Author: Vinod Kumar*, R Hruthika*

(Guided by: Prof. Gouhar Sultana*, Asst. Prof. K. Naveen Kumar)

“One’s Health Status is Always A Prior Responsibility’’

KEYPOINTS

• Individual clinical profile defines one’s health status (patients) during their lifetime (birth to death) by providing the demographic and medical details.
• It serves as a memory bank of individual’s clinical history and as a platform of resource or reference.
• The medical history of each patient can be stored in the electronic format which can be easily accessed by the individuals.
• Individualized patient specific treatment can be provided upon medical reconciliation.
• The medical reconciliation errors (use of same ineffective drugs, allergies, previously occurred ADR’s) can be limited, which can improve the patient’s quality of life.
• The clinical data determines patient specific therapy thereby decreasing the economic burden on patient.
• The data in turn establishes the epidemiological studies and aids in clinical navigation.
• The epidemiological studies can be used further to assess the risk factors occurring in specific regions.
• Clinical navigation in health sector aids in early prognosis and prevents complications and progression of disease.
• The clinical data can be served as an evidence for providing health insurance in case of financial distress.
• Software databases included in CoverMyMeds care, pointclick care, sigma care can be served as a reference for the development of clinical profile.

INTRODUCTION

Globally, the total population is around 8 billion. Over 95% of world’s population has health problems, with over a third having more than five ailments.¹

The WHO defines “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.²

There are millions of cases treated worldwide in day-to-day life. In the present scenario, the health records (OP, IP in hospital) of the patient are available in the written format only hence there is a possibility of incomplete clinical data entry upon medical reconciliation.

The Rationale of this article is to provide the complete details regarding health status of the patient there by projecting history of patient clinical condition in determining the accurate therapy. The concept is not only beneficial for the patient outcomes but can also promote clinical navigation (early diagnosis) for physicians and in epidemiological studies (countries, state, district, local regions).

By this context, we can improve the individual therapy upon reconciliation and also prevent the ADR’s (hypersensitivity reactions, ineffective drugs, complications, etc.), resistance of drugs and decrease economic burden on patient.

This can be generated via an app or webpage (centralized or private) it exists in four sections (patients, physicians, epidemiologists, clinical data managers). The data can be accessed separately for each section by their respective identity codes. The aim of this study is to provide complete details regarding the individual patient health profile, which includes patient demographics (personal, allergy, resistance, ineffective drugs) and clinical profile (medical history).

The clinical and demographic details of patients interlink and provide the information on epidemiological studies (also in assessing risk factors), clinical navigation by referring to similar case reports.

OBJECTIVES:

• Development of clinical profile for individual patient regarding their health status during the lifetime.
• To provide appropriate treatment approach upon medical reconciliation and minimize errors of medical reconciliation.
• To promote early clinical navigation by referring to similar case clinical findings
• To estimate epidemiological data and assess the causative factors.
• To decrease economic burden on patient by not repeating the primary lab findings (blood group, sensitivity tests etc.)
• To determine and prevent ADR’s of same drugs in future upon reconsultation.

METHODOLOGY

Section-1: Patient Profile (One’s Health Status)

The access for the patient clinical history can be viewed by entering a unique identity code for individual patient. The code can be generated as like an ID proof (Ex: Aadhar Number, Pan Card or QR Code etc.). In case of emergency (accidents, unconscious patients and in recondite demographic cases) the patients biometric or retina can be included for accessing the data.

This section provides the details regarding the;

• Demographic details (name, age, sex, weight, height, occupation, address, marital status)
• Medical details (blood group, allergies, vaccination, resistant drugs, ineffective drugs, diseases, lab investigations, drugs, surgeries, etc.).

The clinical details of patient can be provided in the following format:

By providing these details the life status of patient can be assessed priorly and necessary prophylactic therapy can be provided, it also aids in prevention of previously assessed side effects.

These clinical details can be provided for physicians for clinical navigation and assessing the risk factors based on epidemiological studies. The data can be established and made available in various health sectors like Government Agencies, private hospitals, pharmacies etc. for healthcare professionals like physicians, pharmacists and also patients in the form of any data base (Electronic Health Record) or hard copy. As the profile is dealing with the clinical conditions of patient, it is necessary to keep the details in confidential manner, a private ID can be provided for each individual as like mobile password so that it can be legally accessed only by the patients.

An op-ed (opinion-editorial) section is provided to share the opinion or viewpoints from patient for the profile updates.

Section-2: Clinical Navigation

One of the major factor of increasing mortality rate is “time (disease) progression”. An early diagnosis and treatment initiation can help to improve the patient’s quality of life. We can make these easily by providing the appropriate resources i.e. case reports. Several categories of diseases are accompanied by salient clinical feature , one can easily estimate the prognosis of diseases. It also serves as a reference for professionals for a better treatment approach.

Physicians can access the section through a code (Ex: Medical license)

An appropriate clinical presentation or any laboratory findings which is specific for the disease, provides a platform for the early identification of the disease condition. This section involves all the clinical profiles of patients listed (without demographics as matter of confidentiality).

Ex: Identification of poisons based on clinical symptoms (pinpoint pupil and rhabdomyolysis in opiate poisoning) and providing appropriate therapy, titration of doses (corticosteroids tapering), withdrawal symptoms (alcohol) and behavioral patterns on step-down therapy etc.

This section provides the details of patient cases categorized according to departments involving all related diseases. The physician can access the data by clicking on specified department and related disease. The clinical feature can be mentioned in search bar, such that the related cases with specific feature will be displayed accordingly.

An op-ed (opinion-editorial) section is provided to share the opinion or viewpoints from physicians for the profile updates (for any clinical intervention).

Section-3: Epidemiological Studies

Epidemiology is the study of the distribution and determinants of HEALTH-RELATED STATES in SPECIFIED POPULATIONS, and the application of this study to CONTROL of health problems. Based on the available clinical data, epidemiological studies can be performed to determine the specific related diseases.

Based on these data, we can estimate the total number of cases available within the country, state, district & local regions and we can also demonstrate the major reasons and type of individuals who are prone to it. The study also determines the reasons for developing the endemic diseases and establishes a plan in assessing the risk factors. These will alert or warn the individuals who are likely to fall under the same category. An individual’s health condition determines the overall health status of a country; hence it is necessary to begin the prophylactic assessment of individual’s health condition before, rather than after prone to disease. This will aid a way in improving overall health quality and economy of the region.

Ex: Case Reports of Tuberculosis in India – NIKSHAY³

Nikshay is the web enabled patient management system for tuberculosis control under the National Tuberculosis Elimination Programme (NTEP).

Section-4: Clinical Data Curator

The clinical data curator can be a person with a background of medical knowledge. As this ideology is completely based on entering the data and requires up-to-date information, hence it can reviewed frequently and make updates in the provided section. The opinions/viewpoints from the patients, physicians and epidemiologists are reviewed and the required information should be updated according to the norms.The number of clinical curators can be assigned based on the number of cases receiving within the hospital according to departments.

Legal View-points:

• This ideology is more effective and provides rapid outcomes when centrally implemented.
• Individual’s health profile is a confidential matter; hence data should be secured appropriately.
• The number of view/visits for every profile should be available as in case of legal liaison.
• The access can be provided freely for the patients in the form of hard copy or mail as required with legal approval.
• The access points for each section should be clearly defined for respective individuals (staff and public).

Applications:

• Development of individual clinical profile, promotes patient specific appropriate therapy.
• The clinical data software can be implemented at centralized level or at private level (chain hospitals).
• Introduction of this clinical software data can be a contributing factor for Ayushman Bharat under the “OneHealth” policy.⁴
• To promote appropriate details upon medical reconciliation and prevent medical reconciliation errors (ADR’s, unnecessary drug therapy, resistance patterns etc.)
• Early clinical navigation preventing complications and disease progression.
• Decreasing economic burden on patients by initiating effective drug therapy
• Promoting epidemiological studies and determining the health progress of a country.
• Graphical representation (Health progress chart) can be made in case of long-term hospitalized individuals.

Limitations:

• It includes the data of patients attending the hospital only.
• The data should be highly secured and privacy should be maintained.
• Lot of information need to be entered.
• Graphical data in long term hospitalized patients might provide inappropriate details.
• Internet access is required, which limits underdeveloped areas.
• Inadequate information on past history of phytomedicine or botanical medicine.
• Illiterate individuals are not able to access the data, hence require a secondary person to access it.
• Appropriate education and several tasks are required for implementing it.

References:

1. sciencedaily.com ( https://www.sciencedaily.com)
2. Health-Wikipedia (en.m.wikipedia.org)
3. Nikshay portal (https://reports.nikshay.in/)
4. https://www.acko.com/government-health-insurance-schemes-in-india/