The National Health Policy (NHP) 2017 has the following goal: “The attainment of the highest possible level of health and wellbeing for all at all ages, through a preventive and promotive health care orientation in all developmental policies, and universal access to good quality health care services without anyone having to face financial hardship as a consequence.”
In a follow-up of the NHP’s specific goals for adopting digital technologies, the Ministry of Health and Family Welfare constituted a committee headed by Shri J. Satyanarayana to develop an implementation framework for the National Health Stack.
This committee produced the National Digital Health Blueprint (NDHB), laying out the building blocks and an action plan to comprehensively and holistically implement digital health.
NDHB is now envisioned as the National Digital Health Mission (NDHM).
Let us know the mission of NDHM which is as under:
“To create a national digital health ecosystem that supports universal health coverage in an efficient, accessible, inclusive, affordable, timely and safe manner, that provides a wide range of data, information, and infrastructure services, duly leveraging open, interoperable, standards-based digital systems, and ensures the security, confidentiality, and privacy of health-related personal information.”
Now that we are clear about the preamble, let us discuss how NDHM intends to give health care to all Indians, and the residents of India, with the best infrastructure like hospitals, doctors, research laboratories or all stakeholders with the best possible data systems, the best evolving software and identity to every Indian medically transferable and comparable to the best in the world.
The whole document is reproduced from the web site as under:
National Digital Health Blueprint (NDHB). This was put to the public for comments and 300 of them, from all stakeholders, were received and used.
https://nha.gov.in/NDHB
This is the master document produced by the best brains of India and is set to create world level medically and digitally comparable facility to its 1.33 billion-plus of population, never attempted anywhere in the world.
To implement, the following document is also put on the web by the ministry concerned for public comments.
National Digital Health Mission:
https://ndhm.gov.in/assets/uploads/NDHM_Strategy_Overview.pdf
Disclaim: Being produced by the best brains of India, I shall try to explain them as simple as possible and kindly bear with any of my indiscretion in the process. A lot of technical terms have been used by the committee.
What are the objectives of NDHM?
Let me reproduce them and then discuss its elements in simple language.
Objectives of National Digital Health Mission
To strengthen the accessibility and equity of health services, including a continuum of care with citizen as the owner of data, in a holistic healthcare program approach leveraging IT & associated technologies and support the existing health systems in a ‘citizen-centric’ approach, the NDHM envisages the following specific objectives:
1. To establish state-of-the-art digital health systems, to manage the core digital health data, and the infrastructure required for its seamless exchange;
2. To establish registries at the appropriate level to create a single source of truth in respect of clinical establishments, healthcare professionals, health workers, drugs and pharmacies;
3. To enforce the adoption of open standards by all national digital health stakeholders;
4. To create a system of personal health records, based on international standards, easily accessible to individuals and healthcare professionals and services providers, based on an individual’s informed consent; 5. To promote the development of enterprise-class health application systems with a special focus on achieving the Sustainable Development Goals for health;
5. To adopt the best principles of cooperative federalism while working with the States and Union Territories for the realization of the vision;
6. To ensure that the healthcare institutions and professionals in the private sector participate actively with public health authorities in the building of the NDHM, through a combination of prescription and promotion
7. To ensure national portability in the provision of health services;
8. To promote the use of clinical decision support (CDS) systems by health professionals and practitioners;
9. To promote better management of the health sector leveraging health data analytics and medical research;
10. To provide for enhancing the efficiency and effectiveness of governance at all levels;
11. To support effective steps being taken for ensuring the quality of healthcare; and
12. To strengthen existing health information systems, by ensuring their conformity with the defined standards and integration with the proposed NDHM.
To understand the whole system, who are stakeholders involved?
- The citizen/patient as the center for whom the whole system is evolved
- Policymakers: state governments, central government (federal system)
- Providers: hospitals, clinics, laboratories, pharmacies, and wellness centers
- Allied private agencies: TPAs, Insurers, Health-tech companies
- Healthcare professionals: Doctors- Modern medicine & Ayush and other practitioners
- Non-profit organizations: Associations, Development partners, and NGOs.
- Administrators: Regulators and program managers.
National Digital Health Mission document from the above web site contains 3 chapters and 6 annexures.
Chapter 1: Context of Mission
Chapter 2. Scope of Mission
Chapter 3. Implementation of Mission
Annexure 1. Building blocks
2. NDHM – Support needed
3. NDHM – Pilot services
4. NDHM – Stakeholder engagement plan
5. NDHM – Organogram
6. NDHM – Budget
Let us understand a step, step, the progress to be made.
What is the opportunity for NDHM?
In a nutshell, the following explains the whole gamut of operations.
“The current strong public digital infrastructure—including that related to Aadhaar, Unified Payments Interface and wide reach of the Internet and mobile phones (JAM trinity) —provides a strong platform for establishing the building blocks of NDHM.
The existing ability to digitally identify people, doctors, and health facilities, facilitate electronic signatures, ensure non-repairable contracts, make paperless payments, securely store digital records, and contact people provide opportunities to streamline healthcare information through digital management.”
Do we have any experience in the near past to follow immediately without wasting time and energy?
Ayushman Bharat—Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) has successfully used the available public digital infrastructure to provide end-to-end services through an information technology (IT) platform from the identification of beneficiaries to their admission and treatment in hospitals to their discharge and paperless payment to hospitals. Ayushman Bharat has attracted nearly 100 million citizens as the beneficiaries and more than 100,000 hospitals have enlisted to serve these patients.
By extension or duplication with better infrastructure will explore the benefits to 1330 million of Indians.
Emerging technologies such as artificial intelligence, the internet of things (IoT), Blockchain and cloud computing provide additional opportunities for facilitating a more holistic digital health ecosystem, that can increase the equitable access to health services, improve health outcomes and reduce costs.
In a concise form, let me state that patients have the best choice of hospitals, doctors and medicines, doctors get opportunities to store, refer and offer the best service while a host of all connected operating professionals get a chance to refer, use, develop and offer the best technologies to expand the plan. Medical data is transferable in the digitalized form with the best security, privacy, and availability features.
Ayushman Bharat will be the guiding searchlight for progress.
Anyone would like to know the “Guiding Principles” of NDHM.
What are the Guiding Principles?
A. Business Principles (Health Domain Principles)
- NDHM will be wellness-centric and wellness-driven – Wellness centers and mobile screening teams will be strengthened through real-time access to personal health records.
- NDHM will educate and empower individuals to avail a wide range of health and wellness services – Mass awareness and education will be promoted through the use of appropriate platforms and a portfolio of Health App.
- NDHM systems will be designed to be inclusive – Specialized systems will be designed to reach out to the “unconnected”, digitally illiterate, remote, hilly, and tribal areas.
- NHDM will ensure security and privacy by design – A National Policy on Security of Health Systems and Privacy of Personal Health Records will be developed, in accordance with the PDP Bill 2019. All the building blocks that require handling personal health records will be designed to comply with such a policy at the outset.
- NDHM will have a national footprint and will enable seamless portability across the country through a Health ID – Personal Health Identifier, with supporting blocks, including the adoption of Health Information Standards will play a pivotal role in national portability.
- The landmark of the system will be: “The eco-system of NDHM will be built basing on the principle, “Think big, start small, scale fast”
B. NDHM will be developed by adopting India Enterprise Architecture Framework (IndEA) –
All the building blocks and components of NDHM will conform to open standards, be interoperable and based on Open Source Software products, and open source development.
Federated Architecture will be adopted in all aspects of NDHM – Only the identified Core Building Blocks will be developed and maintained centrally.
NDHM will be an Open API-based ecosystem – All the building Blocks will be architected adopting the Open API Policy notified by MeitY, GoI, and will share data as per standards as defined in NDHB.
All major legacy systems will be assessed for conformance to NDHB principles and leveraged to the extent feasible – Compliance of legacy systems to the Blueprint principles and Agile IndEA principles will be assessed through an appropriately designed assessment tool to evaluate the current conformance and effort required to integrate them with NDHM.
All the components, building blocks, registries, and artifacts of NDHM will be designed adopting a minimalistic approach.
All the registries and other master databases of NDHM will be built as Single Source of Truth on different aspects and backed by strong data governance.
Now we are clear about some aspects of NDHM in detail.
National Digital Health Mission: Building Blocks (Annexure 1)
The National Digital Health Blueprint recommends that a federated architecture be used instead of large centralized systems for the management of health information.
Let me quote from the text so that technically minded readers may apply their minds over the vast canvas of things to be applied.
“The infrastructure layer of NDHM will create secure networks wherever access to sensitive health data is involved, setup proactive Security and Privacy Operation centers to protect data and support patients on any grievances in getting access to their data.
The data layer of NDHM will help create the master data across various aspects of health care including identification of patients, doctors, health facilities, drugs, etc.
It will also create the digital assets required to support the adoption of health standards.
The technology building blocks layer will provide useful digital services to the sector including health information exchange, consent management, anonymization, telemedicine, health data analytics, etc.”
Kindly refer page 28 for detailed explanations.
Annexure 2 gives the following information for various ministries.
Ministry, DigiDoctor Platform, Health Infrastructure Registry, Health ID, Personal Health Record, Tele Medicine, e-Pharmacy.
What are the Ministries involved or others involved in the project?
Ministry of Health and Family Welfare, Ministry of Electronics and Information Technology, Medical Council of India/ National Medical Commission, Ministry of Women and Child Development, Insurance Regulatory & Development Authority of India, Ministry of AYUSH – CCIM, Dental Council of India, Ministry of Road, Transport & Highways, Ministry of Finance, Ministry of Commerce – QCI.
Annexure 3 titled pilot services clearly narrates the operation of a project with its trajectory.
Budget: The envisaged budget requirement for the implementation done by National Health Authority will be ₹ 144 Crores. The further component-wise break-up of the budget is placed as Annexure 6.
Let us learn a bit about building blocks that form the structure for the development of NDHM.
In the context of the evolution of a digital ecosystem, building blocks are reusable frameworks or artifacts that most stakeholder groups need to rely upon for designing, developing, and delivering their services. Building blocks constitute the core of NDHB. The Blueprint identifies the minimum viable set of building blocks required for the NDHE to evolve and describes their capabilities at a high‐level. It is for the NDHM, as a specialist organization, to work towards the design, development, and establishment of these building blocks. Conformance to both the NDHB Principles as well as to the NDHB Standards and Regulations is critical for efficient design and development of the building blocks.
Conclusion
National Digital Health Mission is a practical approach to ensure the best medical treatment for any Indian citizen(total of 1330 million-plus), the best doctors and other facilities, most digitalized records system ever attempted in the recent past among all nations based on huge population alone, and vast areas to be covered in the nation.
This is the most opportune moment for all stakeholders to get benefits for their operations. Either manpower utilization, best hardware/ software development, all facilities to be offered to the patients on a 360-degree level or financial services offered will be on a huge scale unheard of in Indian history. The purpose of this article is to open the eyes of the professionals to see, think, and apply the opportunities to be part of the national build of medical history.
Ultimately, NDHM will have to do the following for the success:
The institutional framework of NDHM will have to operate at two levels, namely, the governance level and the implementation level.
The Governance architecture of NDHM should comprise of the following elements for it to
be a successful enterprise:
- Clear and well‐defined leadership structure with reasonable autonomy
- Clear demarcation of roles and responsibilities
- Separation of policy, regulatory and operational functions
- Decentralized leadership and decision making
- Robust and transparent processes and systems
Implementation architecture of NDHM must incorporate key elements such as a clear leadership structure, convergence between core ministries and departments, citizen‐centric approach and services, conducive policies, legal and regulatory frameworks, appropriate technology architecture, information management and security, infrastructure expansion, planning, monitoring, and evaluation in a comprehensive manner.
Let us all try to part of this unprecedented medical history to gain our benefits. Unprecedented financial gains will be the bye product.
Disclaimer: All views are purely personal based on web sites quoted. The views neither reflect taxfuru.in nor any of the government departments. They are not responsible for my views.
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