The Government of India is soon going to launch a new digital initiative called as the ‘National Digital Health Mission’ (NDHM) to act as a principal depository for all the data collected through the flagship health insurance scheme Ayushman Bharat. (1,2) Through NDHM, the government plans to map health data of citizens on the lines of the Aadhaar database and set up ‘digital health’ as public infrastructure.(3)
The Ministry of Health & Family Welfare (MoHFW, Govt. of India) has already introduced a National Digital Health Blueprint (NDHB), inviting public comments till August 4th, 2019. This blueprint lays out standards, agenda, and principles of data analytics for technology-based health infrastructure. It also proposes that the NDHM be the hybrid of the goods and services tax (GST) network, UIDAI (the agency that administers Aadhaar), and the National Payments Corporation of India, since health is a state subject. Also, incorporation of the private sector including service providers and insurance is also recommended in the blueprint.(1)
The rationale for NDHM, as laid out in the NDHB, is establishing and nurturing the digital health ecosystem [National Digital Health Eco-system (NDHE)]. The government plans to follow the concept of ‘continuum of care’, as introduced in the National Health Policy (NHP) in 2017. The policy is aimed at following the principles of people centricity, quality of care, better access, universal health coverage (UHC), and inclusiveness. These can be achieved by revamping the current schemes as well as by introducing new initiatives including the digital ones. In addition, digital health technology has a great potential for supporting the UHC. Consequently, MoHFW has prioritized the utilization of digital health to enhance service delivery paired with citizen empowerment in order to significantly improve public healthcare delivery.(1)
Furthermore, it is expected that Ayushman Bharat, through already offered public and private sector services, will generate vast amounts of health data, primarily in digital form. Therefore, to appropriately leverage this data, using innovative digital technologies, it is important to focus on creating suitable architecture and data structures pan-India. The current system for data capture is fragmented by multiple stakeholders and lacks standardization, which may lead to unwanted categorization of digital health assets. Therefore, to overcome these challenges, there needs to be a state-of-the-art ecosystem (NDHE) to facilitate leaping through many traps that cause troubles in the health information systems.(1)
The NDHM proposes to offer a technical platform for collecting basic health data from patients and providers alike together with data interoperability through a unique identifier called the Unique Health Identifier. Other components offered by NDHM include The Health Cloud, similar to the government community cloud of the Ministry of Electronics and Information Technology, a Health Locker to mirror a repository for personal health records (given with consent), and health analytics. Moreover, geographic information system or visualization services are another components offered by NDHM to map, for example, a) nearest hospital with a particular specialty, or b) incidence of a disease in a geographic area, to help in area-wise planning and monitoring of health services.iii
The blueprint mentions that the digital framework will be designed in reference to smartphones as the end device. The concept of ‘consent manager’ has also been introduced in the blueprint, which is for individuals to control the data they would like to share/be used. Following are some of the provisions proposed by NDHM:
- Easy accessibility to electronic health records for citizens, preferably within 5 clicks;
- Integrated health services at a single point, even with multiple agencies, departments or services providers in place;
- ‘Continuum of care’ to citizens, across primary, secondary and tertiary care as well as public and private service providers;
- A framework for the combined communication centre to facilitate voice-based services and outreach;
- National portability for healthcare services
The NDHM can be successful only when the outreach activities with both public and private sector players are well-planned and executed. The NDHM will have to team up with the market players, such as MedTech companies, non-governmental organizations, foundations in health space, since they build the public utilities in the form of registries, personal health records, health IDs, and health information exchanges.(1,3)
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- Ministry of Health & Family Welfare- Government of India- eHealth Section. Placing the report on National Digital Health Blueprint (NDHB) in public domain for comments/views regarding. July 15th, 2019.
- Srivastav S. Govt Plans Centralised Digital Entity For ‘Ayushman Bharat’ Scheme. July 17th, 2019.
- Alawadhi N. Govt floats idea for Aadhaar-like database for mapping citizen health. July 18th, 2019.
Written by: Ms. Tanvi Laghate