National Digital Health Blueprint: A blueprint to transform healthcare
Universal Healthcare (UHC) by 2030 is a pivotal commitment for India, as it impacts achievement of all other SDGs. Across most developed economies, digitisation of healthcare has made it accessible, equitable and affordable, accelerating the path to UHC.
In 2015, efforts to augment digital health infrastructure were initiated with the ‘Digital India’ movement. Yet, it was the COVID-19 pandemic that necessitated rapid adoption, and on March 25, the government issued the Telemedicine Guidelines 2020. On August 10, the national telemedicine service, e- Sanjeevani, completed more than 1,50,000 tele-consultations.
Even though telemedicine has been around for two decades, it has been utilised to its full potential only now. The Apollo247 app has been downloaded by a few million individuals, and more than 5,000 tele-consultations-a-day is the norm. Over 5 crore Indians accessed healthcare online in March-May 2020. A coalition of over 100 healthcare specialists came together to launch Swasth, a nationwide telemedicine platform for COVID-19.
Nevertheless, the biggest announcement is expected to be made by the PM today, as he formally launches the National Digital Health Mission (NDHM), which can transform Indian healthcare. The change that it will usher in, is exciting, but it is paramount that the implementation roadmap is crafted assiduously.
An efficient and secure implementation of digital health solutions requires a unified framework and a strong foundation for data integration. Launched in 2018, the National Health Stack (NHS) was envisioned as the foundational component for UHC to leverage Big Data Analytics, Machine Learning and Artificial Intelligence.
Standardisation across the board is vital to the implementation of UHC, and also for the development of a digital health framework. FICCI had coordinated the development of National Standard Treatment Guidelines (STGs) for 20 specialties, covering 280 conditions, and the EHR (Electronic Health Records) Standards, to help promote standardisation in clinical practice, notified in 2013 and 2016, respectively. Since then, these guidelines have been expanded and updated by the government, yet have not been implemented across providers and states.
FICCI has been also working very closely with IRDAI on health insurance standardisation. The new regulations that fructified in 2013 included most of the chamber’s recommendations. These standards are essential to develop the basic framework for the interoperable digital data records.
The NHA has been working on the National Digital Health Blueprint (NDHB), in consultation with the industry, which is the architectural document for the implementation of NHS. The Blueprint lays out five horizontal and two vertical building blocks for its implementation. While the document lists National Health Standards as Vertical Layer-1, it does not detail out the implementation of STGs, which will be the foundation for integrating the patient data from providers.
The Horizontal Layer-2 includes the Personal Health Records, indicating a federated system with multiple players working on an interoperable standard for sharing of health data. The Blueprint also recognises the importance of standards for safety and seamless interoperability of all the building blocks and prescribes the use of EHR Standards.
The Centre needs to mandate adoption of these central norms by the states, in a mission mode, for the effective roll-out of NHS. The government could even consider incentivising organisations that comply to EHR Standards to help boost the digital movement.
The Blueprint also includes security and privacy of data as important principles, and mentions the development of a National Policy on Security of Health Systems. However, rolling out a major digitisation programme involving the data of millions of citizens without a data protection law in place would be detrimental. It is important that the implementation of the proposed Digital Health Security Act is fast-tracked. Likewise, Health Records Management is a specialised field with several time- and cost-intensive elements, and the government should consider providing adequate support to both public and private healthcare facilities, as was provided by the US government.
To accelerate the implementation of NDHB, the government should consider partnering with the private sector to build public infrastructure that can be open-sourced and potentially used at scale by both public and private entities. Many of the core building blocks of NDHB such as the consent manager, health gateway, etc, can be rapidly built by the private sector and deployed by the government as public good. This PPP will help the government move on overdrive in implementing the vision of NDHB.
The author is President, FICCI, & joint managing director, Apollo Hospitals Group