New health era will begin in India with National Digital Health Blueprint
The National Health Policy 2017 had defined the vision of ‘health and wellbeing for all at all ages’. Continuum of Care is a concept strongly advocated by the Policy. These lofty ideals are sought to be achieved by refactoring the existing schemes and introducing several new schemes including some digital initiatives.
The main objective of National Digital Health Blueprint (NDHB) is to create a system of Personal Health Records, based on international standards, and easily accessible to the citizens and to the service providers, based on citizen-consent. It also includes promoting Health Data Analytics and Medical Research; enhancing the efficiency and effectiveness of Governance at all levels and ensuring quality of healthcare.
In this NDHB, Unique identification of Persons, Facilities, Diseases and Devices is a key requirement. The uniqueness in identification of Persons (citizens) required as an essential attribute of Personal Health Identifier (PHI), is sought to be achieved through a combination of Aadhaar-based Identification / Authentication. And Health Locker will facilitate the creation and maintenance of Personal Health Records.
The Principles of NDHB are stated,
NDHB will be wellness-centric and wellness-driven.
Special focus will be laid on the building blocks and applications relating to Health Education, awareness, screening, early detection and AYUSH. Wellness centres and mobile screening teams will be strengthened through access to real-time Personal Health Records. Citizens will be encouraged to follow a well-designed referral system
NDHB shall educate and empower citizens to avail a wide range of health and wellness services
Mass awareness and education will be promoted through use of appropriate a MEDucation Platform and a portfolio of Health Apps targeting citizens of different agegroups and access to toll-free medical advice. Personalization and localization will facilitate higher uptake of the education and awareness services.
NDHB systems shall be designed to be inclusive.
Specialized systems will be designed to reach out to the “unconnected”, digitally illiterate, remote, hilly and tribal areas. Telemedicine will focus on reaching out to such groups to provide them with services of experts.
NDHB shall ensure security and privacy by design.
A National Policy on Security of Health Systems and Privacy of Personal Health Records will be developed. All the building blocks that require handling personal health records will be designed to comply with such policy ab-initio
NDHB shall be designed to measure performance and display accountability of all providers of service.
Real-time monitoring of the Service Levels and health sector KPIs will be the key driver to measure and publish performance of all health institutions and professionals. Real-time dashboards, data analytics and visualization tools will support the Performance Management.
NDHB shall have a national footprint and shall enable seamless portability across the country.
Personal Health Identifier with its supporting blocks, including adoption of Health Information Standards will play a pivotal role in the national portability. A system of incentives will be put in place for early adoption.
The eco-system of NDHB shall be built basing on the principle, “Think Big, Start Small, Scale Fast”
While the “Big Picture” of NDHB will be comprehensive containing all the Building Blocks required to fulfil the Vision, NDHB will adopt a combination of strategies like taking a minimalistic approach for designing each Block, prioritizing and sequencing of the development/ launch of the building blocks, and designing a technology architecture that can scale horizontally and vertically.
Over the past two decades there have been several Digital Health initiatives that were launched globally to improve the quality of health care and bring down the healthcare costs. While some countries like the United States are ahead of the curve in terms of the availability of Information and Communication Technology (ICT) infrastructure, other countries are in the process of reforming their respective health care sector and using IT as a key component of the process.
In England, the National Health Services-Digital (NHS Digital) is the national provider of information, data and IT systems for commissioners, analysts and clinicians in health and social care. It provides digital services for the NHS, including the management of large health informatics programmes. They deliver national systems through in-house teams, and by contracting private suppliers. These services include managing patient data, the NHS Spine, which allows the secure sharing of information between different parts of the NHS, and forms the basis of the Electronic Prescription Service, Summary Care Record and Electronic Referral Service.
India has made remarkable progress in the Information & Communication Technology (ICT) space over the past two decades. The IT revolution in India has also had a positive impact on the public sector Governance Architecture in India which led to some transformational initiatives like Unique Identification Number (UID Aadhaar) for almost all the residents of India, IT enabled platform for GST, IT systems integration in banking sector and IT-enabled public service delivery. While India has pockets of IT excellence within the Public Sector the application of IT enabled systems has not been uniformly adopted across the entire Governance System. The IT initiatives in the Health Sector in particular, have been fragmented and compartmentalized hindering the realization of the full potential of ICT.
National Digital Health Infrastructure is a public good. Its funding model must reflect this. In the earlier years, it must have budgetary support from the Government of India to get the National Digital Health Infrastructure built and operational.
A study was conducted to understand key cost components associated with the set up and running of organizations such as GSTN, UIDAI, NHA etc. to assist in the estimation of budgets required to support successful formation and running of the National Digital Health Mission.
It was observed that Development cost (Capital cost), People and Property (operating costs) formed the major cost components of such organizations. For the National Digital Health Mission (NDHM) to be successful it will be important to undertake outreach activities with public and privates sector players. The NDHM will have to co-opt market players like MedTech companies, NGOs, Foundations working in Health space as it builds the public utilities in the form of Registries, PHR, Health ID and Health Information Exchange etc.
The outreach organization will have to have strong presence in all the states to ensure adoption of public utilities both by the state govt. as well as the Health ecosystem players. If the new organization raises a part of its funding through a transaction fee, it drives a service orientation within the organization. However, it must be done without the risk of diluting the public good nature of the Institution. This can be done by using the concept of toll pricing model where no profit-making is allowed.