NDHM facilitates a comprehensive feedback loop between researchers, policymakers, and providers
Dr Praveen Gedam, Additional CEO, NHA talks about how the National Digital Health Mission’s will transform healthcare delivery and consumption in India and updates on its progress, the learnings, future plans, and more, in an interview with Lakshmipriya Nair
How will NDHM catalyse the growth of a holistic health ecosystem and transform the ways and methods of healthcare delivery and consumption?
This pandemic has highlighted the absolute necessity to ensure essential healthcare to all citizens at all times. It has pushed us to understand the need for an expanded, stronger, more responsive and holistic health system that enables better access to, affordable, timely and quality healthcare. The National Digital Health Mission is building an integrated digital health infrastructure that aims to significantly improve the efficiency, effectiveness, and transparency of the overall health service delivery in India, enabling a better continuum of care. The mission is voluntary and is centred on the key principles of privacy, security, and consent.
With NDHM, citizens can maintain all their health records in one place making it easy for doctors from across disciplines access the patient’s medical history and provide a more accurate diagnosis and thus, prescribe appropriate and effective health interventions. On the other hand, patients will also have comprehensive information on health facilities and service providers. NDHM will empower individuals with accurate information to make clear and informed decisions. It also helps digitise the claims process and enable faster reimbursements. Thus, NDHM will enhance the overall access, ease of providing services as well as increase the accountability of healthcare providers.
From a larger picture perspective, this data will enable advanced analytics, geography, demography, and time-based evaluations, better planning and preventive healthcare. This will aid policymakers and programme managers to strengthen the monitoring and implementation of health programs and evidence-based policy formulation. Finally, a digital health ecosystem of this nature will aid researchers with data required to evaluate the effectiveness of implemented health policies/interventions and help with initiating efficient solutions in a pandemic. NDHM facilitates a comprehensive feedback loop between researchers, policymakers, and providers.
NDHM is a massive endeavour. Where do you foresee the biggest challenges in its rollout and implementation? What are the steps being taken to mitigate them?
The biggest challenge could be implementing the mission in rural or remote areas which face concerns of digital literacy, low internet connectivity and access to doctors and hospitals. However, these factors have been taken into account and offline modules have been envisioned along with assisted participation that will enable individuals, doctors, hospitals and all other stakeholders to seamlessly participate in the NDHM ecosystem and reap all the benefits of it regardless of connectivity issues.
The second challenge would be to increase participation by individuals and healthcare providers. This means NDHM will have to explain the benefits of this mission effectively. In short, individuals will be able to access all their medical records and have easier access to healthcare providers.
NDHM’s building blocks – HealthID, Doctors’ Registry, Personal Health Records, Health Facility Registry, and Telemedicine – have been designed to enable citizens to move from more conventional forms of health-seeking behaviour to adapt digital means to access healthcare. This will also aid in transitioning from a curative to preventive and wellness-based healthcare delivery model.
The third challenge would be to enable health facilities, medical practitioners, doctors, and other healthcare providers adopt the platform and utilise it to efficiently drive improved health outcomes for their patients.
To test the mission’s building blocks and then incorporate the learnings to implement the mission across the country, Government has rolled out the pilot in the six Union Territories—Puducherry, Chandigarh, Dadra and Nagar Haveli & Daman and Diu, Ladakh, Andaman & Nicobar Islands, and Lakshadweep. The goal is to identify all the hurdles in the pilot phase and implement viable solutions accordingly to plug the gaps in implementation.
Implementing and executing NDHM will necessitate huge digital infra and technological capacity? What are the steps being taken in this direction?
Based on the principles of health for all, the National Digital Health Mission aims to build the backbone necessary to create an integrated digital health infrastructure. Other than the core registries such as Health ID, DigiDoctor, and Health Facility Registry, other enabling components such as PHR, Telemedicine etc. will have public and private applications available. This will not only serve to ensure that accessibility is maximised but also lead to the development of a vibrant, innovative and self-sustaining ecosystem.
The participation of the broader public sector and the private sector will be vital in making India a Digital Health Nation. The mission envisages connecting all digital health systems through interoperable platforms. This can be compared with the UPI framework in the financial sector. The only incremental cost for this mission is the cost for such an interoperable platform and core building blocks, which is not significant. At the same time, the process of ramping up infrastructure in public health facilities will be undertaken.
Can you elaborate on the role that NDHM will play in enabling improved accessibility to crucial services to the deserving and ensuring UHC?
NDHM has been designed to become a one-stop solution for every citizen’s healthcare needs. With NDHM’s personalised electronic health record system individuals can access their longitudinal health records anytime, anywhere. It also envisions providing individuals with access to both public and private health services, facilitating compliance with set guidelines and protocols, ensuring transparency in the pricing of services and improving accountability for the health services being rendered.
With all reports and records in one place, unnecessary expenditure like repeat tests can be avoided. Also, healthcare providers will be able to provide a better quality of healthcare. Besides, patients will be able to search for doctors, health facilities online and the health sector can make all services more “searchable” and thus more accessible. Telemedicine is likely to grow exponentially in the near future and help bridge the accessibility gap. The NDHM ecosystem will certainly accelerate India’s journey towards UHC.
Data integrity and safety are major concerns. How will the endeavour ensure these aspects?
There are various laws and Supreme Court judgements that provide a comprehensive legal framework data security and privacy. The National Digital Health Mission follows a “privacy by design” approach to ensure that standards followed to protect patient information and the privacy of their personal health data are of the highest order.
The draft Health Data Management Policy has been drafted keeping in mind the core tenets of privacy, security, and patient consent-based sharing of health information. The draft policy has been developed under the statutory framework of existing laws such as the IT Act, Aadhaar Act, and judgements by the Supreme Court on data privacy and data security. Further, the draft Policy also draws from the Personal Data Protection Bill.
This draft policy is the first step in actualising NDHM’s guiding principle of “Security and Privacy by Design” for the protection of individuals’ data privacy. It acts as a guidance document across the National Digital Health Ecosystem and sets out the minimum standards for data privacy protection that should be followed across the board to ensure compliance with relevant and applicable laws, rules and regulations.
The participation of States, UTs and all other stakeholders in this programme is key to the successful implementation of this mission. NDHM is an entirely voluntary scheme. A citizen who holds the Health ID will have complete control over his/her health records and can decide on how he/she wants to manage their personal/ sensitive data. He/she can decide on when, with whom and how much information he/she wants to share with the doctor/healthcare provider and grant permission to view the records for a stipulated period. Besides, the patient can withdraw “consent” at any time.
The draft Health Data Management Policy clearly defines the nature of consent and the applicable laws and also the requirement for fresh consent for any new or previously unidentified purpose.
Furthermore, NDHM is a federated architecture, which means that the data is not centrally stored. All participants in the NDHM ecosystem will need to be in compliance with all relevant policies including the NDHM’s Health Data Management Policy and Privacy and Security Policy. The NDHM infrastructure as per policy can only be in India.
Any global examples that NDHM has drawn inspiration and inferences from? What are the major learnings from these examples?
NDHM has the potential to become one of the world’s largest integrated digital health ecosystems. It is in the nascent stage and given our country’s unique healthcare challenges, no single example of a healthcare scheme of another country can suffice as a complete parallel to NDHM.
However, while designing and building NDHM, the health systems and similar government-run schemes in countries like the UK, US, Singapore, South Korea, Thailand, Estonia, UAE, and Israel have been studied and learnings and best practices from their experiences have been drawn.
What are the unique features of this programme? What has been the progress of NDHM since its launch on August 15, this year?
NDHM will provide the necessary national digital health ecosystem that will accelerate India’s progress towards universal health coverage. What is unique about this mission is that it will engage all stakeholders across the entire healthcare sector – doctors, patients, healthcare facilities, insurance companies, public health and nutrition programmes, etc.
The implementation of NDHM is expected to significantly improve the efficiency, effectiveness, and transparency of health service delivery overall. Patients will be able to securely store and access their medical records (such as prescriptions, diagnostic reports and discharge summaries), and share them with healthcare providers to ensure appropriate treatment and follow-up.
NDHM is a citizen-centric scheme that will empower individuals with accurate information to enable informed decision making and increase accountability of healthcare providers. NDHM will provide the choice to individuals to access both public and private health services, facilitate compliance with laid down guidelines and protocols and ensure transparency in the pricing of services and accountability for the health services being rendered.
NDHM is currently focused on the pilot that has been rolled out in the six union territories mentioned previously. In this pilot stage, across the six UTs, NDHM has started enrolment of individuals for HealthID, doctors and healthcare providers. The next step will involve testing the digitisation of medical records, implementing standards for seamless interoperability, mechanisms for consent-based sharing of information.
NDHM is in the process of rolling out the core elements. NDHM will further refine it based on learnings and experiences in the pilot. The mission is on track and has already deployed the three key building blocks—health ID; creation of a doctor’s registry and the health facility registry. In the three months since its launch, over 2.8 lakh Health IDs, 1,000 Doctor IDs have been verified, and 628 health facilities have been approved.
Each citizen can join the mission by a very simple process: An individual can create/generate a digital Health ID (14-digit number) on our website (https://healthid.ndhm.gov.in/) using either Aadhaar ID or mobile number. The provisions for using other valid KYC documents will be rolled out subsequently.