Internationalization Support
Purpose: Multi-country compliance, localization, and regional requirements
Overview
The new schema supports healthcare operations across multiple countries with different:
- Regulatory requirements
- Identifier systems
- Tax structures
- Payment methods
- Language preferences
Supported Countries
Current Markets
| Country | Code | Currency | Health Exchange | Tax System |
|---|---|---|---|---|
| India | IN | INR | ABDM | GST (18%) |
| UAE | AE | AED | DHA | VAT (5%) |
| USA | US | USD | - | State Tax |
GCC Expansion
| Country | Code | Currency | Health Exchange | Tax System |
|---|---|---|---|---|
| Saudi Arabia | SA | SAR | NPHIES | VAT (15%) |
| Qatar | QA | QAR | MOPH | No Tax |
| Kuwait | KW | KWD | MOH | No Tax |
India (IN)
Regulatory Framework
| Regulation | Description | Schema Support |
|---|---|---|
| ABDM | Ayushman Bharat Digital Mission | integration.abdm_* tables |
| ABHA | Health Account identifier | clinical.patients.abha_id |
| DPDP | Digital Personal Data Protection | audit.* tables, consent logs |
| MCI | Medical Council registration | identity.practitioners.identifiers |
| GST | Goods and Services Tax | billing.invoices.tax_details |
ABDM Integration
The schema fully supports ABDM through:
integration.abdm_records
├── ABHA ID linking
├── Health record types (prescription, report, etc.)
├── HIP/HIU integration
└── Care context management
integration.abdm_consents
├── Consent lifecycle (request → grant → revoke)
├── Purpose codes (treatment, emergency, etc.)
├── Health information types
└── Date range management
integration.abdm_callbacks
├── Callback event logging
├── Transaction tracking
└── Error handlingABHA Identifier
Stored in clinical.patients:
patients
├── abha_id: "12-3456-7890-1234" (14-digit ABHA)
└── identifiers: [
{ "system": "abha", "value": "12-3456-7890-1234" }
]Indian Tax (GST)
Stored in billing.invoices.tax_details:
{
"tax_type": "GST",
"gstin": "29ABCDE1234F1Z5",
"components": [
{ "name": "CGST", "rate": 9, "amount": 90.00 },
{ "name": "SGST", "rate": 9, "amount": 90.00 }
],
"total": 180.00
}Indian Practitioner Identifiers
{
"identifiers": [
{ "system": "mci", "value": "12345", "state": "Karnataka" },
{ "system": "nmc", "value": "NMC-2024-12345" }
]
}UAE (AE)
Regulatory Framework
| Regulation | Description | Schema Support |
|---|---|---|
| DHA | Dubai Health Authority | Practitioner licensing |
| MOHAP | Ministry of Health | Federal regulations |
| Emirates ID | National identifier | Patient identifiers |
| VAT | Value Added Tax (5%) | billing.invoices.tax_details |
UAE Identifiers
Patients:
{
"identifiers": [
{ "system": "emirates_id", "value": "784-1234-1234567-1" }
]
}Practitioners:
{
"identifiers": [
{ "system": "dha_license", "value": "DHA-P-1234567" },
{ "system": "haad_license", "value": "GP12345" }
]
}UAE Tax (VAT)
{
"tax_type": "VAT",
"trn": "100123456789003",
"rate": 5,
"amount": 50.00
}USA (US)
Regulatory Framework
| Regulation | Description | Schema Support |
|---|---|---|
| HIPAA | Health data privacy | audit.phi_access_logs |
| NPI | National Provider Identifier | Practitioner identifiers |
| DEA | Drug Enforcement Admin | Controlled substance prescribing |
| State Licenses | State medical licenses | Practitioner identifiers |
HIPAA Compliance
The audit schema provides HIPAA compliance through:
audit.phi_access_logs
├── Who accessed (user_id, user_role)
├── Whose data (patient_id)
├── What data (resource_type, data_categories)
├── Why (access_reason, reason_detail)
├── When (created_at)
├── From where (ip_address)
└── Emergency access trackingAccess Reasons (HIPAA TPO):
treatment- Treatment purposespayment- Payment processingoperations- Healthcare operationsemergency- Break-the-glasspatient_request- Patient accesslegal- Court order
Retention: 6 years minimum
US Identifiers
Patients:
{
"identifiers": [
{ "system": "ssn", "value": "***-**-1234" }, // Masked
{ "system": "mrn", "value": "MRN-12345678" }
]
}Practitioners:
{
"identifiers": [
{ "system": "npi", "value": "1234567890" },
{ "system": "dea", "value": "AB1234567" },
{ "system": "state_license", "value": "MD-12345", "state": "California" }
]
}Insurance Support
US operations require insurance integration:
billing.insurance_claims
├── policy_number
├── authorization_number
├── diagnosis_codes (ICD-10)
├── procedure_codes (CPT)
├── claim_amount
├── approved_amount
└── denial_reasonSaudi Arabia (SA)
Regulatory Framework
| Regulation | Description | Schema Support |
|---|---|---|
| MOH | Ministry of Health | Provider licensing |
| NPHIES | National Health Insurance | Payer integration |
| NHRA | National Health Regulatory | Facility registration |
| VAT | Value Added Tax (15%) | billing.invoices |
Saudi Identifiers
Patients:
{
"identifiers": [
{ "system": "national_id", "value": "1234567890" },
{ "system": "iqama", "value": "2012345678" } // For residents
]
}Practitioners:
{
"identifiers": [
{ "system": "scfhs", "value": "SC-12345" }, // Saudi Commission
{ "system": "moh_license", "value": "MOH-12345" }
]
}NPHIES Integration
Similar to ABDM, Saudi insurance exchange:
integration.nphies_claims
├── Eligibility verification
├── Prior authorization
├── Claims submission
└── Remittance adviceQatar (QA)
Regulatory Framework
| Regulation | Description | Schema Support |
|---|---|---|
| MOPH | Ministry of Public Health | Provider licensing |
| Qatar Health Card | Patient identifier | Patient identifiers |
| PHCC | Primary Healthcare Corp | Primary care integration |
Qatar Identifiers
Patients:
{
"identifiers": [
{ "system": "qid", "value": "12345678901" }, // Qatar ID
{ "system": "health_card", "value": "QHC-123456" }
]
}Kuwait (KW)
Regulatory Framework
| Regulation | Description | Schema Support |
|---|---|---|
| MOH | Ministry of Health | Provider licensing |
| Civil ID | National identifier | Patient identifiers |
Kuwait Identifiers
Patients:
{
"identifiers": [
{ "system": "civil_id", "value": "123456789012" }
]
}Schema Support
Country Configuration
The reference.countries table stores country-specific settings:
reference.countries
├── code: "IN"
├── name: "India"
├── phone_code: "+91"
├── currency_code: "INR"
└── compliance_flags: {
"abdm_enabled": true,
"hipaa_required": false,
"gdpr_required": false,
"dpdp_required": true,
"gst_rate": 18,
"vat_rate": 0
}Identifier Systems Registry
The reference.identifier_systems table defines valid identifiers per country:
| Code | Country | Entity | Validation |
|---|---|---|---|
| ABHA | IN | patient | ^\d{2}-\d{4}-\d{4}-\d{4}$ |
| MCI | IN | practitioner | - |
| NPI | US | practitioner | ^\d{10}$ |
| DEA | US | practitioner | ^[A-Z]{2}\d{7}$ |
| EMIRATES_ID | AE | patient | ^\d{3}-\d{4}-\d{7}-\d$ |
| DHA_LICENSE | AE | practitioner | ^DHA-P-\d{7}$ |
| NATIONAL_ID | SA | patient | ^\d{10}$ |
| SCFHS | SA | practitioner | - |
| QID | QA | patient | ^\d{11}$ |
| CIVIL_ID | KW | patient | ^\d{12}$ |
Multi-Currency Support
The billing schema supports multiple currencies:
billing.invoices
├── currency: "INR" | "USD" | "AED" | "SAR" | "QAR" | "KWD"
└── amount fields in specified currency
billing.subscription_plans
├── price_inr
├── price_usd
├── price_aed
├── price_sar (future)
└── price_qar (future)Localization
Localized content stored in JSONB:
reference.specialties
├── name: "Cardiology"
└── name_local: {
"hi": "हृदय रोग",
"ar": "طب القلب",
"es": "Cardiologia"
}
reference.facility_types
├── name: "Hospital"
└── name_local: {
"hi": "अस्पताल",
"ar": "مستشفى"
}Adding New Countries
Step-by-Step Process
-
Add Country to Reference Data
reference.countries └── Add new country with compliance_flags -
Define Identifier Systems
reference.identifier_systems └── Add country-specific identifier types -
Configure Tax System
- Update billing schema for new tax type
- Add tax calculation logic
-
Enable Integrations (if applicable)
integration.* └── Add country-specific integration tables -
Update Audit Policies
- Add country-specific retention requirements
- Configure PHI logging if required
Compliance Flag Pattern
{
"abdm_enabled": false, // India only
"nphies_enabled": false, // Saudi only
"hipaa_required": false, // USA only
"gdpr_required": false, // EU countries
"dpdp_required": false, // India
"vat_rate": 0, // Country-specific
"gst_rate": 0, // India only
"prescription_format": "standard", // Country-specific
"date_format": "DD/MM/YYYY", // Localized
"phone_format": "+XX-XXXXXXXXXX"
}Summary
| Feature | Schema Tables |
|---|---|
| Country config | reference.countries |
| Identifier systems | reference.identifier_systems |
| Patient identifiers | clinical.patients.identifiers (JSONB) |
| Practitioner identifiers | identity.practitioners.identifiers (JSONB) |
| Tax handling | billing.invoices.tax_details (JSONB) |
| Health data exchange | integration.abdm_, integration.nphies_ |
| Compliance logging | audit.phi_access_logs, audit.consent_audit_logs |
| Localization | JSONB *_local fields |