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Unique Patient Identifiers in Resource-Limited Settings

Added on 21 Dec 2011
Last updated on 20 Jan 2012

Authors: Sophie G. Beauvais, Reviewed by Joaquin A. Blaya, PhD

A member working at a clinic in rural India shares challenges with patient identification. Advocates for unique patients identifiers (UPI, also “patient ID” and “unique identifiers”) insist that a health care system in which every patient has a unique, nondisclosing patient identifier is desirable for reducing errors, simplifying interoperability, increasing efficiency, improving patient confidence, promoting flexibility, and improving the continuity of care for chronic conditions like HIV/AIDS and across the health system. (RAND. 2008. UNAIDS. 2009) They also note privacy concerns over personal health information. Members from across the American, Asian, and African continents share their experiences with various health IT systems and thoughts on policy issues.

Key Points

  • UPI allow for easy patient registration, medical record retrieval, and the reduction in paper record for staff.
  • Baobab Health in Malawi had good results with bar-coded ID cards and labels attached to health passports.
  • Members agree that organizations should start with the simpler approach over biometrics such as finger prints. Also, before starting a new ID system from scratch which can be very long and politically-charged, one member advises to research into other groups and government agencies that might use and store IDs that can be worked with.
  • Geographic Information System (GIS) technology, which provides coordinates for home addresses usually linked to head of household, can be a starting point.
  • Mobile phones can be used in combination with a Personal Identification Number (PIN) to establish a robust 2-factor authentication of individuals. The Subscriber Identity Module (SIM) card of a phone is a globally unique ID coupled with the PIN. The member who suggested this model adds that “As a best practice, the PIN should be keyed using an interactive voice response type of system (IVR) or some other alternate to SMS since they leave the PIN codes in the text outbox (which does not protect the PINs between multiple people sharing the same phone).
  • Jessica Haberer, a moderator of the Adherence & Retention community, shared that her group ran into issues using PINs with patients in rural Uganda (AIDS Behav. 2010). She advises on doing focus groups and other testing before setting up PIN systems.
  • In areas where mobile phone adoption is not as strong, a "community phone" at the clinic could be employed. Such systems are used today in some regions to support mBanking (see references).
  • An alternative to SMS is Unstructured Supplementary Service Data (USSD) but the start-up costs are high.
  • Patient ID systems can support emergency preparedness and response.

Policy and Regulations

  • Knowledge of the regulatory environment is a must before planning and implementing any patient ID systems since health data privacy laws vary a lot betweencountries. The Health Insurance Portability and Accountability Act (HIPAA) is one example in the United States.
  • In cases where there are multiple jurisdictions, an Enterprise Master Patient Index (EMPI) should be set up. “An EMPI is a form of Customer Data Integration (CDI) specific to the healthcare industry. Healthcare organizations or groups of them will implement EMPI to identify, match, merge, de-duplicate, and cleanse patient records to create a master index that may be used to obtain a complete and single view of a patient. The EMPI will create a unique identifier for each patient and maintain a mapping to the identifiers used in each record’s respective system.” (Source: Wikipedia, Accessed December 20, 2011)
  • According to one member in Swaziland, the difficulty comes from the Ministry of Health not adopting/agreeing upon a consistent strategy with respect to national IDs as well as the prevalence of similar names and the lack of enforcement of needing a birth certificate. Additionally, there are politics and mistrust about using the IDs of the Department of Home Affairs for medical reasons.

Specific examples

  • Operation Asha in India has teamed up with Microsoft Research and Innovators in Health to launch eDOTS, a system that uses a fingerprint reader and a cell phone to identify patients, record their adherence and alert a health worker when to visit a patient.
  • The Unique Identity Authority of India (UIDAI) recently rolled out Aadhaar, the brand name for the program to issue every resident a unique identification number linked to the resident's demographic and biometric information, which can be used for identification anywhere in India.  A project description can be found here.
  • After noticing that even the poorest families in Pakistan own a cell phone, a member’s organization used cell phone contact numbers as patient identifier. As several people could use the same phone, the organization staff then used names, gender and other details to further identify patients.
  • A major hospital in Pakistan uses a camera to take pictures of patients at registration which then gets attached to their records.
  • The Millennium Villages Project (MVP) uses OpenMRS with a base-30 character set  and a Luhn algorithm Mod 30 identifier validation scheme as a check digit for both OpenMRS-entered patients and the ChildCount+ information system for community health workers (mobile phone entry). 
  • A member in Ecuador notes that they use the national identity card number as the unique patient ID.

Key References

Enrich the GHDonline Knowledge Base
Please consider replying to this discussion with the following information

  • What does your health center/organization do for patient identification? What are the pros and cons of this system?
  • Have you had experience in creating a patient ID system at a local, regional or national level where you have learned valuable lessons to share with others?

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