Every sector is going through rapid digital transformation. In this context, the health sector has been a laggard compared to others. However, the COVID-19 pandemic has catalyzed the ongoing digital transformation of the health sector. Every technology is a double-edged sword with potential for benefits and harm. The world has witnessed the tremendous power of digital technology in the form of telemedicine, digital surveillance, monitoring the vaccination of billions of people, etc., during the COVID-19 pandemic. AI applications are rapidly penetrating the domain of the cognitive powers of doctors.
The flip side of the ongoing transformation is that there is a real threat of the digital divide becoming a new social determinant of health. There are growing concerns about data privacy and security. We have witnessed the dangers of infodemic during the pandemic. Vaccine hesitancy grew rapidly, despite easy access to vaccines. Wearable digital monitors, while extremely useful, are raising the anxiety levels of large populations. The pace of digital transformation is such that the regulatory systems are left way behind with unknown consequences.
Micro-small-medium-enterprises (MSMEs) account for more than 90% of healthcare services in the private sector. These include single-doctor clinics, nursing homes, small and medium-sized hospitals, diagnostic labs, pharmacies, etc. There is a risk of these being left behind by the larger corporates with unknown systems-wide consequences. The real benefit of digital transformation of healthcare will not be realized fully unless these enterprises are digitalized. Public investments in digital infrastructure are essential for the inclusive transformation of all. This is akin to public investments in essential utilities like water and electricity supply to every household and motorable roads to every village.
The case example of India is very interesting in the way it is driving the national digital transformation of every sector through the Digital India mission. It is based upon three core pillars – digital public infrastructure (DPI), e-governance, and digital literacy. India has adopted the principle of digital stack, popularly known as ‘India Stack’ in building digital infrastructure. While the government is investing in building the core building blocks like identification systems (Aadhaar, ABHA, HPR, HFR, PAN, TAN, DIN, etc.,), consent managers, accounts aggregator, DigiLocker, and providing unified interfaces (UPI, UHI, etc.,) to integrate exploding open APIs being developed by the growing start-up ecosystem in the private sector. In addition, public investments are enabling last-mile digital connectivity of regions not reached by the private sector.
National Digital Health Blueprint (NDHB) outlines the digital health architecture based on the India Stack principle. Ayushman Bharat Health Account, now popularly being known as ABHA, is the unique health identifier of every person. Personal Health Records (PHR) are populated with standards-based data generated across health systems being linked to the PHR. Each health professional will be identified through a unique number entered into the Health Professional Register (HPR). Similarly, each healthcare facility (clinic, nursing home, hospital, labs, pharmacies, etc.,) will be issued a unique ID as part of the Health Facility Register (HFR). Health Information Exchange (HIE) facilitates the secure exchange of information between patients, professionals, providers and payers. Health Claims Exchange (HCX) enables seamless claims processing by interfacing with patients, insurers, and providers. The government is investing significantly in building a robust digital health infrastructure. Coupled with this, there is an explosion of digital health applications (Hospital, Laboratory, Clinic, and Pharmacy Information Management Systems to help providers, Personal Health Record applications, Digital Health Assistants to help patients, Clinical Decision Support Systems for doctors, Fintech and Insurtech solutions to handle health financing, Big Data surveillance systems, etc.,) that can interface with the digital health highway being laid by the government. This is akin to connecting all regions of the country through national highways which is essential for the economic growth of the country.
The next challenge is to make people, professionals, providers, and payers use the digital health infrastructure being created. Public healthcare remains the single largest healthcare provider in the country. It is comparatively easier for public healthcare to transform digitally compared to a private healthcare system which is highly fragmented and poorly regulated. Various strategies are being explored to make people, professionals, providers, and payers aware of the tremendous value the digitalization of healthcare, to access and adopt various digital applications in their daily use. Large payers like public health insurance agencies, employee social insurance agencies, and private health insurance companies have the power to nudge healthcare providers to adopt digital health information systems by automating claims processing and paying. Early adopters who have realized the power of digital health transformation can influence their peers by example. Quality accreditation agencies like NABH and NABL can lay down standards for digital health infrastructure and digital health information by the providers as part of the quality assurance of their services.
Despite many challenges, India is progressing slowly but steadily to achieve its ambitious Ayushman Bharat Digital Mission (ABDM). The government has been partnering with the private sector (both non-profit and for-profit) to catalyze the inclusive digital health transformation across the country. The real benefit of the transformation will be a reality when a remotely living tribal patient can access needed healthcare when, where, and how he/ she wants!
Dr. N. Krishna Reddy
President, InOrder-The Health Systems Institute