In his address to the nation on India’s 74th Independence Day, the Prime Minister announced the launch of the National Digital Health Mission (NDHM). The mission aims to create a management mechanism to process digital health data and facilitate its seamless exchange; develop registries of public and private facilities, health service providers, laboratories and pharmacies; and to support clinical decision-making as well as offer services like telemedicine. The NDHM has the potential to make the health system more evidence based, transparent and efficient.
It is noteworthy that India’s health sector is characterised by a multiplicity of providers. In fact, it is estimated that nearly 98 per cent of the country’s health facilities employ 10 people or less. There are various levels of care in the public sector, including primary health centres, community health centres, health and wellness centres, district hospitals and super specialty tertiary centres, among others. Similarly, several types of establishments exist in the private sector, including nursing homes, clinics, corporate hospitals, informal providers and chemists.
Despite being information-intensive, India’s health sector has hitherto remained somewhat impermeable to digitisation. While considerable progress has been made in leveraging technology for developing customised information systems — like NIKSHAY, a web-based application for tuberculosis — these systems do not interact with each other, leading to the formation of multiple disconnected clusters of healthcare information. Moreover, one of the consequences of health provider fragmentation is that patient records are scattered across disparate manual or IT systems with limited or no possibility of interoperability. This is a direct consequence of the lack of shared standards for health records as well as the absence of a common healthcare taxonomy and consistent design principles.
Health data integration
Operationalising a single health ID and profile for every citizen, as envisaged under the NDHM, is an important reform for optimising health information systems. From a policy perspective, a system-wide electronic health profile can enable monitoring of diseases and efficient analysis of patient data, thus enabling quicker decision-making. It can also facilitate geographical, demographical and risk-factor based monitoring of health, followed by the design of targeted interventions.
For instance, in the current fight against Covid-19, if we had access to comprehensive digital health profiles of a substantial part of the population, it could give us a head start in identifying people with comorbidities and implementing preventive health interventions expeditiously. Further, an effective IT infrastructure linking public and private healthcare establishments, through information exchanges, will ensure data consistency across systems, eliminate duplication and minimise the reporting burden.
Patients will not only be able to share their health profiles with providers for treatment and monitoring purposes, but also access accurate information about the credentials and pricing of services offered by various health facilities, providers and diagnostic laboratories. Inclusion of telemedicine in the NDHM’s digital suite will connect patients with doctors and specialists for consultations in a broad range of areas, beyond Covid.
Proper use of data
For researchers, access to this health data goldmine can facilitate the evaluation of programme and policy effectiveness as well as accelerate innovation. The use of technologies like artificial intelligence for anonymised, aggregated health data can pave the way for predicting the likelihood of a patient falling sick.
Of course, the success of the NDHM will depend greatly on ensuring that its product offering is understood by and useful for all stakeholders. There is potential for a vast amount of health data to be generated once the mission is fully operationalised, and it is vital that there is clarity amongst stakeholders with respect to why the data is being collected, for whom and what purpose it will serve. Knowledge and skills of healthcare staff at every level will need to be upgraded to equip them to function effectively within the new digital health ecosystem.
No one is claiming that digitisation can substitute actual delivery of services. However, much like human resources, digital health too is a critical enabler for accelerating our progress towards universal health coverage. This is especially true because we find ourselves in a highly paradoxical situation. While on the one hand, India is one of the most data-rich countries in the world, fragmentation, duplication, inconsistency and — perhaps most crucially — the absence of a systemic approach has hitherto limited data availability for policymakers, researchers, providers and patients alike. Given this context, the launch of the highly ambitious NDHM has come not a moment too soon.
Prasad is public policy specialist, NITI Aayog and Singh is former programme officer, United Nations. – The Hindu BusinessLine