A digital health revolution to empower citizens
Former Union Health Secretary
IT was in mid-2019 that the National Digital Health Blueprint (NDHB) was launched, in keeping with the vision of the National Health Policy-2017 and adopting the principle of ‘Think Big, Start Small, Scale Fast’. As the then Union Health Secretary and Chairperson of the Global Digital Health Partnership, it is a matter of pride for me that India was one of the few countries that had a comprehensive and transformative vision of its digital health path ahead. The NDHB, based on the J. Satyanarayana Committee report, is now seeing a determined actualisation.
On August 15, 2020, the Prime Minister announced the implementation of the National Digital Health Mission (NDHM) in the country. Its vision is to create a national digital health ecosystem that supports universal health coverage in an efficient, accessible, inclusive, affordable, timely and safe manner, with the creation of a seamless online platform through the provision of a wide range of data, information and infrastructure services, leveraging open, interoperable, standards-based digital systems, while ensuring the security, confidentiality and privacy of health-related personal information.
On September 27, 2021, the Ayushman Bharat Digital Mission (ABDM) was launched by the PM, and on February 1, 2022, the Finance Minister, in her Budget speech, announced that the ABDM would be rolled out this year. On February 26, the Union Cabinet approved the national rollout of the mission with a budget of
Rs 1,600 crore for five years. The National Health Authority will be the implementing agency. It is gratifying that within a couple of years, the country has prepared the ground for an initiative that has high potential to be a game-changer for healthcare delivery.
There are several digital solutions developed in the recent past that are being effectively used in our healthcare system. These solutions are aimed at empowering frontline workers and service providers by facilitating data collection used to improve individual and population health outcomes, enable digital training platforms for rapid dissemination of new knowledge, streamline procurement, distribution and payment systems and most importantly allow public engagement, thereby improving transparency and governance. Some examples are ANM-online (ANMOL), the Health and Wellness Centre portal, Nikshays, i-GOT, Mera Aspatal & Online Registration System (ORS), e-Raktkosh, e-Sushrut, Electronic Vaccine Intelligence Network (eVIN), Integrated Disease Surveillance Programme (IDSP), and so on. The importance and value of digital health tools became even more apparent during the pandemic, when solutions such as telemedicine (through eSanjeevani and others), Aarogya Setu, and CoWIN greatly helped in driving public health interventions and the delivery of various health services to the people.
However, despite the rising acceptance of the role of digital health services, most of the digital health solutions, be it public or private, have continued to develop in a fragmented manner, restricted to their own silos, with little consideration of interoperability and a comprehensive larger picture. The ABDM envisages a unifying platform with open APIs (application programming interface) based on INdea (India Enterprise Architecture) notified by the Ministry of Electronics & Information Technology to provide a single window for patient-centric healthcare.
India’s digital initiatives like Aadhaar, Direct Benefit Transfer, Unified Payments Interface (UPI), Digilocker, though viewed with scepticism initially, have benefited the public immensely, helped weed out discretion and corruption and won international accolades. The most recent initiative of CoWIN is now being emulated by other countries.
There is scepticism regarding the ABDM too. Concerns have been raised regarding data privacy, absence of a regulatory framework, and the possibility of exclusion due to the digital divide. It is acknowledged that health data is sensitive data and health is a State subject. That is why the mission envisages a Federated National Health Information Architecture consistent with well-defined data standards across public and private health providers, across state and national levels and across different health systems (modern medicine and Ayush). Privacy and security of health records is a key focus area of the mission.
The ABDM can be seen as a digital highway connecting various players across the healthcare ecosystem. Loss of medical records and the need for repeat tests will be minimised as citizens will have access to their complete medical history through digital health records. Ascertaining the availability of doctors, hospital beds and medicines will become easier with a single ecosystem helping citizens find the services they need efficiently.
Healthcare providers will also benefit from ABDM. Timely access to relevant digital medical records can help healthcare providers make better decisions in the interest of their patients. Providing teleconsultations can help them serve patients from far off areas as well, and not just in their vicinity.
The ABDM would not just enable the delivery of healthcare, but also be able to harness data for real-time public health decision-making. Policy-makers can also improve decision-making based on population-level health data in an anonymised and aggregated manner. Digital health records can also help doctors and patients seek follow-ups, second opinion from specialists or avail of referrals, allow for the development of integrated decision support systems which aim to maximise effectiveness and patient safety.
Public health programme beneficiaries can also be provided services with greater ease with the support of a digital health ecosystem. Portability of benefits for beneficiaries can be carried out more efficiently.
There will be a need for digital workforce enablement, capacity building and aligning processes facilitating security and privacy of data. The Personal Data Protection Bill, 2019, under consideration of Parliament, will help lay down the legal framework. In the meantime, the ABDM has already and will further develop the ecosystem for digital health through Ayushman Bharat Health Account (ABHA) — a unique 14-digit randomly generated health ID number for individuals, Health Facility Registry and Healthcare Professional Registry. Assisted mode and an offline mode for registration is also provided for to enable greater inclusion for all. Stakeholders are coming together in the form of a community to develop the protocols for exchange of services in the ecosystem, in open source.
In the coming years, along with another health sector scheme, PM-Ayushman Bharat Health Infrastructure Mission (ABHIM), the ABDM will set the scene for affordable, inclusive, quality universal healthcare in the country.
