National Digital Health Mission: A Giant Leap in the Healthcare Ecosystem?

Ashish M. Shaji

23 Nov, 2020

Indian Prime Minister Narendra Modi announced a consequential initiative in the form of the National Digital Health Mission on the 74^th Independence Day of the country.  It is set to be another flagship initiative of the government like Ayushman Bharat. Let’s discuss this new digital initiative in detail.

What is National Digital Health Mission?

The blueprint of the programme was released last year. Its aim is to provide efficient and affordable health coverage through a wide range of data and infrastructure services.

It is a complete digital health ecosystem. The digital platform will be launched with the following key features:

• Health ID;
• Personal Health records;
• Digi Doctor; and
• Health facility register.

This Digital Health Mission is implemented by the National Health Authority under the Ministry of Health and Family Welfare^[1]. The National Health Authority is also the implementing agency for the flagship initiative of the government Ayushman Bharat.

The main feature of this mission is the technology part. It will leverage open digital systems to provide quality health care services to all. It will integrate different digital health services to create an ecosystem that can assimilate extant health information systems.

What is Digital Health ID?

The Health ID will be a warehouse of all information on the health of Indians. Every person in the country will get a health ID, which is a digital format of all his or her health records, and it will be linked to the registry of doctors and health facilities in the country.

The health ID shall be in the form of a mobile application. A patient who seeks to have his or her health records digitally must create a unique health ID with their basic details and mobile or their Aadhaar number.

The health ID will be linked to a health data consent manager that would be used to seek the consent of the patient and allow a seamless flow of health information from the Personal health records module. This health ID will be voluntary, and it shall be applicable across states, hospitals, pharmacies, etc.

Background story leading up to the launch of National Digital Health Mission

The origin of this new mission goes back to the National Health Policy of 2017, which led to the new National Digital Health Authority. The National Digital Health blueprint was released in the amount of July 2019 by a committee headed by former UIDAI (Unique Identification Authority of India) chairman Satyanarayana.

As per the blueprint, the aim of the digital mission is to achieve citizen-centric, universal health coverage, which provides quality health care with better accessibility and inclusivity by leveraging the power of digital technologies.

The National Digital Health blueprint recommended for the setting up of the National Digital Health Mission, a governmental organization with complete autonomy on the lines of UIDAI and Goods and Services network.

In the blueprint, the suggestion was made that it should look at establishing and managing core digital health data and the infrastructure that is needed for a seamless exchange. It should also promote adoption of open standards for developing several digital health systems that range across the sector, from wellness to disease management.

One of the main objectives of this mission, as stated in the blueprint, is to create a system of personal health records that is easily accessible to the citizens and to the service providers based on citizen consent. Two building blocks are recommended by the blueprint- Personal Health Identifier and Health master directories and registries for handling the requirements of unique identification of persons, facilities, diseases, and devices. These building blocks would be equipped with the option of interoperability to access digital records seamlessly.

What does this digital ecosystem imply?

The Digital ecosystem of the National Digital Health Mission points to four main aspects:

• Patient has been given the authority

The government has given the power in the hands of patients with the health ID, thus making them the most vital cog in this initiative. With this unique ID, a patient would be able to store information digitally relating to their medical conditions and diagnostic reports, etc. The government has not made it mandatory for people to opt for health ID; it has made in this way that once a patient opts for a Health ID, all of his data will only be accessible when he would authorize for it. Moreover, patients have been given a choice to voluntarily go for health ID, and they have been given the authority over their medical data and whom they want to share with.

• Inclusive healthcare

The plan is to bring e-pharmacies and telemedicine services under the fold of this mission.  Moreover, as per a recent report in the US, India is facing a shortage of doctors. The ratio of doctor-patient in the country is below the stipulated limit of WHO. The push by the government to telemedicine and e-pharmacy might ensure inclusivity and equality in healthcare.

• Reliance on Big data

The National Digital Health Mission is relying on big data to solve problems of healthcare. By leveraging machine learning and artificial intelligence techniques, it aims to go past just digitizing of personal health records to analyze data in order to know disease patterns, predict its onset, effectiveness, and transparency in healthcare delivery. 

• Curbing increasing costs

One of the main targets of this new initiative is to cut down on health care costs. Technology is set to play a pivotal role in helping to make healthcare facilities more affordable in the country. The financial burden can be reduced arising from medical care.

Is there a threat to the privacy of individuals with this National Digital Health Mission?

India has been contending on the requirements under its Draft Personal Data Protection Bill for the last two years. In this bill, data pertaining to health, finance, etc. is considered sensitive personal data as the disclosure of the same can cause serious harm to an individual or an institution.

Indian is not new to these types of threats and has seen this in the banking sector in the past. In the year 2016, more than 30 LAKH debit cards were recalled by banks due to data breach, and in September 2019, RBI termed the sharing of financial data by NBFCs with unregulated entities illegal.

The adoption of this new mission in the absence of a data protection law has led policymakers to plan for twin policies that are- security of health systems and privacy of personal health records.  

These policies will adopt norms like privacy by design, risk management, and fiduciary principles framework for building forthcoming digital health records ecosystem. The National Health Authority has a critical task at hand in the development of policies and management of this new health mission. As a government regulator for this mission, it would be responsible for the regulation of the healthcare market while ensuring consumer protection.

There is a need to follow the principles of transparency and accountability while functioning as the regulator for digital health records in this country.

Way forward for National Digital Health Mission

As we advance, the following points must be kept in mind:

• The national digital health mission doesn’t recognize health as a justiciable right. There can be a draft to make health a right as prescribed in the draft National Health Policy, 2015.
• One of the biggest challenges going forward would be data security and privacy of patients. It should be ensured that the patient’s health records should remain confidential and secure.
• The failure of an identical National Health Service (NHS) in the UK should be researched to know the essential aspects and technical implementation related deficiencies should be addressed proactively. 
• The standardization of its architecture in the country should find ways to accommodate state-specific rules.

Conclusion

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