PATIENT BIOMETRIC

STANDARD
OPERATING PROCEDURE (SOP)
V1.0.4

Contents
Background………………………………………………………………………………………..
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STANDARD OPERATING PROCEDURES

PBS Device Use: Recommended Standards.........................................................................................

Facility Hardware Requirement:.........................................................................................................
Operating System Requirement:..........................................................................................................
Pre-requisite Tools.................................................................................................................................
Routine EMR Enhancements………………...
…………………………………………………………...5
Process Flow for PBS Data
Deduplication……………………………………………………………….5
Fingerprint Capturing Process………………………….
………………………………………………..5
Fingerprint Validation:.........................................................................................................................
Fingerprint Image Quality:...................................................................................................................
Patient with Non-Functional Friction Ridges......................................................................................
Verification/
Identification…………………………………………………………………………………6
Goal.........................................................................................................................................................
Objectives...............................................................................................................................................
The ‘Suspected Duplicated’ List...........................................................................................................
The ‘Suspected Duplicated’ Type.........................................................................................................
1. Perfect Miss match:...................................................................................................................
2. Imperfect Miss match:...............................................................................................................
Conducting Manual Adjudication at Facility-
Level……………………………………………………..6
What is adjudication?...........................................................................................................................
Who is involved?....................................................................................................................................
There are 2 categories of duplicates: Intra and Inter Facility............................................................
Intra-Facility Duplicate:....................................................................................................................
Inter Facility Duplicates:...................................................................................................................
Guide on duplicate validation through manual adjudication Scenarios...........................................
Case 1: Intra-Facility Duplicate........................................................................................................
Case 2. Inter Facility Duplicate........................................................................................................
Figure 1: PHIS3 Activity. (Line-list generation of duplicate records based on valid biometrics)......10
Figure 2: Facility Activity (. Field-based adjudication process)..........................................................10
Dropping
Fingerprints……………………………………………………………………………………11
PURPOSE............................................................................................................................................11
APPLICABILITY...............................................................................................................................11
RESPONSIBILITIES..........................................................................................................................11
PROCEDURES....................................................................................................................................11
Pediatric
Fingerprints…………………………………………………………………………………….11

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STANDARD OPERATING PROCEDURES

Background:

Current patient identification procedures in Nigeria's HIV program require the patient’s demographic
data. However, these identifiers are often inaccurate in the HIV program context, as data systems are still
evolving and often inadequate to establish patient identity. An effect of this on HIV programs is that it
limits accurate patient identification (PI) and classification, which can lead to poor health outcomes and
inefficient resource allocation. In addition, HIV programs are being constrained to accurately capture the
continuity of care for people living with HIV (PLHIV) as it is impossible to follow and document
continuity of care across service delivery points and outlets. 

Support for biometric-linked electronic medical records (EMR) has grown as a potential solution to
overcome these challenges in Nigeria. Potential advantages offered by biometric registration among
PLHIV include strengthening continuity of care, linking and integrating data to strengthen the current
fragmented data systems, and improving the flow of information across the general health system, thereby
enhancing the quality, comprehensiveness, and continuity of HIV-specific services.
HIV Patient Biometrics System (PBS) is composed of three (3) components.

 Architecture
 Process flow
 Verification/Identification

Architecture

Patient
Biometric
System
Verification
/Identification
Process Flow

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STANDARD OPERATING PROCEDURES

Patient Biometric System Architecture

PBS Device Use: Recommended Standards

There are various biometric systems used for different biometric purposes ranging from finger printings,
irises, faces, and signature capture. The HIV PBS program in Nigeria is currently implementing
fingerprints capture and for uniformity among all IPs, below are the recommended specifications;

Table1
S/N Description
1 SDK License
2 Biometric
Standards/Specs
3 Supported SDK
4 Image quality
Requirement
Free/License (Secugen/Futronic)
FMRecord.VERSION_ISO_20
NRD version 2.0 ISO templates (ISO/IEC 19794-4:2005)
Windows, Linux, and Mac
500DBI

Facility Hardware Requirement:

There is a need to have a system with a very good capacity that can support the nature of data generated
by the PBS application. The table below itemizes the minimum recommended hardware specification for
optimal deployment and implementation of PBS in the facility.

Table2
S/N Description Very High Volume High Volume Medium volume Low
Facility Facility capacity Volume
capacity
1 Facility Size 5000 and above 1000-4999 500-999 1-499
2 Laptop/Desktop Desktop Desktop Laptop Laptop
3 RAM 64G 32G 16G 8G
4 Hard Disk 2 Terabyte 1 Terabyte 500G 256G
5 Core Core i9 Core i9 Core i7 Core i7
6 Processor 4.0 3.6 - 4.0 2.4 - 3.6 2.4
7 UPS 1.5Kva 1.5Kva NA NA
8 Battery capacity NA NA 12 Cell Battery 12 cell
battery

Operating System Requirement:

 Ubuntu 18.04 and 20.04 LTS (Recommended)

 Windows10/11 64bits (Minimum)

Pre-requisite Tools:

 Java SDK – version 8 and above

 Google Chrome (Latest version)
 Mozilla Firefox (Latest version)

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STANDARD OPERATING PROCEDURES

Process Flow for PBS Data Deduplication

Fingerprint Capture Process:

• The biometric operator controls the process of enrollment and verification, hence there is a need
to understand the importance of high-quality enrollment capturing and explain to a subject how to
provide his/her fingerprints properly and also how to use the enrollment devices (scanners).
• There should be provision for administrative roles and permission to prevent unauthorized access
to the captured client data and to provide a proper biometric capturing adjudication audit process.
• Fingerprint capturing requires all 10 fingers of the patient but in some exceptional cases, where
all 10 fingers cannot be captured, a minimum of 6 fingers i.e., three (3) fingers from each hand
preferably (Thumb, index, and middle fingers) are required.

Compliance with Implementation Standards:

In implementing a patient biometric system at the EMR level, implementing partners are required to
conform to the recommended technology standard as indicated in this SOP. These standards specify a
concept and data formats for the representation of fingerprints using the fundamental notion of minutiae.
It is generic, in that it may be applied and used in a wide range of application areas where automated
fingerprint recognition is involved. Please refer to the table1 above:

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STANDARD OPERATING PROCEDURES

Valid and Invalid Fingerprint:

How to Reduce the Chances of Your Fingerprints Being Rejected

Valid Fingerprints

Let's start by showing what a VALID FINGERPRINT looks like. The center of the loop (circles) and the
deltas (triangles) must be visible.

Invalid Fingerprints

Look below for fingerprints that would be rejected (unsuitable for conducting deduplication on NDR.

Reasons, why fingerprints are invalid, include:

 Pressed too lightly. (1)

 Pressed too hard. (2, 3, 5, 6, 8, 9)
 Too much ink (may not be an issue if you don’t press too hard). (2, 3, 5, 6, 8, 9)
 Not enough ink covering the entire fingertip (3, 7)
 Fingertip to warm/sweaty. (2, 3, 5, 6, 7, 8, 9)
 The fingertip is too dry. (7)
 Center loop and/or Deltas are not legible. (All of them)

1 2 3 4 5

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STANDARD OPERATING PROCEDURES

6 7 8 9 10

Technical Causes (Facility Level)

1. The software used at the facility to capture patient biometrics is often a separate entity from the
EMR system. Therefore if the application fails to save the patient fingerprint in the biometric
table in the EMR can cause an invalid fingerprint template.
2. An outdated application version often causes the system to malfunction since the product isn’t
compatible with the recent release.
3. Different SDK and IOS template installations produce invalid prints due to standard differences
between capture SDK and Mega Matcher SDK processors.
4. Export and import of fingerprint data from one computer to another most time damage the
fingerprint template which result to invalid or unreadable format.

Tips on How to Reduce Invalid Fingerprints:

Risk-Reduction Strategies. Patient fingerprints may be of low quality or unrecognized for a variety of
reasons. Examples below.

Physical Causes:
 The patient has many wrinkles
 Patient fingerprint ridges are worn from the type of work he/she does
 Patient fingerprints are illegible due to a medical condition
 Patient hands are very sweaty, causing your fingerprints to smudge easily
 The patient hands are very dry
 It was difficult to take clear fingerprints due to deformity
 Patients have scars or missing fingers.

Technical Reasons:
 Not enough pressure was applied (fingerprint too light)
 Too much pressure was applied (causing smudging)
 The fingerprint application only took partial fingerprints (e.g. did not roll enough left to right)
 Not enough ink was placed on the fingertips (fingerprint too light)
 Too much ink was placed on the fingertips (the fingerprint too dark)

Possible Solution:
 If the patient has lots of wrinkles, worn ridges, or dry hands, help clean or moisturize his/her hand
a lot before capturing.

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STANDARD OPERATING PROCEDURES

 If the patient hands are sweaty, wipe them frequently while being captured. But, be sure the
patient hands are not wet when being captured at all times.
 Sometimes the patient might be tense, so try and relax the patient fingers and wrist when
capturing the patient. The care provider should assist at this point to ensure the patient is
captured. 
 If the patient fingerprint is hard to take, be sure to document the issue and share the report with
PHIS3.
All Implementing Partners are required to develop and have their standard Biometric job aids at the PBS
implementation facilities.

Fingerprint Validation:
To mitigate some of the issues encountered during searching of fingerprints template from DB,
the use of Probabilistic algorithms is recommended whereby verification is done in a batch
format and once a match is found, validations stop as against validating the entire 10 fingers.

Fingerprint Image Quality:

To correct most of the valid fingerprint issues encountered during upload to NDR, there’s a need
to maintain below-capturing fingerprint quality standards;
<= 59 = low quality (Red), 60-74 =Good(Blue), 75-100=Excellent(Green)

Patient with Non-Functional Friction Ridges:

Electronic Medical Record is required to add an optional comment for patients with non-
functional ridges whose fingerprints could not be captured to the PBS capturing page.

Verification/Identification
Goal
The goal is to outline procedures for conducting manual adjudication of suspected duplicate
clients targeted at achieving unduplicated Treatment Current (TX_CURR).
Objectives
• Describe the content of the ‘Suspected Duplicates’ List
• Describe different case scenarios, possible causes, and how to resolve them and prevent future
occurrences.

The ‘Suspected Duplicated’ List

This line list contains all clients with a possible duplicate with another client, which can be within
the same facility or another facility within the State or outside the State. With Patient identifier
(PEPID), Sex, DOB, enrolled facility, and duplicate facility.

The ‘Suspected Duplicated’ Type

There are two types of suspected duplicates:
1. Perfect Miss match: This is a list of patients whose Fingerprints match with Sex and Age also
the same. This type of suspected duplicate requires manual adjudication.
2. Imperfect Miss match: This is a list of patients whose Fingerprints matches while their Sex and
Age are NOT the same. This is mostly a situation where multiple patients share the same
fingerprints which may be caused by system issues (usually during merging), erroneous or
deliberate replication, etc. This type of duplicate is expected to have its fingerprints voided and
recaptured on the EMR.

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STANDARD OPERATING PROCEDURES

Conducting Manual Resolution at Facility-Level

What is adjudication?
Adjudication is a dispute resolution process that allows Parties to present their dispute to an
independent Third Party for a decision in the context of this process where 2 or more Human
beings are to look at Suspected duplicated clients to ascertain whether they are true duplicate or
false duplicate base on the high matching score or low matching score.

Who is involved?
The stakeholders here are the facility case management team. The tracking team is expected to
call the clients that are suspected of duplicating care to establish their true identity and decide on
the next action to be taken.

There are 2 categories of duplicates: Intra and Inter Facility.

Intra-Facility Duplicate: These patients whose fingerprints are found in more than one client
record within the same facility.

Inter Facility Duplicates: These are patients that fingerprints are found outside their primary
facility that is their fingerprints are found in more than one facility. It could be within the same
State, with IP, and outside IPs

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STANDARD OPERATING PROCEDURES

Guide on duplicate validation through manual adjudication Scenarios.

Case 1: Intra-Facility Duplicate.

Scenarios Possible Causes Recommended Expectation from IPS

‘Preventive’ Solution

When Multiple System issue as a This scenario is not Clients should be invited to
patients share the result of merging likely to happen again. both the unique and duplicates
same biometrics biometrics captured at However, partners and recapturing is done for
most of them are more than one (facilities) should be both again and uploaded to the
Active. Patient (standalone) points encouraged to use LAN NDR.
records (folders) implementing multi- during multi-point
exist and are also point capture during capture. EMR POC In addition to the
verified to be biometrics drive. should also be upgraded recommendation above,
different patients via to allow biometrics develop and implement a
phone calls. One person using capture from the client’s strong Community Dispensing
his/her fingerprints for computer (workstation). strategy to cater to patients
multiple patients e.g. Instead of importing into accessing care from remote
Relative/Spouse the DB leading to one villages clearly outlining
collects ARVS for client having more than standard data management
others. 10 fingerprints. processes and procedures.

Parents sharing the Non- readability of a Void both fingerprints Void both fingerprints and
same biometric with child’s fingerprint led and recapture both recapture both parents and if
infant to using parents’ parents and children. the child’s fingerprints are not
biometrics for them. captured, Partners should
document the PEPID of the
children.

Same patient with Merge folders as well as Optimize EMR internal

the same biometrics EMR records into the duplicate fingerprint capture
having multiple Double patient very first folder opened prevention functionality.
records (folders) registration within the retaining the very first Presently, when this
same facility. And the ID allocated to the functionality is active (TRUE),
Site Verification is patient. The other IDs it slows down fingerprint
turned off. should NOT be capture.
reallocated to any
patient ever.

Case 2. Inter Facility Duplicate.

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STANDARD OPERATING PROCEDURES

Scenarios Possible Causes Recommended Expectation from IP.

‘Preventive’ Solution

Same patient with Roaming patients Formalize the transfer The case management team
same biometrics picking ARVs from process by documenting will engage both client and
having multiple a different location the transfer-out from the the facility for the client to
records (folders) (formally or facilities where the patient choose the Primary site to
across multiple informally). Mostly left. As well as TI in the be active at every T time.
facilities (Inter- affects uniform new facility not counting
Facility). Within the personnel due to as new again. Continue
same State and IPs. transfers, long- managing the patient at the
distance drivers, KP, facility where s/he is In addition to the
Both records are PMTCT service, etc. active. recommendation above,
“Active”: Patients develop a strong Door-to-
roam around multiple Non-disclosure of Upgrade NDR to have a Door Dispensing strategy
facilities to access HIV +ve status to “Client Registry” which for VIP patients and a
ARVs for purposes partner but want the will enable patients to strong Community
other than HIV partner to be taking have access to care Dispensing strategy to cater
management. e.g. ARVs (including drug pick-ups) to patients accessing care
PMTCT Service. across facilities without from remote villages
ARV drug pick-up to interruption (Transfer, clearly outlining standard
sell out to VIP self, or documented). data.
patients (dignitaries,
politicians, etc.)

The same patient with Optimize EMR internal Delete fingerprints on

a single record duplicate fingerprint clients’ records and
Non- readability of
(folder) but returned capture prevention recapture them.
some fingers to be
as duplicate by functionality. Presently,
captured leads to this
biometrics. when this functionality is
finger interchange to
active (TRUE), it slows
get a minimum
down fingerprint capture
number of fingers
(28mins to capture 1
required by EMR
finger). This makes
during capture.
facilities turn it off
(FALSE).

Same patient with For both sites, CMT will

same biometrics call the client to visit the
having multiple Formalize the transfer facility for interrogations
records (folders) process by documenting for the client to choose
across multiple Roaming, Clients, his/her preferred primary
the transfer-out from the
facilities (Inter- Self-Transfer in and site to be ACTIVE at a time
facilities where the patient
Facility). Across IP Transferred Out, and re-upload with new
left. As well as TI in the
e.g. APIN State and Patients Deceits, etc. Status of TI or too.
new facility not counting
CCFN State as new again.

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STANDARD OPERATING PROCEDURES

Figure

1: PHIS3 Activity. (Line-list generation of duplicate records based on valid biometrics)

Figure 2: Facility Activity (. Field-based adjudication process)

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STANDARD OPERATING PROCEDURES

Routine EMR Enhancements

Partners are required to communicate any modifications or updates made to their EMR to the managers of
the National Data Repository (NDR). This is to guarantee that any updates or modifications to the EMR
adhere to the NDR data transfer protocol. Failure to communicate will result in data mismatches, inflated
treatment currents, inaccurate biometric fingerprint templates, and a slew of other problems.

Dropping Fingerprints from NDR

Purpose

The goal of this standard operating procedure is to guarantee that all of the steps required to request for
the dropping of patient fingerprints are accurately followed.

Applicability

Only those patients for whom Implementing partners make requests with convincing arguments and
reasons as to why the dropping should take place will have their biometric data deleted from the NDR.

Responsibilities

The Government of Nigeria, Federal Ministry of Health under the leadership of NASCP and other
technical stakeholders will review the reasons presented and determine either to approve or deny request
of dropping data on the NDR.

Procedures

Implementing partners must submit a request to the management of the NDR regarding the list of
fingerprints that should be removed. Below are the standards and timelines for different batches and sizes
for each request:

 1 – 5,000 patients will take 24 hours of response time.

 5,000 – 10,000 patients will take 48 hours of response time.
 10,000 – 100,000 patients will take 72 hours of response time.

Following that, the fingerprints will be erased from NDR, and an email will be sent to the Implementing
Partner who requested the data deletion from NDR as soon as the dropping is completed.

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