Every citizen to have a Personal Health Number
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In the past nine months, I have written several columns in the Business Times on various aspects of eHealth and ICT implementation in Sri Lanka. Some of them have been descriptions of what is going on in the country and others, like the column in August,proposed a change to the status quo and a new way forward. Of these columns, the one which grabbed the most attention and reaction from the readers was the one in August (readers check -http://www.sundaytimes.lk/150830/business-times/health-record-system-paves-the-way-for-digital-health-in-sri-lanka-162125.html)
https://ssl.gstatic.com/ui/v1/icons/mail/images/cleardot.gif> That tells us that the public is not happy about the current state of affairs and they look forward to a change. A change in the way their health information is collected, shared and disseminated. The background to this is slowly being put in place.
First step
The first step in this process is the rolling out of a Personal Health Number, which has already commenced in several hospitals. The National eHealth Guidelines and Standards adopted recently by the Ministry of Health states that computerised systems in the Sri Lankan healthcare sector shall use the Personal Health Number (PHN) to connect the healthcare recipients to their appropriate health record. The PHN is a unique number assigned to a particular individual. The PHN will be issued to the patient upon his first contact with the healthcare sector and it is strongly advised to continue it for his/her life. It is recommended that all healthcare institutions issuing the PHN should not issue a new PHN for individuals already having a PHN, unless in instances where ensuring the anonymity of the individual is requested.
There are three components to the number, which are: Point of Issue number (a four digit alphanumeric number, which is assigned to every health care institution or point at which an individual comes into contact with the health care system whether it be in the government sector or the private sector); a Serial Number (6 digit numeric which will be serially generated for each point of issue) and a check digit (generated using the modified Luhn Algorithm used by Regenstrief Institute Inc). The Health Information Unit (HIU) of the Ministry of Health will be the issuing authority to assign a number for the point of issue. State and private healthcare institutions can obtain the point of issue number from the HIU. What was noteworthy was that this initiative was welcomed by the representatives of the private sector who were present at the final consultative meeting to adopt the National eHealth Guidelines and Standards. This initiative has been nearly six years in gestation and, for those of us who have been invited in from the beginning; mission accomplished.
Patient-held personal
health record
With the adoption of the National eHealth Guidelines and Standards, the stage is set to move to the next step which would be to work towards the patient-held or patient-controlled personal health record that I described in my column in August. There are many direct to consumer personal health record initiatives in Sri Lanka. The first one that gained national recognition was the personal health record system developed and deployed by Dr. Deepal Wijesuriya through his hospital, the Family Care Hospital in Kalutara (www.familycarehospital.com).
The system today is said to be used by over 5,000 patients. It received an eSwabhimani Merit award in 2012. A somewhat similar initiative is edoctor.lk. Another system developed and deployed by Dr. Harsha Jayakody that is being rolled out in the private sector. It is said to have over 10,000 patients.
The largest hospital based electronic health record initiatives however are still in the government health sector. The Hospital Health Information Management System (www.hhims.org), an initiative of the ICTA, has been deployed in 19 base (general) and district hospitals and clinics of some larger hospitals. The system has gained popularity largely due to the efforts of Dr. Sampath Kulathilake of the Dompe Hospital. The Hospital Information System, an initiative of the Ministry of Health, driven by Medical Officers in Health Informatics in the Ministry, is led by Dr. Nishan Siriwardena and has been deployed in large hospitals. What is interesting is that doctors both in the government and private sectors are driving these initiatives. It is said that products of any particular system would maintain the status quo, in this case, however, these doctors have come forward to make a difference.
300 hospitals
2016 would be a crucial year as eHealth deployment in Sri Lanka starts gathering momentum. The ICTA is planning to support the computerisation of up to 300 hospitals in the next three years with major improvements in Internet connectivity. The time is right, therefore, to discuss what the patient-held personal health record should look like and the minimal set of information that the systems being deployed at institutional level should share with or contribute to the patient-held personal health record. I believe that the patients should have a voice in these discussions and I hope that that discussion would commence sooner than later through both the print and electronic media.(The writer is the President, Health Informatics Society of Sri Lanka; the Past President, Sri Lanka Medical Association; the President-Elect, Commonwealth Medical Association; and a Fellow of the National Academy of Sciences of Sri Lanka. He can be contcted via vajirahwd@hotmail.com).