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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.
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.
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.
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.