As part of the Digital India initiative, All India Institute of Medical Sciences (AIIMS) issues a Unique Health Identification (UHID) number to each patient, which documents their entire journey in the hospital. AIIMS has called for a mandatory linkage between UHID and Aadhaar. In this article, Mudit Kapoor, Associate Professor at ISI Delhi Centre, explains how this step can have significant positive implications for delivery and democratisation of healthcare.

All India Institute of Medical Sciences (AIIMS) has requested the Ministry of Health for a mandatory linkage between Unique Health Identification (UHID) and Aadhaar¹. This seems like a simple and a straightforward suggestion but deep down it has major implications for delivery and democratisation of healthcare. In this article, I argue that this linkage should be mandatory for all hospitals, both public and private, primarily because it empowers the patients to have access to their own medical records.

How UHID works

As part of the Digital India initiative, AIIMS issues a UHID to each patient who visits the hospital for the first time. In subsequent visits, the patient is expected to reproduce this number. The UHID plays an instrumental role in documenting the patient’s entire journey in the hospital. With this it is possible to track the date and time of the patient visit, the departments where the treatment was offered, the tests and the sub-tests that were undertaken and their results, if the patient was admitted (in-patient) then date and time of the ward in which the patient was admitted, the procedures performed, date and time of discharge, the release description (such as cured, expired, etc.) and the diseases codes. Within AIIMS, availability of this data helps the doctor to develop a more accurate medical history of the patient. Also, this significantly reduces the burden on the patient to either produce past medical records or recall all the necessary treatments or procedures done. This has significant impact on quality of care by reducing the risks of medical errors and negligence, better patient management, avoiding unnecessary investigations, etc.

Linking UHID and Aadhaar

In practice, however, there are many patients that are either unable to produce records of their previous visits to the hospital or do not recall the UHID number, as a result of which a new UHID is issued and in the process, precious medical history of the patient is lost. Aadhaar has a potential to resolve this issue. Aadhaar is a nationwide unique identification which is used for multiple purposes, therefore, significantly easier for patient to reproduce. If this is linked to the UHID then it will be much easier for doctors to access the medical history without putting any burden on the patient. Moreover, the patient has cheap and reliable access to his own medical records.

A medical record is the property of the patient and just like any property its value depends on proper identification, accurate documentation, easy transferability, and the rights to access it. If all hospitals’ UHIDs are linked to Aadhaar, then it has the potential to create a universal health record for the patient. With Aadhaar, patients can request the hospital to transfer their medical records to their digital locker which they can access from anywhere at any time. This will lead to democratisation of healthcare delivery.

Let me illustrate this with an example. Consider a patient from a village in Bihar who is visiting a district hospital for an ailment. Under the Digital India initiative, the district hospitals are expected to maintain a Hospital Management Information System (HMIS) that records the details of patient visits, disease, treatment offered, and outcomes (cured, referred, expired, etc.). If this information was linked to the patient’s Aadhaar, then this could potentially be stored in the patient’s digital locker. Now suppose the patient is referred to tertiary healthcare such as at AIIMS (more than 50% patients in AIIMS come from Uttar Pradesh and Bihar). With easy access to the digital locker at any time, the patient can transfer all the past medical information to the doctor in AIIMS who will have a far more accurate medical picture than a scenario in which he has to rely only on the testimony and the records of the patient.

Perhaps in the future it would be possible to link all medical visits, from the primary health centres, community health centres, secondary, and tertiary care hospitals to Aadhaar. This will help in the development of a comprehensive health record of the patient that is accessible anywhere at any time.

What the government should do

As a first step in the development of a comprehensive health record of a patient, it is important that the government makes it mandatory for all the hospitals to link their UHID to Aadhaar and give digital access to the patient to their own medical records which can be stored in the digital locker. To achieve this the government must take steps to ensure that basic data on each patient is collected in all hospitals:

• Date and time when the patient was admitted.
• Vitals of each patient: weight, height, blood pressure, hypertension, diabetic or not
• Disease code using the ICD-10 codes².
• Date and time stamp when the patient was discharged.
• Discharge outcome: Cured, death, LAMA (Leave Against Medical Advice), etc.

In conclusion, linking UHID to Aadhaar can allow for the development of comprehensive health records of the patients. It empowers the patient with the right to access his own medical records anywhere at any time. This can be an important step in the democratisation of healthcare delivery.

This article first appeared on Mudit Kapoor’s blog: http://mudit-kapoor.blogspot.in/2016/12/unique-health-identification-and-aadhar.html

Notes:

1. Aadhaar or Unique Identification number (UID) is a 12-digit individual identification number issued by the Unique Identification Authority of India (UIDAI) on behalf of the Government of India. It captures the biometric identity – 10 fingerprints, iris and photograph – of every resident, and serves as a proof of identity and address anywhere in India.
2. ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases.