Ayushman Bharat Digital Health Mission – Explained, pointwise

Introduction 

Almost a year after it was implemented, on a pilot basis in six Union Territories, Prime Minister launched the Ayushman Bharat Digital Mission for the entire country on 27th Sep 21.

The mission aims to provide digital health IDs for all Indian citizens to help hospitals, insurance firms, and citizens access health records electronically when required. The health record of every citizen will, therefore, be digitally protected.

Let’s discuss the significance and issues associated with Ayushman Digital Health Mission (ABDM) in detail.

What is the Rationale Behind Digital Health Mission?

This is a much-needed intervention given that management of chronic diseases, has become a critical public health challenge in the past 15 years, due to the absence of digital health records.

Problems for patients: With the current processes in hospitals, when a patient develops any complication, it gets difficult to track events. Moreover, in the absence of digital health records, a patient has to carry files of several years of treatment. In the event of an emergency, even this is not possible. Due to this, a lot of time, of both the patient and doctor, is wasted, and the cost of treatment too, increases a lot, as the medical consultation and investigation have to be started from absolute zero.

Problems for health professionals: Like patients, in the absence of a digitized medical history, it’s a nightmare for doctors to get all the medical data required to make an accurate clinical diagnosis. They are under tremendous pressure due to the fear of possible human error, which can adversely affect a patient’s life.

The Digital initiative seeks to address these issues by creating a seamless online platform to access treatment records, and enable faster and effective treatment.

What is the unique health ID?

A health ID is a randomly generated 14-digit number, that will uniquely identify every citizen and will be a repository of their medical history.

The ID will be broadly used for three purposes:

– unique identification

– authentication, and

– threading of the beneficiary’s health records

All this will be done only with their informed consent, across multiple systems and stakeholders. Also, a user will be able to permanently delete or temporarily deactivate her health ID.

The beneficiary will have to set up a Personal Health Records (PHR) address for consent management, and for future sharing of health records.

What is a PHR address?

It is a simple self-declared username, which the beneficiary is required to sign in to a Health Information Exchange and Consent Manager (HIE-CM). Each health ID will require linkage to a consent manager to enable sharing of health records data.

An HIE-CM is an application that enables sharing and linking of personal health records for a user. At present, one can use the health ID to sign up on the HIE-CM.

The National Health Authority (NHA), however, says multiple consent managers are likely to be available for patients to choose from, in the near future.

What is the significance of the Ayushman Bharat Digital Health Mission?

Technology with the protocol will make India’s Health sector one among the safest industries in the world: Unfortunately, in healthcare delivery, it is difficult to follow treatment protocols since over 90% of hospitals in developing countries including India do not have Electronic Medical Records (EMR). In this regard, EMR will help us document real-time events happening around a patient, inside the hospital, with seamless movement of data between various stakeholders on a mobile platform.

Affordability, Accessibility: Providing smart digital tools to doctors, nurses, and technicians, morbidity mortality in healthcare will come down significantly. Access to healthcare will also improve and the cost of healthcare will come down.

Data portability and mobility: A unique digital health ID will help chronic patients carry their medical records on their phones, which can be seen by doctors on their computers anywhere.

Prevents repetition: Since most of the blood tests, CT scans, MRI, ultrasound reports will be available on the cloud from anywhere, patients do not need to go for painful and expensive repeat tests.

Facilitate analysis of Data: Data analytics will build clinical decision support systems on EMRs which will suggest alternative diagnostics based on the patient’s condition.

Early identification of trends: The most granular data could also drive public health measures down to the village or block level and help identify early trends in diseases.

End to Quackery and fake medicines: Only registered doctors will be allowed to prescribe medication on digital prescription pads. Moreover, with the barcoding of medicine strips, fake medicines will also disappear.

Optimize resource utilization: Digitisation has disrupted every industry. For instance, Uber, the world’s largest taxi company, owns no vehicles. Facebook, the world’s most popular digital media owner, creates no content. Similarly, the world’s largest healthcare provider will have no beds because it’s going to be a Health app.

The system also makes it easier to find doctors and specialists nearest to you. Currently, many patients rely on recommendations from family and friends for medical consultation, but now the new platform will tell the patient who to reach out to, and who is the nearest. Also, labs and drug stores will be easily identified for better tests using the new platform.

What are some issues/challenges/concerns WRT the mission?

i). Issues related to data entry:

– Poor internet speeds could make data entry a difficult task for rural healthcare providers.

– In the USA, The task of data entry — a lot of which might not always be relevant to clinical care — has added to a doctor’s burden and is seen by experts as one of the major reasons for the high rate of physician burnout in the country.

ii). Data Protection: The Ayushman Bharat Digital Mission gives patients the option to choose the records they want to share. However, given the asymmetrical relations between health service providers — doctors, hospitals, pharma, and insurance companies — and the absence of a data protection law, breaching of patient confidentiality cannot be ruled out.

iii). Misuse of data: Also, there is a danger that any large private insurance company could use sophisticated algorithms across the health and other databases to construct risk-profiles for people and make access to affordable insurance difficult. Data mining can prioritise certain rich demographics for their services and direct public and private resources to people who can afford a high premium for their services rather than to those who need them but cannot pay as much.

iv). India’s meager health budget: Without a sufficient health budget and revamping of existing public healthcare infrastructure, the mission will not achieve its intended targets. Currently, total health expenditure (both private and public) in India is just 3.6 percent, while public spending on health is just above 1 percent of the country’s GDP. It is very low compared to the countries that have some of the best digital health systems in the world. Public sector spending on health in Canada and Australia is around 8 percent and 6.3 percent of its GDP, respectively. Canada ranks first and Australia ranks eighth among the best healthcare systems in the world.

v). Lack of infrastructure: Digital literacy and accessibility of digital records is a particular concern in rural areas, as most villages do not have the required digital infrastructure. Even government hospitals and dispensaries had limited information and communications technology infrastructure, with only a few major public hospitals having computers and connectivity.

vi). Increase in cost of patient care: While private hospitals are yet to on-board, they are also not clear how the system will work and whether they will have to make additional investment. Additional costs, say experts, will also mean an increase in the cost of patient care.

vii). Besides, the efficacy of the DHID relies on the assumption that every visit and every drug consumed by the patient is faithfully and accurately recorded. With the digitised records virtually “speaking” for the patient, information gaps can be problematic.

What are the suggestions to improve?

i). To address the interoperability (the right exchange and use of information) issues, we need to ensure interoperability standards. Further, the right tools and bandwidth will be required to address issues such as non-working links, data not being updated, and faster uploads for large file sizes such as X-ray’s, MRI scans, etc.

ii). The govt needs to pass and implement the Personal Data Protection Bill. This could ensure uniformity in data usage laws while providing better protection of citizen’s data, addressing privacy concerns.

iii). A 2018 report prepared by the ministry of electronics and information technology (MeitY), titled Adoption of EHR: A Roadmap for India, indicated that a large investment in hardware and software is required to ensure a robust ICT infrastructure.

iv). We need to conduct pilot studies to assess the use of technology for streamlining patient flows and medical records and thereby increase efficiencies across different typologies of hospitals and facilities.

It is better to go slow and steady, testing the waters as we go along to make Digital Health ID sustainable and acceptable with the aim to achieve this aspiration within the next decade or two. That’s the only way to ensure that a good policy does not die along the way due to poor implementation