The Government of India recently launched the National Digital Health Mission (NDHM), a policy envisioned as a giant leap in India’s journey towards Universal Health Coverage.Coming at the time of a grave public health crisis, the mega policy initiative has the potential to transform the healthcare sector into being more efficient, inclusive, and delivery-driven.

The government contends theNDHM as being one of the game-changing policy initiatives launched in 21st-century India.   Through this program, it envisages creating a national health ID for every Indian. It necessitates the use of technology to streamline processes such as medical record-keeping, sharing of healthcare data, appointments and similar healthcare processes to help citizens make informed decisions on treatments.

The National Digital Health Mission is a digital health ecosystem under which every Indian citizen will have a unique health ID for digitised health records with identifiers for doctors and health facilities. It is a voluntary healthcare programme which will integrate doctors, hospitals, pharmacies, and insurance companies among others to create a digital health infrastructure.The Mission is expected to bring efficiency and transparency in healthcare services in the country. The government also hopes that it would ease problems faced by citizens in accessing healthcare, though it is not immediately clear as to how. 

So what exactly is the NDHM? What are its origins? How can it transform the healthcare landscape in the country? Read onto find out more.

What is the NDHM?

Under this scheme, every Indian’s unique health ID will work as their individual health account. This account will contain details of  every test, every disease, doctors visited, medicines taken, diagnoses of the individual. This information will be easily accessible even if the patient shifts to new place or visits a new doctor. The key components to be made available under the NDHM are health ID, health data standards for interoperability, national registries for health professionals and clinical establishments, Electronic Health Record (EHR) and Personal Health Record (PHR), Health Information Exchange (HIE), digidoctor, telemedicine, e-Pharmacy , healthcare registry and personal health records digitally stored.

Origin

The idea behind NDHM was first proposed by the NITI Aayog in 2018 in its National Health Stack wherein it recommended creating a centralised system to manage healthcare in the country. National Digital Health Blueprint (NDHB) was released based on J Satyanarayana committee. The NDHM is notified to implement the Vision and Strategies articulated in NDHB. National Health Authority, an autonomous organizations under the Ministry of Health and Family Welfare, has been entrusted with implementation of NDHM.

Why NDHM?

India’s healthcare system is plagued with many complexities. Some of these are unequal access, absence of service integration, poor quality, and unsustainable cost of accessing healthcare to name a few.

The current pandemic stresses the need to make healthcare accessible to every resident of the country.  India’s National Health Policy, 2017 has prescribed specific goals for adoption of digital technologies. It emphasizes the urgent need to transform existing digital health systems from providing disparate electronic services into integrated digital services. The policy also envisages leveraging ‘the potential of digital health for systemic linkages between primary, secondary and tertiary care to ensure continuity of care’.

Citizencentricity, quality of care, better access, universal health coverage, and inclusiveness are some of the key principles propagated by the policy. All these aspirations can be realized principally by leveraging the power of the digital technologies. India’s size and diversity make this agargantuan task requiring all stakeholders to adopt a holistic, comprehensive and interoperable digital architecture. In the absence of such architecture, the use of technology in the health sector continues to grow in an uneven manner and in silos.

In the above context, the National Digital Health Blueprint (NDHB) came into being. In addition to being an architectural vision, it also provides specific guidance on its implementation. It recognized the need to establish a specialized organization, called National Digital Health Mission (NDHM) that can drive the implementation of the blueprint, and promote and facilitate the evolution of the national digital health ecosystem. The NDHM, with its mandate to bring all stakeholders – patients, doctors, insurance companies, and pharmacies together on a common platform, will help remedy the current situation.

Key Features:

The NDHB is an ‘architectural document’ with specific details of the building blocks required for realizing digital health in a holistic manner. The key features of the blueprint include a federated architecture, a set of architectural principles, a five layered system of architectural building blocks, Unique Health Id (UHID), privacy and consent management, national portability, electronic health records, applicable standards and regulations, health analytics and above all, multiple access channels like call centre, Digital Health India portal and MyHealth App.

The NDHM has been designed as a layered framework, with the vision and a set of principles at the core, surrounded by the other layers relating to digital health infrastructure, digital health data hubs, building blocks, standards and regulations, and an institutional framework for its implementation.

Some of its salient features are:

Unique Health ID for every citizen

The mission adopts a ‘citizen-centric’ approach comprising six pillars: Health ID, Digi Doctor, Health Facility Registry, Personal Health Records, e-Pharmacy and Telemedicine. The National Health Authority states that every citizen who wishes to have their health records available digitally will have to create a unique Health ID. This ID is to be created by using a person’s basic details and mobile number or Aadhaar number. The health ID is likely to be in the form of a mobile application. It will contain his or her medical data such as prescriptions and diagnostic reports, and summaries of previous discharge from hospitals. The ID will reportedly be applicable across states, hospitals, diagnostic laboratories, and pharmacies.

Privacy of data

The NDHM has brought with it concerns of data security. The policy document, however, states that health records will be accessible and shareable by the patient with appropriate consent and complete control of the records will remain with the patient. The mission will also require doctors/hospitals to upload a digital copy of any health reports being physically shared with the patient to enable the creation of health records.

Connecting the unconnected

To reach out to and empower a large portion of unconnected population, the NDHM is building specialised systems and offline modules that will be designed to reach out to the marginalised, digitally illiterate, remote, hilly, and tribal populations.

The all-important Interoperability

NDHM strongly advocates the adoption of interoperability, a prerequisite for the development of integrated digital health services and establishing a continuum of care. NDHM will push growth by creating a level playing field for all stakeholders.

Governance under a Single Authority

The governing body for both NDHM and AB-PMJAY is National Health Authority. This will help in streamlining the rollout and other processes. In the first phase, the pilot will be rolled out in six Union Territories, Andaman and Nicobar Islands, Chandigarh, Dadra and Nagar Haveli and Daman and Diu, Lakshadweep, Ladakh and Puducherry. 

Improved Service Access and Delivery

Given the significant reach of smartphones and the potential for further spread of smartphone technologies, the NDHM emphasizes the ‘mobile first’ principle for delivery of majority of stakeholder-facing services. This is expected to improve access to healthcare in a significant way.

Challenges

Implementation of a mammoth policy such as this will not be bereft of challenges.  The NDHM is supposed to cover all government health programmes. This will be a huge exercise, similar to the Aadhaar project. It would require more resources than the currently allocated amount, making private participation a necessity.

In addition to the logistical challenges, the initiative also gives rise to concerns about data privacy. Considering that the mission involves collaboration between hospitals in both public as well as private sectors, laboratories, insurance firms, pharmacies and telemedicine, there is a risk of exposing individual healthcare data to hacking and commercial misuse.

The NDHM is currently a voluntary exercise. However, like the Aadhaar, it could become mandatory for availing government health services. In such a context, ensuring the safety of individual health data becomes paramount. The NDHM will be in compliance with the global best practices on data privacy.  There should be more clarity on questions such as: who will own, maintain and manage citizen’s health data. Insurance companies should not be allowed to misuse personal data.

In Conclusion

With a number of important policy reforms rolled out by the Government in recent times, the healthcare sector in India is set to undergo a revolution. Digitalization is sure to contribute the most to this transformation. The Indian experiment could bring out important lessons on large scale rollouts of digital initiatives. Healthcare stakeholders across the globe are likely to monitor the story of digital health in India, closely.