As medicine undergoes a rapid digital transformation, the emergence of large quantities of healthcare related data is inevitable. This has been accelerated by COVID-19, with one example being the use of digital health passes. Consideration around holding, presenting, and accessing the information will be vital in continuing the trust built between patients, clinicians, and organizations. Check out our April 28, 2021 webinar, where we hosted Dr. Manreet Nijjar, Consultant Physician in Infectious Diseases at Barts Health NHS Trust, NHS England Clinical Entrepreneur fellow, and co-founder of Truu. He shared an insider’s perspective on how providers can benefit from more trusted, user-centric data and what it takes to design for the complex privacy, regulatory, and ethical needs facing healthcare. We covered: • Lessons learned from working with self-sovereign identity (SSI) at the NHS, and the needs highlighted when leading the frontline response during COVID-19 • What digital health passes mean for the adoption of SSI • Applying the four principles of healthcare ethics to verifiable credential technology • The top use cases for healthcare, including “staff passports” and portable health records

1. @evernym | info@evernym.com | April 2021
Credentials, COVID-19,
& Digital Staff Passports
Lessons from the NHS Frontline

2. MODERATOR
Andrew Tobin
Managing Director, EMEA,
Evernym
Today’s presenters
PRESENTER
Dr. Manreet Nijjar
Consultant Physician in Infectious Diseases,
Barts Health NHS Trust
Co-Founder, Truu

3. If you have questions….
Please enter them in the Zoom Q&A, and
we’ll get to as many as we can.
Please note, this webinar is being recorded and will be
available at www.evernym.com/webinars.

4. On the agenda
Medical Ethics
Digital Staff Passports: The journey so far...
COVID-19: Experience from the frontline
Vaccine Passports
SSI in the future of healthcare
Q&A

5. Consultant Physician in Infectious Diseases & Acute Medicine Whipps Cross Hospital
Associate Clinical Lead Covid-19
Whipps Cross Hospital Barts Health NHS Trust, London, UK
Co-founder Truu
Digital Staff Passporting, Credentialling and verification platform for healthcare workers &
organisations
NHS England Clinical Entrepreneur Fellow

6. "The physician must ... have two special objects in view with regard to disease,
namely, to do good or to do no harm.”
Hippocrates, Epidemics (book I, section. 11) c. 410 BC

7. Autonomy – respect for the patient’s right to self-determination
Beneficence – the duty to ‘do good’.
Non-Maleficence – the duty to do ‘no harm’.
Justice – to treat all people equally and equitably for the benefit of society.
4 principles of biomedical ethics

12. • User needs analysis
• As-is process modelling
• Stakeholders:
• Clinicians
• NHSE Medical Directorate
• HEE
• GMC
• NHS I
• NHS Digital
• Lead Employer
• Digital Identity Service
• Locum Agencies
• Medical Education
• HR & Recruitment
• Rota Coordinators
• NHS X
• Most difficult but transferrable
use-case selected for POC

13. • Issued GMC license to practice credential to wallet
• Verified by hospital
• Hospital issued sign in credential
• Login into clinical system

14. No more in my everyday life have these four pillars been so important to me as they have been over the past
year.
I clutched on to these while delivering care to patients gasping for breath, clinging onto life and some sadly
succumbing to COVID-19.
The most challenging time I have ever had as a doctor and as a being.
Autonomy – respect for the patient’s right to self-determination
Beneficence – the duty to ‘do good’.
Non-Maleficence – the duty to do ‘no harm’.
Justice – to treat all people equally and equitably for the benefit of society.

15. Not only has it impacted people’s health & mental wellbeing directly and indirectly
through restrictions, delays in treatment for other illnesses but also economically and
societally.
It has been a difficult time for most with events highlighting the widening inequalities
we knew already existed.

16. Reflecting and remembering on these times it would be gruelling 17-
18 hours days on the frontline, which would include treating your
colleagues, worrying about personal protective equipment (PPE)
stocks, equipment, and oxygen supplies.
Arrive home to see social media posts from connections in the
identity and technology world talking about immunity passports,
sensitivities & specificities of Covid tests, and how their proposed
solutions could solve problems.
Many well intentioned, some purely commercially driven, however
all like many things over the past year not very well informed.

19. NB – Currently out for submission

20. https://beta.staffpassports.nhs.uk/
An interim COVID-19 Digital Staff Passport in beta testing
84 NHS organisations

24. There may be many different technical ways to meet a set of product requirements
and they all fall on a spectrum from ethical/good-for-individuals all the way to
unethical/bad-for-individuals.
However if we do not understand the exact problem we are trying to solve and the
context they become irrelevant or even worse have intended or unintended negative
societal consequences.

25. Do we need a Covid vaccine passport whether this is paper based or digital?
If there is or are contexts where a vaccine passport would be more beneficial than
not, what are the technical principles, implementations and considerations that need
to be met to ensure that they are implemented to comply with medical ethics and
law?
After all this is personal health information and therefore should be treated as such.

26. What problem are really trying to solve with a Covid Vaccine Passport, Covid
Passport, ‘Covid’ credential, digital green certificate, or any other named health pass
solution?
To do this there needs to be a basic understanding of this infectious disease, what
tools we have currently to deal with it and address assumptions that have been
made, many of which may change or are yet unknown such is the dynamic nature of
a pandemic.

28. Access to Medicines Medecins Sans Frontier

29. Yellow fever is the only disease specified in the International Health Regulations
(2005) (IHR (2005)) for which countries may require proof of vaccination from
travellers as a condition of entry under certain circumstances and may take certain
measures if an arriving traveller is not in possession of such a certificate.

30. This is not about Covid Digital Vaccine Passports.
It is greater and more important than this is about personal health information.
How systems and technology is implemented in healthcare and what ethical
framework are they held to?

31. Medical Ethic Medical Law 12 Principles of SSI
Autonomy Consent
Confidentiality/Privacy
Access to Records
Interoperability
Control & Agency
Privacy & minimal disclosure
Portability
Security
Beneficence Negligence Law Verifiability & Authenticity
Transparency
Non-Maleficence Criminal Law
Negligence Law Regulation
Verifiability & Authenticity
Transparency
Justice Anti-discrimination law Representation
Participation
Equity & Inclusion
Usability, Accessibility & Consistency
Developed by Dr Manreet Nijjar April 2021

32. Decentralized digital identity in healthcare: the foundations
of a new era of trusted relationships between individuals,
organizations, and clinical things
Paul Knowles and Dr. Manreet Nijjar
Digital Pre-print. Manning Publications

33. Digital Pre-print. Manning Publications

34. “Only a life lived in the service to others is worth living.”
― Albert Einstein
Thank You
manreet@truu.id @ManreetSNijjar @truu_id

35. Thanks for tuning in.
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