Improving the health status of people is one of the core functions of a health system. Knowing the existing health status of people is the first step to improving it. Information on health and disease is currently being gathered by the government through a variety of means. Population based surveys have remained the mainstay of information over decades. In addition, a large amount of information is gathered from disease-specific vertical programs. Traditionally, information gathering focused mainly on maternal and child care and communicable diseases. Reporting of notifiable diseases by healthcare providers is a part of traditional surveillance systems. Recent years have witnessed a growing focus on information gathering related to non-communicable diseases (NCD) and mental health, as the burden of diseases has transitioned to NCDs in every Indian state.

Private sector accounts for nearly two-thirds of healthcare provision in India. Most of the health information gathered by the private sector is not shared, leading to a big void in population health information. While information on births and deaths is improving across states, the cause of death remains poorly documented. The recent controversy on excess deaths during the COVID-19 pandemic era reflects the present gaps in recording deaths.

The new millennium is witnessing an increasing frequency of epidemics, culminating most recently in the COVID-19 pandemic. Globalization, climate change, and rapid urbanization have increased the threat of spill over from animals and the rise of vector borne illnesses. Antimicrobial resistance (AMR) has been identified as the next big threat that humans will encounter in future. There is a growing movement towards redesigning surveillance systems to encompass zoonosis under the One Health concept.

Efficient management of rivers of health information flowing across the most fragmented and complex health systems is vital for the normal functioning of health systems. Advances in information and communication technologies are in a position to integrate this information. Unique health ID, facility register, provider register, unified health interface (UHI), health information exchanges (HIE), data standards, data privacy and security laws envisaged in national digital health blueprint (NDHB) and being implemented under Ayushman Bharat Digital Mission (ABDM) will enable building a robust integrated national health information system.

Existing public health information systems have started moving towards ABDM compliant solutions. Creating the needed infrastructure, building human resource capacity in health informatics, managing the needed change in cultures and practices, engaging the private sector in information sharing are some of the major challenges that the Mission has to overcome in realizing the dream of an integrated national health information system.

While integration is the vital first step, converting information into effective action is essential to improving the health status of people, and to respond to their health needs without financial hardships. Building human resource capacities in processing and analyzing the information is essential to inform policies, strategies, and operational plans. The use of artificial intelligence (AI) in processing voluminous data enables real time data visualization to mount rapid responses during a health crisis. 

Integrated health information systems will enable monitoring of epidemiological trends in disease prevalence and incidence. These trends are needed to monitor the effectiveness of policies under implementation. Health needs assessment can be undertaken as per accurate data on disease burden in planning the supply of healthcare services in a given geography.       

There is a convergence of factors in India that raises hopes of realizing an integrated health information system. These include penetration of digital information and communication technologies, rapidly growing mobile, smartphone and internet use rates, improving data speeds, lowering of costs, increasing digital literacy, needed policy thrust, and enabling laws. The COVID-19 pandemic has accelerated the use of digital technologies in healthcare. Success of implementing Aadhaar, Unified Payment Interface (UPI) to support digital economy, and roll out of Goods and Services Tax (GST) regime give hope that we may realize the dream of having integrated national health information systems that have the potential to make our health system stronger and more resilient.

(Views expressed are personal.)

Dr Krishna Reddy Nallamalla
President, InOrder
Regional Director, South Asia, ACCESS Health International.

Photo Credits: Learning Bot

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