Data Use Community, February 2023
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The Data Use Community (DUC) is an open global community passionate about improving health and healthcare data sharing. It is a forum of virtual meetings and an online discussion board for sharing and learning from peers and country experiences. On February 22, 2023, Dr. Joseph Sitienei with the Ministry of Health in Kenya shared the government’s experience establishing a unique patient identification process and framework. Below is a summary written by the DUC Secretariat of what was understood at the time of sharing.
Background
As individuals move throughout the health system, it becomes difficult to understand and track the entirety of health services delivered and received – leading to duplication of services, medical errors, and poor patient management. Systems and processes to support unique patient identification (UPI) can help with ensuring that individuals receive the continuity of care needed for better health outcomes. With Kenya’s implementation of Universal Health Coverage (UHC) and focused care approach, the Ministry of Health (MoH) recognized that UPI has the potential to strengthen patient management and quality of care, promote efficiency in service delivery, support disease surveillance, and advance efforts towards the digitalization and integration of shared health records.
To support Kenya’s efforts to deploy UPI processes at health facilities, the MoH developed the Health Sector Unique Identification Framework, which outlines the governance and systems requirements necessary for successful implementation. The Partnership Coordination Framework was used to guide the co-creation approach for developing the framework (Diagram 1).
Diagram 1: Partnership Coordination Framework
Technical Approach
Kenya uses a distributed generation approach with the UPI being “generated at the point of assignment without any reference to a central authority”. The diagram below outlines the workflow for how a patient is registered and verified when entering a health facility (Diagram 2).
Diagram 2: Patient Registration and Verification Flow
As part of the UPI process, queries may be sent to both the local patient registry (e.g. health facility) and Kenya’s Master Patient Registry (KMPR) to determine whether or not to register an individual as a new patient. The diagram below highlights KMPR’s architecture and workflow (Diagram 3).
Diagram 3: Kenya’s Master Patient Registry Architecture
The technical components and processes used to generate UPIs are mentioned below (Table 1).
Table 1: Technology Components
Impact & Challenges
During the COVID-19 pandemic, the KMPR was used to capture individual information as part of the vaccine registration process – bringing the total number of registered to 22 million or nearly half of all Kenyan citizens. While efforts to scale continue, there are several challenges worth noting:
Existing health system infrastructure not optimally configured for UPI with disparate health information systems, including paper-based that are not set up to capture unique numbers;
Limited resources to implement advanced technologies like biometrics to capture individual identifiers; and
Change management issues due to lack of awareness from patients and health providers on the benefits of UPI.
Lessons Learned
There are several takeaways from Kenya’s experience implementing UPI processes at health facilities.
Gaining stakeholder trust is critical when collecting sensitive information. Patients and health workers need to be engaged when developing the process, so that there is buy-in from the start.
Leveraging existing resources can help move the process along, while at the same time investments are being made to strengthen the infrastructure and processes.
Strong political will can mobilize increased resources and investments. The government’s commitment to digitalizing the health information system has supported the passing of an e-Health bill that will anchor many of the requirements outlined in the Health Sector Unique Identification Framework into law.
Looking Ahead
The Kenyan government took a variety of steps to help ensure the implementation and acceptability of a UPI system to uniquely identify patients and deliver optimum health care. These steps included leveraging the country’s national person identification system (KMPR) and involving the community to “own” the process. As a next step, the MoH will work to scale the UPI country-wide and continue to explore other technologies for identifying individuals such as biometrics.
For more information on the experiences in Kenya, please visit the DUC presentation here.
References
DUC Meeting February 22, 2023: Presentation by Dr. Joseph Sitienei, Ministry of Health - Kenya
