One citizen, one record - A take on the different aspects of the National Digital Health Blueprint

The National Digital Health Blueprint, recently introduced by the Government, is a call for attention on the optimum use of data and analytics for a healthier India. With the aim of creating a digital health ecosystem based on international standards, the Government intends to build on the core digital health data of its citizens and the infrastructure required for its seamless exchange. 

A typical scene at the OPD of any hospital is of the patients waiting for their turn with a file of health records. What becomes important is to ensure that all previous health records are carried by the patient. Or imagine another situation where a patient is brought into the emergency ward and the relatives don’t know about the exact past history or the allergies of the patient.

Now imagine that in either of these two situations, you just provide an identification number and your treating doctor gets an access to your past health history, all at the click of a button. That is exactly what our Government is planning for us!

In the recent past, the Government has introduced many new initiatives that are set to benefit the public at large. Needless to say, there will also be a repository of data generated which can be used to study current disease trends as well as provide scientific information for future research.

In fact, the Government’s National Health Policy 2017 envisages creation of a digital health technology eco-system, National Health Stack (NHS). The NHS represents a holistic platform that supports a multitude of verticals, and is capable of integrating future IT solutions for the health sector. It will be usable by the centre and state across public and private sectors.

With the Ayushman Bharat set to benefit around 10.4 crore families, the need for a future ready digital health system has become even more important. In addition, the recently announced National Essential Diagnostics List (NEDL) builds upon the Free Diagnostic Service Initiative and other diagnostics initiatives of the Health Ministry to provide an expanded basket of tests. So, while the NEDL would provide guidance to the government for deciding the diagnostic tests that healthcare facilities in villages and remote areas require, there is a need for digital integration of data and analytics for a healthier India.

The Government recently released the strategy and approach paper for NHS; The National Digital Health Blueprint.‘One citizen, one health record’ is the core of NHS. Under the proposal, Electronic Health Reports (EHR) will be readily available through an individual’s unique digital health id. The government hopes the move will help it achieve its goal of Universal Health Coverage, making healthcare available, accessible and affordable.

In my opinion this is a move in the right direction, to make healthcare safe for patients. Data if collected properly can also provide a plethora of information for the epidemiological studies, to better understand the disease trends and geographical distribution. For example, a well gathered public health data on the Kerala floods in the last 2-3 years, can give an analysis on the changes in the various metabolites and other physiological parameters in the survivors, which can be a good correlation study for the pharma companies to study the efficacy of a particular drug in that region.

On the diagnostic front, digitalization is set to make diagnosis more accessible. In February 2018, the Government of India announced the creation of 1.50 lakh Health and Wellness Centres (HWC). To ensure delivery of Comprehensive Primary Health Care (CPHC) services, existing primary health centres would be converted to Health and Wellness Centres. Telepathology and telemedicine can be used to connect these HWC in a rural area, giving the patients access to high end treatment options. Secondly, the NHS will make it mandatory for facilities to have safety certificates for the equipment that they use. This should aid in standardization of quality of services.

Having said that, it is worthwhile to note, that data protection remains the biggest concern. One of the major roles of the Government will be setting standards and privacy laws. Unlike countries like Europe and USA, India still doesn’t have any law in place for health records privacy. The blueprint aims at promoting the adoption of open standards for developing several health systems that span across sectors from wellness to disease management. A lot of homework needs to be done on the required capital investment to ensure seamless transition of data from lets say a private to a public entity, with a stringent law in place.

Another point that needs clarity is whether data is going to be collected at both IPD and OPD. 5 out of the 8 mandatory data elements of the document deal with clinical data to be collected at the time of doctor patient interaction. This can be a big challenge especially in Government hospitals where high work-load limits the interaction time.

A cause of concern is the extent to which patient data will be disclosed to private players in the system, such as insurers, pharmacies, and hospitals, among others. The document says that data will not be available to any care provider without explicit consent of the patient. However, what happens in the case of illiterate patients, or those brought in an emergency?

Nevertheless, the platform looks set for India to take the next big leap in to digitalization and can aim to set up digital health records for all citizens by the year 2022.

Sources: 

• https://www.businesstoday.in/bt-buzz/news/national-digital-health-blueprint-challenges-galore-path-data-sharing/story/366978.html
• https://www.niti.gov.in/writereaddata/files/document_publication/NHS-Strategy-and-Approach-Document-for-consultation.pdf 

Authored by: 

Anil Jotwani

Sr. Advisor
Transasia Bio-Medicals Ltd.