BS READS: National Digital Health Mission - 2 yrs in making, seen as healthcare's UPI

PM Narendra Modi addressing the nation from ramparts of Red Fort on Independence Day
While flagging off the National Digital Health Mission (NDHM), the Prime Minister spared few words for a project that has been in works for two-plus years and has rallied the health ecosystem in the country. 

The NDHM, implemented by the newly created National Health Authority (NHA), is a digital infrastructure for delivery of health services. It envisages creation of digital health profiles of citizens and care-givers, along with blocks like digital payments, consent authorisation and analytics portal, for seamless interaction digitally. 

“From today a new campaign is going to start in the country. It is the National Digital Health Mission, which will bring a new revolution in the health sector in India,” Prime Minister Narendra Modi said in his address on India’s 74th Independence Day ceremony.

"Every Indian will get a Health ID card. Every time you visit a doctor or a pharmacy, everything will be logged in this card. From the doctor's appointment to the medication, everything will be available in your health profile.”

Many experts feel NDHM and National Health Stack (NHS) will do what UPI did for the payments ecosystem, or may follow how Aadhaar became the foundation for direct-subsidy transfer and e-KYC. Similarly, the health stack is envisaged as the foundational blocks for India’s digital healthcare ecosystem.  

Essentially, the PM today launched a few key components of the NHS, said Nita Tyagi, core volunteer at iSpirit, which developed the platform in partnership with the government. These include: Health ID, DigiDoctor and Facility Registry, and Consent Manager for Personal Health Records.

“The whole idea is to empower all stakeholders in the ecosystem – government, hospitals, insurance, researchers – and distribute the capability to solve these (health) problems,” said Tyagi. “Now in order to do that you need to have certain foundational blocks, certain standards, so that whatever you do, you are not inventing the thing over and over again. And there is interoperability and standard so that it all adds up.”

Components of NHS

Health ID: A unique digital ID that will have information including demographic and location, family/relationship, and contact details. It will be used for the purposes of uniquely identifying persons, authenticating them, and threading their health records.

DigitDoctor: A single, updated repository of all doctors enrolled in the nation with all the relevant details such as name, qualifications, name of the institutions of qualifications, specialisations, registration number with State medical councils, years of experience, etc.

Health Facility Registry: A single repository of all the health facilities in the country. It will be centrally maintained, and will store and facilitate exchange of standardised data of both public and private health facilities in the country.

Personal Health Records (PHR): An electronic record of health-related information on an individual that conforms to nationally recognised interoperability standards. The most salient feature of the PHR, is that the information it contains is under the control of the individual. 

Electronic Medical Records (EMR): A web app for clinics that displays patients data. It contains the patient's medical and treatment history from a ‘single’ health facility, and allows clinics to track patients' health over time as part of treatment.

Every individual will be able to create a profile on NDHM by filling up a form and uploading requisite documents. The process would be similar to creating a UPI handle and will be linked to the person’s Aadhaar number. For those who can’t do it on their own, the government will launch sign-ups drives, said Tyagi. 

Simultaneously, an effort is underway to sign-up healthcare providers – doctors, hospitals, pathological labs, drug stores and tele medics – onto NDHM. The idea is that when a patient shows up at a hospital, the doctor is able to simply retrieve his or her medical history, including past diagnostics and tests reports, to administer treatment. The said care-givers will also be able to update the records through an e-authentication mechanism.

To enable this, a framework is required for patients to give their consent for their information to be used. As per the notes shared on iSpirit’s website, fresh consent will be sought from patients each time their medical history is sought and this will be done through mobile phone-OTPs. 

“The problem today is that the electronic health records listed in one app or ecosystem are not easily portable to other systems,” goes a status report on iSpirit’s website dated 1 August.

“There is no common standard that can be used to discover, share, and authenticate data between different networks or ecosystems. With the PHR (Personal Health Records) system, a user is able to generate a longitudinal view of their health data across providers. The interoperability and security of the PHR architecture allows users to securely discover, share, and manage their health data in a safe, convenient, and universally acceptable manner.” 

The initial roll-out will be followed up by other parts of the stack, namely, a coverage and claims platform and national health analytics platform. As per the plan, private ehealth players will be asked to create services on top of the NHS.

The initiative will have many benefits, industry participants said. Besides being a one-top for patients' health records, the NHS will quell health data arbitrage and reduce cost of delivery of services. “Imagine now, that the insurance companies will not have to physically go to small towns and go through tons of paperwork for verifying claims. They can do it, or at least some part of the process, digitally. NHS will help them reduce costs and offer their services at better rates to peoples” said Tyagi.

“Covering all 1.3 billion Indians' healthcare through technology is a fantastic initiative that will not only improve access but also ensure better medical treatment and care, particularly in emergencies,” said Ananth Narayanan, co-founder and CEO of Medlife, a leading e-health start-up. “With the right privacy safeguards in place, this is futuristic looking positive news for India’s health scorecard.”

“This amounts to fodder for research,” Shuchin Bajaj, founder director of hospital chain Ujala Cygnus, said at a recent TiE webinar in response to a question on the NHS. “Right now what is happening is that we are good at delivering healthcare but not really good at keeping the data, analysing it and squeezing out the information needed for long-term research.”

However, the biggest beneficiary of the initiative is the Ayushman Bharat Scheme. The scheme, now called PM Jan Arogya Yojana (PMJAY), envisages to provide insurance cover of up to Rs 5 lakh per family to 100 million poor and marginalised families. NHS as a bedrock for PMJAY was first touted in a NITI Aayog “blueprint” for the stack released in July 2018.

“The National Health Stack is designed to provide the foundational components that will be required across Ayushman Bharat and other health programs in India. The Health Stack is a nationally shared digital infrastructure usable by both Centre and State across public and private sectors,” the paper said.

In 2019, the blueprint was taken up for a feasibility study by a committee headed by former UIDAI chairman and IT secretary J Satyanarayana. The committee submitted its report in November. Simultaneously, erstwhile National Health Agency was revamped to National Health Authority and was carved out as an autonomous institution. NHS currently manages PMJAY and NDHM. 

With the onset of Covid-19, digital health has come to the forefront. The government on 25 March, laid down rules for the tele-medicine and tele-consultation sector, essentially giving it a green light. At the time, leading ehealth players like 1 MG, Practo and Cure.Fit, among others, came together to form what is called Swasth Alliance. The group launched a free tele-consultation app for Covid-queries also called Swasth.

But the Swasth Alliance is much more than just tele-medicine. The alliance is essentially the first set of private players who are testing out the NHS by creating services on top of it. Swasth is led by Infosys co-founder Kris Gopalakrishnan, Manipal Group’s Ranjan Pai and iSPIRT’s Sharad Sharma, and has representation from start-ups Medlife and e-commerce firms Flipkart and Udaan, among others.

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