India's Digital Health Initiative: Where It Stands Right Now
By Arunima Rajan
NDHM's vision is to provide healthcare that is inclusive, accessible, affordable, efficient, safe, and timely.
On 15 August 2020, the Indian Prime Minister proposed the introduction of the National Digital Health Mission (NDHM). Two years later, the pilot initiative — known as the Ayushman Bharat Digital Mission as of April 2022 — has gained traction, yet there is still a lot left to learn.
The NDHM seeks to digitise India’s healthcare system by including all citizens’ personal health-related information in an internal database. Via an online portal that the mission has created, citizens can access various standardised digital healthcare services.
Some key features include the introduction of Digi Doctor, the Health Facility Register, Personal Health Records and Electronic Medical Records.
Each user is given a Health ID card which contains their confidential medical data and gives them access to their health records. This includes their medical history, prescriptions, diagnostic reports and discharge summaries.
Since its introduction, 24,54,39,322 million Health IDs have been registered. The number of health records linked is 1,49,02,351.
The health ecosystem is fragmented, with multiple touchpoints and disaggregated data sets in siloes. At an individual level, it affects patients as they lack a seamless end-to-end digital health experience. At an aggregate level, it impacts the healthcare ecosystem at large, as it hinders health research efforts by the government. Hence, it is imperative to build an open and interoperable network that can enable health facilities as well as patients to interact with each other seamlessly.
Benefits of a digital health (ABHA) card
The ABHA Health ID is a quick and efficient means for citizens to access their health records without having to recall their ID number. All digital records can be easily accessed — including digital lab reports, prescriptions and diagnoses.
Once activated, all citizens can obtain a Health ID from any public hospital, health and wellness centre, community healthcare centre, or private healthcare provider listed on the National Health Infrastructure Registry.
The Health ID card will digitally store all personal health records and information relevant to the cardholder. The Health ID card allows users to access all health information in real-time. It collates the user’s health history, indicating a shift from the time-consuming exercise of sorting through paper-based information.
NDHM and Healthcare Reforms
India already has in place the National Health Policy 2017, as well as the National Digital Health Blueprint, with which it seeks to align its objectives.
Amidst concerns over data privacy, the Government of India has put in place some stringent guidelines to be applied in order to preserve patients’ and users’ privacy as far as possible. Some of these measures include granting one-time access to doctors and hospitals to view a patient’s medical records.
The National Digital Health Blueprint combines best practices in the healthcare sector that the National Digital Health Missions seeks to implement in line with the National Health Policy 2017.
The privacy of health-related documents will need to be emphasised and guaranteed in order to attract the trust of citizens.
“The National Digital Health Mission is working to improve healthcare accessibility, affordability, and quality by using data as a key,” says Harshit Jain, MD, Founder and Global CEO of Doceree.
He continues: “Health IDs ensure that patients' data is accessible to healthcare experts. The digitization of health data enables patients to store their health information securely and share it with healthcare stakeholders. NDHM opens doors for expert care access even in rural India, ensuring better healthcare outcomes. NDHM is a project that will have a huge impact on the country’s economy in the long run. The recent repurposing of Aarogya Setu and CoWin platforms will boost the Indian healthcare ecosystem.”
What is Unified Health Interface?
The Unified Health Interface (UHI) is the foundation of the Mission and its objectives. This refers to a system of open protocols which allows a user to access various digital health services, as well as their health records stored on various databases.
UHI is set to be launched at a future point as an open-source repository of digital health services. This includes open-source End User Applications and Heath Service Providers.
The UHI open network system facilitates End User Applications and Health Service Provider applications, essentially enabling users to access many health services, such as appointment booking, teleconsultation, and service discovery.
The UHI is being expanded to introduce a new spectrum of digital services, namely, the ability to book telephonic consultations, check the availability of critical care beds, and book home visits and lab appointments for sample collections, among other services.
The UHI creates a horizontal network between healthcare providers and users where both parties can connect, creating a more personalised implementation of the initiative.
India has made progress on cross-sector interoperability. “Unified Payment Interface (UPI) in banking; Open Network for Digital Commerce (ONDC) in commerce; and Unified Health Interface (UHI) Gateway, Health Claims Exchange (HCX), and Health Information Exchange and Consent Manager (HIE-CM) in healthcare. India is also embracing the Fast Healthcare Interoperability Resources Specification (FHIR) standard to allow the transmission of healthcare information amongst parties. These aspects are part of a larger movement from walled infrastructure to an open, interoperable ecosystem that can improve discoverability, increase competition, and benefit end-users,” says Dr Omana Rajan, Managing Director of Life Care Clinic, Kerala.
The introduction of the Ayushman Bharat Digital Mission (ABDM) has stoked interest in digital health in India, which is still in its infancy. The launch of the Digital India programme and the use of teleconsultation and electronic prescriptions during the pandemic have been major boosters to ABDM. The groundwork for implementing ABDM in India's healthcare system was created by the digitalization of the country's banking and payment systems. However, barriers to adoption must be removed, including the absence of adequate privacy and security regulations, inadequate infrastructure, and ineffective change management.