAR registry to be able to verify his/her identification as an Indian Citizen with authentic demographic details.

Directory on the other hand does not required to be an official or comprehensive, but mere a collection of data without uniquely identifying entities listed in it and do not serve as “single source of truth”. Example- A telephone directory.

What is a National Health Facility Registry?

A National Health Facility Registry is a centrally maintained registry that stores and facilitates uniform minimum required data or information about both public and private health facilities in the country. It is a building block that is essential to enable nationwide health information exchange. It will do so by identifying each health facility uniquely and creating a unique Identifier for every registered facility. This unique identifier then becomes available to be utilized by states and IT systems as a pointer or primary key to store more facility related data in directories maintained at state/district level, providing comprehensive data on all private and public health establishments

Problem Statement

Indian healthcare has been trying to overcome the problem of interoperability and siloed systems to enable continuum of care. This requires a standard driven health information exchange (HIE), and to enable a HIE, it is essential to uniquely identify each stakeholder and resource (Patient, Provider, facility, health worker) involved in an episode of care.

Also, from a quality of care and governance perspective a facility registry becomes very critical for resource planning to create a reliable, unified registry of country’s healthcare infrastructure & associated resources through associated state or national level repositories like NHRR to show their distribution pattern of health facilities and services areas across the country. This assumes even greater significance in emergencies like Pandemics and disasters.

Several initiatives have been made by the Indian Government in the past to enable a centrally maintained facility registry for India.

Key initiatives undertaken in India for facility registry includes:

  • National Identification Number (NIN) project that was undertaken by National Health System Resource Centre (NHSRC) in 2016 where data pertaining to approximately 1,11,990 health facilities was cleaned and validated by 25 states including longitude-Latitude details. A 10-digit unique National Identification Number (NIN) was allocated to the identified public health facilities. A NIN portal was also developed for missing facilities or new facility registrations and states were provided trainings on the same to keep the NIN facility data updated.
  • National Health Resource Repository (NHRR) project by Ministry of Health and Family Welfare (MoHFW)- In NHRRa Healthcare establishment Census was conducted which included on ground physical survey to enlist all the health facilities as well as resources. NHRR database has listed approximately 8.5 lakhs+ facilities and provides around 7000+ attributes withspatialinformation maintained by the technology partner ISRO.
  • ROHINI (Registry of Hospitals in Network of Insurance)– Dubbed as the AADHAAR of Hospitals by Insurance Information Bureau of India (IIB)- ROHINI is a PAN India registry of hospitals/day care centers that are empanelled with health insurance payers/Third Party Administrators(TPAs) for service delivery to the beneficiaries. It has approximately 35,000 facilities listed so far. Each registered facility is allotted a 13-digit Global unique GS1 identifier, along with geo coding of facility address. ROHINI also has self service portal for registration/inactivation /deletion or amendment of registered facilities. All network hospitals and hospitals involved in cashless reimbursement claims or those that wish to provide this facility, are registered on ROHINI.

All the initiatives as mentioned above had common goals, one to act as single source of truth and second to become single point of reference for facility information as per their identified scope.

Since a lot of effort has gone into each of these initiatives, they should be brought together and harmonized to enable a National Facility Registry that can identify both public and private health facilities uniquely. The data collected under each mentioned initiative can be consumed or exposed as service to get/retrieve additional data about a facility using the same National Unique Facility Identifier that can be allotted by the National facility registry and act as a primary key to stitch the different databases together.

Recommended Approach

1.  Identify Minimum required data elements for Centrally maintained Registry

A central or nationally maintained registry that can be self-sustainable and easy to maintain should not have a long list of data elements or attributes. It should consist of only a set of minimum required data elements that helps to identify the facility uniquely and can be kept updated at all times. The recommended data elements should follow Metadata and Data standards for India (MDDS) which is a standard notified by Ministry of Electronics and Information Technology (MeITY). It is essential to use data standards to collect and store information in a registry, so that if states want to maintain their own facility directories/state registry/database they can use the same standard MDDS elements to define the local registry structure and will be able to push data seamlessly to the National facility registry.

The recommended minimum viable data elements are listed in the Annexure.

2.  Map NHRR-NIN-ROHINI Facilities& State verification and updation

Facilities listed in all the three mentioned databases can be mapped using Machine Logic/AI and manual interventions by making use of the key attributes like name, address and longitude-latitude details.

Following steps are recommended to harmonize and enable a National Health Facility Registry

  • Map ROHINI, NIN and NHRR facilities. The facility data from NHRR, NIN and ROHINI data sources will be harmonized by employing Fuzzy logic-based matching of facility data from each of these different sources. Facility data (NHRR, NIN and ROHINI) shall be matched by deploying fuzzy algorithms like Soundex or levenshtein distance matching etc. The unique minimum required attributes as described in appendix 1 shall be loaded in the facility registry database.
  • Develop standard definitions for attributes using MDDS elements as provided in the Annexure I.
  • Identify & publish mismatches and duplicates in the standard definition template and suggests standard process of verification with district and health state departments.
  • State can filter facilities district wise and get the data verified through the respective district health department.
  • Districts can update information in excel format and request corrections if any to the state.
  • State after verification and validation can push the cleaned facility data to the centre.

 3.  Convert the clean, verified data using a technology partner like NIC into a registry.

The first step towards digitalizing the National Facility Registry after receiving clean and validated data is to load the cleaned facility data into the National Facility Registry. The facility registry shall store the source ID of each system (NHRR ID, NIN ID and ROHINI ID) against the set of data attributes loaded from each of these three data sources to facilitate the facility data set retrieval from registry based on different identifiers (e.g. based on ROHINI ID or NHRR ID) and thus it shall not disrupt the design of existing systems which are using this data.

The loading process of facility data into facility registry shall ensure the uniqueness and deduplication of facility data by using validation/data deduplication engine. A National unique facility Identifier shall be generated for each facility populated in the facility registry (the algorithm to generate the unique facility identifier should be decided by the authority implementing the design of facility registry), The facility unique Identifier will be a 10 digit unique Integer value and should not contain any data attribute based logic in the design of identifier code due to volatile nature of the facility data attributes as that may change in future e.g. if facility identifier contains the logic built based on the location of facility e.g. state and district code, the same may change due to administrative change of the location of facility due to addition or deletion of state or district by the respective state government in future. It is recommended that facility identifier should be a running serial number generated based on a selected algorithm like generation of AADHAR NUMBER which generate a unique number which is unique across the lifetime.

4.    Develop a central portal with standard operating procedures on deletion, updation or addition of facilities.

  • Portal for enrolling new public and private facilities into National Facility Registry.
  • Public Portal for access to National Facility Registry data as part of e-governance.  

 5.    Develop a roadmap for training & updation of National Facility database by state users.

 6.    Maintenance of National Health Facility Registry

For maintenance of Facility data in Facility Registry. openAPI/web service standards can be used to add/update or delete facility data. After Initial load of facility in facility registry any new facility shall be added in the Registry by use of openAPIs/webservices. The updation of facility registry shall follow the design principles for registries as laid out in National Health Stack document and will ensure the single source of truth and non repudiablity of facility data in registry.

Advantages of a harmonized facility registry using NHRR, NIN and ROHINI

  • The National Facility Registry will be a single source of truth for all the clinical establishments or healthcare facilities in India and can be a single point of reference for health infrastructure planning.
  • The Facility registry will always also help the Government to plan emergency responses and predict healthcare expenditure by making operational status of facilities available.
  • Harmonizing the different initiatives like NHRR, NIN and ROHINI will help in collating authentic data for facilities which are already recorded under respective initiatives while the initiatives coexist in harmony and expose the data as a service.
  • A repository like NHRR and state repositories if linked with the National Facility Registry can provide more information about a facility’s resources like Doctors, Nurses, equipment etc which will help a state to plan optimized utilization of available resources.

 A harmonized National facility registry can be one shot solution, which can support the Government to manage and optimize healthcare infrastructure & resources effectively and predict the unmet needs to design an effective risk mitigation plans in advance to combat a future pandemic. It can identify key areas of improvement by upgrading existing health facilities or establishing new health facilities keeping in view the population density, geographic nature, health condition, distance.

For Annexures please read the full Health Facility Registry document on slideshare.

Reach out to us for clarifications:

digital.health@accessh.org

Department of Digital Health, ACCESS Health