The National Health Policy, 2017, created a central government initiated health insurance scheme for 100 million families, PM Jan Arogya Yojana (PM-JAY). A byproduct has been the generation of large data. Building on it, the government started work on the National Digital Health Mission (NDHM), an initiative to create a digital ecosystem of healthcare services across India. A part of this initiative includes the creation of a unique health identifier (UHID), on the lines of Aadhaar. Indu Bhushan, CEO of National Health Authority, the agency that oversees PM-JAY and is now implementing NDHM, speaks to Shimona Kanwar about the current situation:
Will the government work on its own in this ecosystem or rope in the private sector?
NDHM aims to create a national digital health ecosystem based on the participation and partnership of citizens, doctors, health facility providers, state governments, among others. The core building blocks of NDHM will be owned and managed by the Government of India, the data will be solely owned by the entity registering in these registries.
The participation of the broader public sector and private sector will be vital in making India a digital health nation. NDHM has sought and will seek active feedback and participation from all stakeholders in the ecosystem. We have introduced a sandbox for healthcare providers, technology companies, startups and other stakeholders in the private sector to collaborate on the technology products being built, on the precondition that they must be compliant with prescribed privacy and security guidelines.
What is the plan to deal with data security challenges?
NDHM uses a federated architecture for storage of data, which means there is no central data store to hack. Your health record is either held by the healthcare provider who created it or there is a copy with you. All participants in the NDHM ecosystem will need to be in compliance with all relevant policies including the NDHM’s Health Data Management Policy. The NDHM infrastructure as per policy can only be in India.
Is there cultural acceptance of e-health in the country?
We are designing specialised systems and offline modules to reach out to the “unconnected”, digitally illiterate population in remote, hilly, and tribal areas with little to no internet and telecom networks. We plan to align panchayati raj institutions, frontline ASHAs, and Anganwadi workers to enable citizens to create their health IDs and join the NDHM ecosystem.
How will connectivity limitations impact NDHM?
We have taken this reality into consideration. As mentioned before, we are developing offline modules and applications to ensure that the systems work with or without internet connectivity and all stakeholders – citizens, doctors, health facilities – will be able to use the applications and access healthcare through them.
Given the Covid-related disruptions, what’s the current status?
The current focus will be on the pilot programmes launched in six Union territories. This pilot includes enrolment of individuals, doctors and healthcare providers, along with the digitisation of medical records, establishing standards for seamless interoperability, creating mechanisms for consent-based sharing of information and building systems for securely storing data. The core elements will be rolled out and stabilised following which they will be further refined based on the learning and experience of the pilot. Subsequent nationwide rollout will see implementation across states and greater integration efforts to aid citizens end-to-end in their digital healthcare journey, from diagnosis to discharge and follow-ups.
How will digital health programmes help in vital measures such as hunger index and maternal mortality rate?
NDHM envisions making the entire health system more efficient, responsive and sustainable through better access to healthcare data. All services under NDHM are built and designed to strengthen overall healthcare service delivery in India. NDHM shall enable evidence-based decision making, advanced analytics and better preventive healthcare by improving access and quality of healthcare data. NDHM shall also be integrated with various public health and nutrition programmes. We are working out the details on how aggregated and anonymised data from NDHM will be used for more evidence-based policy making.
Telemedicine is fragmented and does not follow a uniform pattern in the country. What is being done about this?
These testing times have propelled large uptake of telemedicine that has shown great potential for expansion. Telemedicine is a core application of NDHM and will significantly enhance access of all citizens, especially those in Tier 2 and 3 cities, remote towns, and villages lacking health infrastructure, to timely and affordable medical attention. It is a key building block of NDHM and alongside the telemedicine guidelines of the ministry of health and family welfare will also lead to the application of standardised telemedicine practices across the country, bring in interoperability to the states/ UTs and help in defining minimum infrastructure to be provisioned at Ayushman Bharat Health & Wellness Centres for conducting teleconsultation services.
DISCLAIMER : Views expressed above are the author’s own.