Data Use Community, April 2023
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The Data Use Community (DUC) is an open global community passionate about improving health and healthcare data sharing and use. It is a forum of virtual meetings and an online discussion board for sharing and learning from peers and country experiences. On April 26, 2023, Gibril Gomez, Director of Health Informatics with Public Health Information, Surveillance Solutions, and Systems (PHIS3), shared the Nigerian experience with deploying a patient identity management system utilizing an existing biometrics solution. Below is a summary written by the DUC Secretariat of what was understood at the time of sharing.
Background
The use of electronic medical records (EMRs) has facilitated the capture of individual characteristics and medical history digitally. The challenge, however, is when individual patients have information stored across different facilities as they seek and receive health services – making it difficult to understand the complete picture of the care received. Patient identity management systems (PIMS) help to identify and link individual patients across different EMRs.
The Public Health Information, Surveillance Solutions, and Systems (PHIS3) is working to scale PIMS in Nigeria by leveraging their successes deploying a biometrics enrollment and identification process at health facilities. To enhance the process of unique patient identification, the Nigerian HIV program began capturing biometric data in the form of fingerprints in 2018.
The goals of PHIS3 were broadly to:
Create a centralized system where all fingerprints in the country could reside.
Maintain a central repository where clients are uniquely identified at the national level.
Enable clients to access care at different facilities through their unique identification.
Link client records from different locations to create complete longitudinal health records.
Authenticate clients at the point of registration to determine if a patient is already in the system, and if not, register the patient and collect biometrics.
Technical Approach
The biometrics data is intended to work with the national data repository (NDR) at the point-of-entry when a patient enrolls at a health facility. National Data Repositories (NDR) are centralized systems that collect individual-level data at the national level. A NDR can be used effectively for secondary purposes such as disease surveillance, monitoring, and evaluation. During enrollment, a patient’s identity is verified using his/her fingerprints collected through the EMR and cross-checked against the NDR. If a patient is not identified as already being in the system, a patient profile is created at the health facility. The flow diagrams below illustrate this process.
Diagram 1: Patient Enrollment Process via Biometrics
Diagram 2: Biometrics Verification Process
The technical components and processes used to collect fingerprint information are highlighted in the table below.
Table 1: Technology Components
Impact & Challenges
This implementation has allowed the Nigerian HIV program to gain insights towards controlling the epidemic by helping with patient record management and continuity of care. Since January 2022, over 80% of clients on antiretroviral therapy (ART) in Nigeria have had their biometric fingerprints captured and as of April 19, 2023, there were 2,072,961 total clients reported as active. Of these, 97% of clients’ fingerprints were captured; 99.94% of the captured fingerprints had been processed; 99% of the processed fingerprints were valid; and 97% of the valid fingerprints were unique.
Lessons Learned
Implementing biometrics at health facilities has had a variety of challenges including the quality of biometric capture, migration of EMRs, enrollment issues, and acceptability. To mitigate these challenges, PHIS3 has implemented several strategies such as:
Having measures in place to assess invalid fingerprints, fingerprint quality, and duplication can help with assessing the population of clients whose fingerprints are not yet captured and collecting fingerprints from those clients.
Having technical assistance (TA) with facilities across the country can help address quality and duplication concerns. In addition to this interaction:
Facilities are provided with weekly line lists of patients so facilities can see their data and know where they stand with regards to patient biometrics.
Weekly meetings are held with partners to provide updates and provide weekly trackers.
Dedicated points of contact (POC) are assigned to facilities and being available as needed to provide support and TA.
A patient biometric dashboard (PBD)was established that refreshes every 24 hours that provides true daily numbers. Previously the dashboard updated every 48 hours.
Looking Ahead
Despite the number of patients with biometrics captured, the issue of invalid fingerprints and duplicate and/or mis-matched records remain. Additionally, the process for verifying a patient’s biometrics information against the NDR is not immediate at the time of enrollment and can take several days.
A beta version of PIMS is currently being tested. The objectives for this project include having fingerprints captured and validated on the NDR; real-time fingerprint authentication on-site, creating a maintenance culture and a data governance policy document. The proposed PIMS has had successful testing in Lagos and Abuja. Testing continues to ensure optimal functionality for the release date in September 2023. The figure below shows the proposed process flow:
Diagram 3: Proposed PIMS Process Flow
For more information on the experiences in Nigeria, please visit the DUC presentation here.
References
DUC Meeting April 26, 2023: Presentation by Gibril Gomez, Director of Health Informatics, PHIS3
https://www.ciheb.org/Data-Resources/Surveillance/Nigeria-National-Data-Repository-NDR/
