Patient Management | Moana Digital Health

Overview

The Patient Management module is the structural foundation of the entire Moana platform. Before any clinical work can be documented, any investigation ordered, any prescription dispensed, or any episode billed, a patient must exist in the system with a single, verified, unique record. Everything in Moana begins and ends with that record.

In health systems where patient identity has historically been managed on paper, managed inconsistently across facilities, or not managed at all, the consequences are significant: a patient presents at a district hospital with no record of the medicines dispensed at the clinic two weeks earlier; a woman delivers at a facility where nobody knows she has a documented high-risk pregnancy; a child receives a vaccine dose that was already administered because no vaccination record followed them from their previous facility. The Patient Management module is designed to close those gaps permanently.

Built for the operational realities of health systems in the Pacific Islands and low-resource environments more broadly, the module supports full demographic registration, longitudinal medical history, allergy and risk alerts, consent management, multi-facility record access, and integrated civil registration within one unified record. Patient data is available on the Electron desktop client even when internet connectivity is completely absent, synchronises to the central database automatically when connectivity is restored, and is accessible across all authorised facilities based on role-based access controls.

The same record that a nurse creates at a rural health post on a Monday morning is the record a hospital clinician reads on a Friday afternoon when the same patient presents to the emergency department. No faxed referral summaries. No duplicate registrations. One record, always current, always accessible to the right people.

Civil registration, the formal recording of births, stillbirths, and deaths, is integrated directly into the patient management workflow rather than managed as a separate administrative process. This is deliberate. In many Pacific health systems, civil registration gaps exist not because clinicians fail to document clinical events, but because the clinical documentation and the registration system are disconnected. Moana removes that disconnection entirely.

Core Capabilities

Full Demographic Registration

Patient registration captures a complete demographic profile: full legal name, date of birth, sex, national identification number, ethnicity, village or address, phone number, and next of kin. Registration supports walk-in patients presenting without prior records, referred patients arriving with a documented referral, and transferred patients whose clinical history must travel with them. Every registered patient receives a unique system-generated MRN that persists for life and across all facilities. Fields are configurable per facility to accommodate national ID formats, address structures, and naming conventions across different countries.

Duplicate Detection and Patient Matching

In multi-facility environments where patients may register at more than one location over their lifetime, duplicate patient records are a persistent data quality problem. Moana's duplicate detection engine compares incoming registrations against existing records using name, date of birth, sex, and national ID, flagging probable matches for administrative review before a new record is created. Where duplicates are identified after the fact, a supervised merge workflow consolidates the records, retaining all clinical history from both, under a single verified identity.

Longitudinal Medical History

Every encounter, diagnosis, prescription, laboratory result, imaging report, procedure, clinical note, referral, and civil registration event is attached to the patient's permanent record. The complete patient timeline is available to any authorised clinician at any connected facility. History is never lost between visits, between departments, or between episodes of care. A clinician reviewing a patient for the first time has access to every documented clinical interaction that patient has had within the Moana network, structured chronologically and filterable by event type.

Allergy and Clinical Risk Alerts

Allergy records, adverse reaction histories, and documented clinical risk factors are stored on the patient record and trigger real-time alerts at the point of prescribing and at the point of dispensing. When a clinician attempts to prescribe a medication to which the patient has a documented allergy, the system presents an alert before the prescription is finalised. When a pharmacist attempts to dispense a medication flagged as contraindicated for that patient, a dispensing alert fires. This dual-layer check at prescribing and dispensing provides redundancy that paper-based systems cannot replicate. All allergy entries are dated, attributed to the recording clinician, and retained permanently on the record.

Consent and Privacy Management

Informed consent is captured digitally and stored as a versioned, timestamped record linked to the relevant clinical episode. Different consent types, including general treatment consent, surgical procedure consent, and consent for specific investigations, are supported independently. Withdrawal of consent is recorded with equal rigour and linked to the relevant clinical record. Consent records are retained as part of the permanent patient file and are accessible in any audit or medico-legal review.

Multi-Facility Record Access and Referral Continuity

A patient registered at any facility in the network is visible to authorised clinicians at any other connected facility. Inter-facility referrals carry the full clinical record, not a manually prepared summary, ensuring the receiving clinician has complete context before the patient arrives. When a patient transfers from a rural health post to a district hospital, the hospital team sees the complete documented history from the health post. Role-based access controls ensure that visibility is governed by clinical need and organisational authority, not by physical location.

Civil Registration: Births, Stillbirths, and Deaths

Birth registration occurs at the point of delivery, linked automatically to the mother's antenatal record, the delivering clinician, the facility, and the date and time of birth. If the baby is born alive, a permanent patient record is created automatically, ready for first vaccinations, growth monitoring, and all subsequent clinical encounters. Back-dated registrations are supported for home births and facility transfers, with mandatory reason codes ensuring data quality.

Stillbirth registration is managed as a distinct clinical and administrative event, capturing gestational age, cause of death where known, attending clinician, and a direct link to the mother's pregnancy record. Stillbirth data feeds the national surveillance layer for population-level stillbirth rate tracking and maternal mortality analysis.

Death registration is completed within the clinical discharge workflow, capturing date and time of death, place of death, cause of death in both plain language and ICD-10 code, and the certifying clinician. The patient record status is updated to deceased, but the complete clinical history is preserved intact and remains accessible for medico-legal review, population health analysis, and civil identity purposes. Neonatal deaths are flagged separately and handled with particular precision: age at death is captured in hours rather than days, because a death at six hours and a death at twenty-five days have fundamentally different clinical implications. Every neonatal death is linked to the corresponding birth record and to any NICU admission that preceded it, providing the complete clinical picture required for case review and quality improvement. All civil registration events flow automatically into the national surveillance layer, supporting Ministry of Health reporting on live births, neonatal mortality rates, maternal mortality ratios, and cause-of-death distribution at facility, district, and national level.

Offline-First Architecture

Patient registration and full record access function completely without internet connectivity. The Moana Electron desktop client maintains a local database with a 1,000-action sync queue. Clinicians register patients, document consultations, record vitals, and add allergy alerts entirely offline, with all data queued locally. When connectivity is restored, the sync engine transmits queued actions to the central server and pulls any changes from other facilities, applying one of four configurable conflict resolution strategies: SERVER_WINS, CLIENT_WINS, MERGE, or MANUAL review. Where two clinicians have edited the same record while one was offline, a conflict notification is sent to both parties and a clinical task is created for resolution. No data is silently lost.

Document Generation from Patient Records

Formal clinical and legal documents are generated directly from the patient record with no separate data entry required. Supported document types include birth certificates generated from the birth registry record, death certificates generated from the death registry record, vaccination cards generated from the immunisation record, discharge summaries generated from the inpatient admission record, and referral letters generated from the referral record. Document generation is idempotent: calling generate twice with the same source record returns the existing document, never a duplicate. Voiding workflows allow incorrect documents to be nullified with a reason code, while the voided record is retained for audit.

Who Uses This Module

Registration and Administrative Staff

Front desk and registration staff use this module to create and update patient records, verify patient identity on arrival, and manage walk-in and scheduled patient flows. Administrative configuration of patient demographics, ID formats, and consent templates is also managed here.

Clinicians: Doctors, Nurses, and Allied Health

All clinical staff access the patient record as the starting point for every clinical encounter. Clinicians review longitudinal history, check allergy and risk alerts, document encounters, and initiate referrals from within the patient record.

Ministry of Health and Programme Officers

Civil registration outputs and population-level demographic data flow into the national surveillance layer, where Ministry programme officers and epidemiologists access aggregated indicators without interacting with individual patient records.

Facility Administrators and Audit Staff

Administrators manage duplicate detection reviews, supervise merge workflows, and access the complete audit trail for every patient record interaction, supporting compliance, governance, and medico-legal requirements.

How This Connects to the Rest of Moana

The patient record is the anchor for every other module in the platform. Clinical Care Management, Laboratory, Pharmacy, Radiology, Maternal and Child Health, and Billing all read from and write back to the patient record created here. The civil registration events recorded in Patient Management feed directly into the Public Health Surveillance System, contributing to national-level population health indicators. The identity management primitives established here, the MRN, the demographics, the allergy list, power the safety checks in every clinical module downstream.

Standards and Interoperability

Patient records are structured to FHIR R4 Patient and Encounter resources. Demographic data supports HL7 v2 ADT messaging for integration with existing facility systems. Civil registration outputs are compatible with national statistics office reporting formats and feed the moana-surveillance layer for population-level indicator tracking. The patient identity framework is designed for alignment with national patient registries and facility registry systems.