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# **Shareable Health Record (SHR): A Game-Changer in Bangladesh's Healthcare Digitalization**
## **Introduction to Shareable Health Record (SHR)**
**SHR** stands for **Shareable Health Record of Bangladesh**, previously known as **Shared Health Record**. The Shareable Health Record (SHR) is a cornerstone of Bangladesh's strategy to establish a seamless **Health Information Exchange (HIE)**. Built on the globally recognized **OpenHIE framework**, SHR enables the secure sharing of health data among diverse digital healthcare solutions. Its ultimate vision is to create a **Personal Health Profile (PHP)** for every citizen, capturing their entire medical journey from birth to death.
SHR ensures **interoperability**, adherence to international standards, and data-driven healthcare policies. It serves as the foundation for Bangladesh’s ambition to achieve **Universal Health Coverage (UHC)** and provides an essential platform for potential health insurance policies in the future.
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## **Core Components of SHR**
The SHR initiative comprises several interrelated components, each crucial for effective health data management and exchange:
### **1. Unique Health ID Service**
- The **Unique Health ID** is pivotal for SHR. It acts as a unique identifier for every citizen, ensuring that health records are accurately linked to individuals across facilities.
- Issued based on **National ID (NID)** or **Birth Registration Number (BRN)**, the Health ID prevents duplication and ensures universal inclusion.
### **2. Master-Client Index**
- A centralized registry linking every Health ID with demographic details, facilitating consistent identification of individuals across healthcare systems.
### **3. Terminology Registries**
These registries standardize data collection and ensure interoperability by providing a unified structure for:
- **Population Registry:** Derived from Health IDs, this provides demographic insights into the country's population.
- **Facility Registry:** A comprehensive database of all healthcare institutions, including public and private sectors.
- **Provider Registry:** A registry of all healthcare professionals from both public and private sectors, ensuring traceability and accountability.
- **Geolocation Registry:** Links health facilities and encounters with geographic locations, enhancing service delivery and accessibility.
- **Citizen Core Data Structure (CCDS):** Captures and records patients' demographic information for consistent documentation.
### **4. Exchange of Clinical Encounters**
- SHR enables the secure and standardized exchange of clinical data between healthcare providers. This ensures continuity of care and avoids duplication of diagnostic tests or treatments.
### **5. Adoption of HL7 FHIR**
- SHR uses the **Fast Healthcare Interoperability Resources (FHIR)** framework, a global standard for exchanging healthcare information electronically. This ensures compatibility with international health IT systems.
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## **Clinical Terminologies: Progress and Future Plans**
To ensure consistency in clinical data, SHR incorporates internationally recognized terminologies:
- **ICD-10:** Used for classifying diseases and health conditions. Plans are underway to upgrade to **ICD-11**, offering more precision and better alignment with digital health systems.
- **LOINC:** Facilitates standardized reporting of laboratory and clinical test results.
- **DICOM:** Enables the exchange of medical imaging data, essential for radiology and diagnostic services.
- **SNOMED-CT:** Currently under discussion, this terminology provides a comprehensive vocabulary for clinical terms, enhancing the detail and accuracy of medical records.
---
## **Vision of SHR: Personal Health Profile (PHP)**
The ultimate goal of SHR is to create a **Personal Health Profile (PHP)** for every citizen, which will:
- Consolidate all medical encounters into a single, unified health record.
- Provide a complete health history from birth to death, accessible with the patient's consent.
- Enhance continuity of care, particularly for patients with chronic diseases or complex medical histories.
- Citizens can access their own **Personal Health Profile** through [https://eappointment.dghs.gov.bd](https://eappointment.dghs.gov.bd).
---
## **Benefits of SHR**
### **1. Health Information Exchange (HIE)**
- SHR ensures that health data can flow seamlessly between different healthcare facilities and systems, improving collaboration among providers.
### **2. Interoperability**
- By adhering to global standards like HL7 FHIR, ICD, LOINC, and DICOM, SHR ensures compatibility across diverse systems, reducing fragmentation in healthcare delivery.
### **3. Data-Driven Policy Decisions**
- Consolidated health data provides actionable insights for policymakers, enabling efficient resource allocation, disease surveillance, and epidemic management.
### **4. Universal Health Coverage (UHC)**
- SHR supports UHC by providing a robust platform for monitoring healthcare access and quality across the population.
### **5. Health Insurance Enablement**
- A unified health record system will be indispensable for implementing a national health insurance policy, ensuring transparency and accountability in claims processing.
### **6. Enhanced Patient Care**
- SHR reduces duplication of tests and treatments, ensures continuity of care, and empowers patients by giving them control over their health data.
---
## **Additional Features of SHR**
### **API-Driven Connectivity**
- SHR is built around a robust set of APIs that facilitate integration with various healthcare platforms and services.
- These APIs enable both **public and private hospitals** to connect with SHR, regardless of the platform of their hospital automation system. Using **OpenMRS** is not mandatory; any compatible system can integrate with SHR.
### **Open Platform for All Hospitals**
- SHR is designed to ensure universal connectivity across Bangladesh’s healthcare network, providing equal opportunities for all public and private hospitals to join the system.
---
## **Challenges in SHR Implementation**
### **1. Standardization of Clinical Terminologies**
- While **ICD-10**, **LOINC**, and **DICOM** have been adopted, there is ongoing debate about including **SNOMED-CT**, which could significantly enhance clinical documentation.
### **2. Infrastructure Gaps**
- Ensuring stable internet connectivity and IT infrastructure across rural and remote areas is critical for SHR's success.
### **3. Privacy and Security**
- Handling sensitive health data requires robust data protection measures to maintain patient trust.
### **4. Stakeholder Collaboration**
- Coordinating among public and private healthcare providers to ensure consistent adoption of SHR is a complex task.
---
## **Conclusion**
The **Shareable Health Record (SHR)** initiative is a transformative step toward achieving **interoperability**, enhancing healthcare efficiency, and building a **patient-centered health system** in Bangladesh. By integrating cutting-edge technology and global standards, SHR is poised to revolutionize healthcare delivery, support **Universal Health Coverage (UHC)**, and enable data-driven policymaking.
As Bangladesh continues its journey with SHR, the initiative will not only improve individual patient care but also empower the nation to address public health challenges with **precision**, **efficiency**, and **innovation**.