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:

Department of Digital Health, ACCESS Health


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