What the National Digital Health Mission means for India
Nations like Denmark and Australia have successfully implemented digital health systems for its citizens. Can India build a robust digital health infrastructure for its citizens? Would the NHA be able to surmount impediments like lack of digital literacy, low broadband penetration and government hospitals with minimal ICT infrastructure? A HE report.
*Parveen works as a house help in one of the gated communities in Powai, Mumbai. What does she expect from the National Digital Health Mission (NDHM) which was announced by PM Narendra Modi in his Independence day speech?
“I hope we get more affordable and accessible healthcare. Yes, it’s indeed a pain to store all our medical records. Many of my employers do consult their doctors on their mobile phones, but this is not something we can do. We want high-quality and affordable care and hope this new scheme will deliver us that.”
Would NDHM fulfil Parveen’s hopes? NDHM is one of the significant steps announced by the government recently. The National Health Authority will manage it. A unique health id will be created for every Indian, and their health records will be stored in these ids.
NDHM Patient Experience Pathway
How will it make the experience of the patient better? UHID will work like this.
A patient enters the hospital, heads to the registration desk, scans the Health ID QR code at the desk using his Personal Health Records app on his smartphone. Hospital immediately gets detailed information about the patient. There is no waiting time for the patient. The hospital also sends a consent request to the patient before accessing his medical history. The patient chooses what data to share with the hospital and for how long the hospital can access this data. Finally, when the patient leaves the hospital, he gets a notification that the medical reports are ready.
An achievable dream? How tech-savvy are Indian hospitals and doctors? How long will it take to implement this? No one knows.
According to a recent report released by BCG and FICCI, here’s a breakup of clinicians who used teleconsultation during the lockdown.
Source: BCG FICCI report, Leapfrogging to a Digital Health System
“An initiative like this was long-awaited and certainly will change the way healthcare is delivered in the country. NDHM will help make quality healthcare available to people in every nook and cranny of the country. It has been so far a privilege for only those living in big towns and cities,” says Dr Harshit Jain, founder and CEO of Doceree, a physician engagement startup.
“The unique health ID will ease the patient’s numerous hassles concerning medical records. Also, in the future, the government will expand the ambit of NDHM to telehealth services which are essential to make healthcare delivery inclusive,” he adds.
Interoperability and Portability
Jain adds that the need of the hour is to plug the gap of shortage of doctors which is only possible when doctors are also available for consultation digitally. “It will multiply their presence far and wide, beyond their physical presence at one place. The government’s intent about introducing telehealth services as part of the National Digital Health Mission is a welcome step towards that direction. Coming to digitising health records, it goes beyond saying how imperative it is. It is not about digitising health records for the sake of safekeeping. It is about interoperability and portability of healthcare data which is the cornerstone for quality healthcare delivery and continuum of care. Presently, there is humungous data available in physical formats. It is pertinent that this data be digitised so that tools like ML and AI could be implemented to analyse it. This would help facilitate learning disease patterns, predict the onset of ailments and suggest seasonal outbreaks, bringing efficiencies and effectiveness in healthcare,” explains Jain.
Source: NDHM Website
What is the problem that the government intends to solve using NDHM?
NEWS Reports
Further, policy makers don't have information about what kind of diseases are coming up, which can be prevented. They don’t have complete monitoring and a unified control.
Perceived Benefits of the Scheme
NEWS Reports
Key Building Blocks
What are the key building blocks of the scheme? Some of the most important ones are Health ID, DigiDoctor, Health facility registry and Personal Health Record.
Health Tech Entrepreneur's View Point
Ayush Mishra, Founder and CEO of Tattvan, points out that the government efforts to digitize the Indian healthcare segment will boost the confidence of the entrepreneurs working in the health-tech industry, especially to new ones who are entering into the industry with innovations. "It brings a huge opportunity for health-tech startups to work with providers and insurers to help build the continuum of patient-centric care. In this mission, digital health will be the only way to reach a large population at affordable costs. The government can also collaborate with private players and newcomers in the digital space who share the same mission and vision to counter any challenges and build technological infrastructure at scale to help bring the Indian digital healthcare dream into a reality," adds Mishra.
Implementation Plan for NDHM:
Source: https://ndhm.gov.in/assets/uploads/NDHM_Strategy_Overview.pdf
Concerns of Medical Community
Dr RV Asokan, General Secretary of Indian Medical Association, has a different take on this subject.
"The Digital Health Mission is a step in the wrong direction. Unfortunately, the government is focusing on non-issues. It is also lopsided coloured vision," says Asokan.
He explains that it is not at all prudent to invest in digitising the health records of millions of people. "Our people seek primary care as well as secondary care mostly within the district, and rarely they go to the nearby city for tertiary care. I don't think anyone is going to benefit due to the portability across the country. The focus still should be on primary care and addressing the social determinants of health. More than hurdles, violations in the privacy of individuals will be a self-inflicted wound. I don't think even a totalitarian state will dare to do it," adds Asokan.
BUDGET FOR NDHM
Source: https://ndhm.gov.in/assets/uploads/NDHM_Strategy_Overview.pdf
Srivatsa YB, National Campaign In-charge, Youth Congress, points out that the National Health Data Mission (NDHM) is the latest' big idea' by the Modi Government towards integrated digital health infrastructure. "Like most of the government's schemes, NDHM sounds good on paper. But it is blind to the glaring social contexts of India's healthcare: poor accessibility, affordability and quality. We are witnessing the burden of weak public health systems in handling the COVID crisis. According to reports, there were 8.5 hospital beds per 10,000 citizens and eight physicians per 10,000. The country's healthcare system was not equipped to deal with a crisis of this nature. This govt's previous big idea was Ayushman Bharat, which has been a non-starter, especially during this pandemic."
He adds that he is not disputing that data and digitisation of records are needed. "But policy prioritisation is important. Instead of channeling our resources towards improving the healthcare system at the bottom of the pyramid, the government is grandstanding and launching schemes for the media more than people. Health data of people is extremely sensitive, making data security and privacy more critical. Yet we still do not have a data protection law in the country."
Privacy Concerns
He also adds that if the medical history of a person is stored digitally and linked to a central database as per NDHM, it would undoubtedly give rise to security issues. "One has seen that happening with Aadhar. In the case of NDHM, there is no clarity as to whether an individual will get notified when his data gets accessed and used by some government body. What happens in the case of data theft? In case employers begin health profiling people? We therefore first need to strengthen our data laws before we expand digital infrastructure in service delivery. On the user end, one has to install the application and register themselves. What happens in rural areas with low internet penetration and limited digital health resources? People will have to depend on others; middlemen will thrive, increasing the risk of data breaches & theft. It seems the government's healthcare solutions are suited more to the needs of the cash-rich insurance industry, and not the poor and vulnerable in urgent need of good healthcare," he concludes.