The central government is discussing the creation of National Digital Health Mission (NDHM), a central digital repository for all the data coming under the health insurance scheme Ayushman Bharat. A committee, constituted under the former Secretary and Chairman of Unique Identification Authority of India (UIDAI) J Satyanarayana, prepared the “National Digital Health Blueprint” (NDHB) report.
The report was submitted to the Ministry of Health and Family Welfare on 24 April 2019. The key features of the blueprint include a Federated Architecture, a set of architectural principles, a five-layered system of architectural building blocks, Unique Health ID (UHID), privacy and consent management, national portability, EHR, applicable standards and regulations, and health analytics.
Some proposed provisions under the NDHM include integrated health services at a single point (though multiple agencies, departments or services providers are involved) and convenient access to health records for citizens. Moreover, the NDHM shall assure a continuum of care to citizens, across primary, secondary and tertiary care and across public and private service providers.
NDHB will use Personal Health Identifier (PHI) and Health Master Directories and Registries to uniquely identify individuals. It also emphasises the need to maintain confidentiality of health records, which the report claims will be done through a combination of three “building blocks”: Consent Manager, Anonymiser, and Privacy Operations Centre. In fact, the report lays down several guidelines to make data safe, reliable, and verifiable.
In order to increase accessibility, NDHB will also use social media platforms, call centres, MyHealth app, and a web portal based on international standards. The web portal, named India Health Portal, is supposed to be a multi-lingual national portal. With a minimalistic design, the online platforms will be interoperable and have open APIs. Moreover, the blueprint also includes apps for medical education, emergency healthcare, public health, and wellness. The report welcomes the contribution of start-ups and the open market in the making of numerous apps.
The proposed infrastructure includes health clouds and secure health networks. The health clouds will be built in partnership with the Government Community Cloud with stronger security and privacy policies. An online signature service, e-Sign, will enable citizens to sign documents digitally.
“States are supported under National Health Mission (NHM) for services like Telemedicine, Tele-Radiology, Tele-Oncology, TeleOphthalmology and Hospital Information System (HIS),” states the report.
The committee has done a comparative analysis of existing organisations to understand their institutional framework. Further, the NDHM aims to study and derive inspiration from international online health systems for its creation. The formation of an organisation, titled the National Digital Health Mission, is proposed. According to the committee’s recommendations, NDHM should have a governing council and a board of directors to regulate its functions. It should also be a government-owned body with a mission to provide access to digital health service to every Indian.
Some potential challenges that have been outlined are low user control, high technical and legal complexity, centralised risk and liability, and potential abuse.
The report is open to comments from the public till 4 August 2019. – Firstpost