ABSTRACT
In today's world, digital technologies are advancing at a rapid pace. Almost every industry has benefited from this ongoing change. In the health sector, the digitization of medical records was proposed decades ago. Whereas some developed countries have successfully adopted and implemented Electronic Health Record (EHR) systems. Developing countries like India still heavily rely on paper-based medical records. Although there are a number of systems for electronic medical record management, they have issues related to interoperability, timely access, and storage. Due to poor infrastructure and design, the current systems are not robust for communicating and tracking medical records. The need for a better EHR system was highly emphasized during the COVID-19 pandemic. The two major shortcomings of the existing system are a lack of interoperability, which causes delays in sharing the information, and a lack of standardization, due to which the data quality of the data that is shared suffers. To mitigate these issues, we need a nationwide EHR system. Another issue is the lack of a ubiquitous UPI (Unique Patient Identifier). In a country like India, the second most populated country in the world, Aadhar is the best option for UPI, which can be used for creating a national EHR system. In this paper, we have presented a framework for a standardized, interoperable, and unified EHR system based on blockchain technology with Aadhar as the UPI. Using blockchain as the base of this model provides numerous advantages over a cloud-based system, like decentralization, better security, immutability, and traceability. © 2023 IEEE.
ABSTRACT
BACKGROUND: South Africa's National Health Laboratory Service (NHLS), the only clinical laboratory service in the country's public health sector, is an important resource for monitoring public health programmes. OBJECTIVES: We describe NHLS data quality, particularly patient demographics among infants, and the effect this has on linking multiple test results to a single patient. METHODS: Retrospective descriptive analysis of NHLS data from 1st January 2017-1st September 2020 was performed. A validated probabilistic record-linking algorithm linked multiple results to individual patients in lieu of a unique patient identifier. Paediatric HIV PCR data was used to illustrate the effect on monitoring and evaluating a public health programme. Descriptive statistics including medians, proportions and inter quartile ranges are reported, with Chi-square univariate tests for independence used to determine association between variables. RESULTS: During the period analysed, 485 300 007 tests, 98 217 642 encounters and 35 771 846 patients met criteria for analysis. Overall, 15.80% (n = 15 515 380) of all encounters had a registered national identity (ID) number, 2.11% (n = 2 069 785) were registered without a given name, 63.15% (n = 62 020 107) were registered to women and 32.89% (n = 32 304 329) of all folder numbers were listed as either the patient's date of birth or unknown. For infants tested at < 7 days of age (n = 2 565 329), 0.099% (n = 2 534) had an associated ID number and 48.87% (n = 1 253 620) were registered without a given name. Encounters with a given name were linked to a subsequent encounter 40.78% (n = 14 180 409 of 34 775 617) of the time, significantly more often than the 21.85% (n = 217 660 of 996 229) of encounters registered with a baby-derivative name (p-value < 0.001). CONCLUSION: Unavailability and poor capturing of patient demographics, especially among infants and children, affects the ability to accurately monitor routine health programmes. A unique national patient identifier, other than the national ID number, is urgently required and must be available at birth if South Africa is to accurately monitor programmes such as the Prevention of Mother-to-Child Transmission of HIV.