Patient Portal

Access to personal health records is a growing demand among patients worldwide, driven by the need for improving continuity of care, convenience, control, and informed decision-making by patients in managing their health data. Despite advancements in healthcare technology, many systems fail to provide patients with seamless access to their data or the ability to control how and with whom it is shared.

This gap becomes especially critical in scenarios of unplanned or cross-border care, where clinicians often lack timely access to essential patient information, leading to delays, inefficiencies, or even errors in treatment. Additionally, patients often lack the tools necessary to manage consent and ensure their data is shared securely and appropriately, compounding concerns about privacy and accessibility. Patient level view of their health record gives the patient the ability to access & manage consent to access to their data.

The primary use case in Sri Lanka comes from Sri Lanka’s free health system allows for patients to be treated anywhere, able to roam between Out Patient Department (OPD) health facilities present challenges of effective continuity of care. Currently patients reregister at each facilities EMR unable to make use of a patient’s prior medical history. Sri Lanka has four major implementations of EMRs in the country:

• Hospital Health Information Management System (HHIMS) managed by the Information and Communication Technology Agency, the apex government entity for national level ICT implementations
• Hospital Information Management System (HIMS), A Ministry of Health owned and managed EMR in larger hospitals with many modules including Laboratory and Radiology Information Systems
• CloudHIMS a cloud based solution primarily used for empanelment of patients to primary care units and Cardiovascular risk assessments with support of the PSSP, the World Bank funded project.
• OpenMRS based cluster information supported by the Asian Development Bank used for primary health care reorganization.
• OpenSRP a community based screening app for non-communicable disease supported by World Diabetic Federation research project, Diabetic Compass.

The primary use case is to enable continuum of care across health facility EMRs, to support patient roaming which is common in Sri Lanka’s free health system.

As part of our pilot project, a secondary use case was identified by the Sri Lanka Ministry of Health is to support regular cross-boarder travel – business or tourism travel of Sri Lanka citizens out of the country. A specific example includes Muslim pilgrims to Mecca, Saudi Arabia, which is particularly relevant in Sri Lanka due to the population profile.

Symbionix is working with the Sri Lanka College of Health Informatics – an organisation for digital health in Sri Lanka who are working closely with the Ministry of Health, Sri Lanka to deliver a FHIR compliant patient centric viewer (PatientPortal) to support the National Digital Health Platform Blueprint.

With Sri Lanka’s National Digital Health Blueprint aligned with the OpenHIE architecture and Ministry of Health heavily leveraging on the OpenHIE reference technologies such as OpenHIM, JeMPI, Open Concept Lab and HapiFHIR, they are looking for a Open-Source citizen facing solution for Sri Lanka’s National Electronic Health Record (NEHR) to empower citizens to view and manage/consent access to their data. We have aligned the architecture & technology with the WHO digital trust network guidelines.

Sri Lanka already has over 2 million records committed to the FHIR compliant NEHR, with 4 hospitals connected, and wish to empower patients with access to their health records in the future. Symbionix in collaboration with Jembi Health Systems have implemented a pilot to demonstrate how the patient summary technology can work and the team in Sri Lanka have the UI designs for such a system already partially developed and completion of that work and connectivity to the backend services will allow them to deploy the solution at a national scale. Plans are to add 80 existing and 30 new hospitals in the next two years. Sri Lanka have 55 million OPD and 9 million out patient visits to the state health sector annually.

Digital literate portion of the population would constitute the potential user base for the PatientPortal system. Digital literacy in Sri Lanka is increasing, with the following statistics for 2023:

• Computer literacy: 39.5% of people aged 5–69 are computer literate
• Digital literacy: 63.8% of people aged 5–69 are digitally literate
• Household computer ownership: 20.5% of households own a desktop or laptop computer

The PatientPortal will contain an extract of a set of patient health data, readily usable by any clinicians for both scheduled (routine) and unscheduled (emergency) patient care in both public and private health care facilities in any country. The generation of a clinical health summary extract is supported within the Fast Health Interoperability Resource (FHIR) specification by Health Level 7 (HL7). This is important because it allows for continuity of care, patient safety (has vital information such as patient allergies), relieves physician exhaustion due to information overload and empowers patients by involving them in their care. Its portability resolves the challenges posed by silo systems in lower-to-middle-income countries (LMIC) and allows for safe cross-border unplanned care.

The PatientPortal is a powerful tool for provision of uninterrupted patient-centred care and health system strengthening. Further use cases we envision include while travelling for business, international studies or medical tourism. The product will empower individuals and their families to securely carry their personal health record in a portable “health pass”, enabling effective continuity of care. By granting temporary access to doctors, travellers can ensure doctors have access to their up-to-date medical history. This product could align with insurance services to support a business case for the platform, offering convenient access to relevant products; travel insurance for business travellers or health insurance for international students or medical tourism.

The pilot was funded by contributions from CDC TAP, Patrick McGovern Foundation, The Global Fund, and Ministry of Health Sri Lanka using private sector funding. Securing funding will allow Symbionix to mature the Open-Source patient centric viewer platform to get closer to making it a reality in collaboration with the Sri Lanka Ministry of Health.

Patient Summary references:

• International Patient Summary watch this video or read more information here.
• Smart Health Links explained.
  

National Sri Lanka Health Standards & Guidelines that the project subscribes to:

• National health guidelines and standards
• National digital health Blueprint
• Blueprint component dependency tree
• OpenHIE Architecture Standards

The PatientPortal builds upon the existing standards based implementation of best of breed solutions, in particular the pilot leveraged the OpenHIE reference applications of OpenHIM, HapiFHIR, JeMPI, and Open Concept Lab.