(GIST OF YOJANA) Towards a National Digital Health Ecosystem [JULY-2019]
(GIST OF YOJANA) Towards a National Digital Health
Towards a National Digital Health
Healthcare has always been central to all development efforts be
it at the state national or global level.
The National Health Policy 2017 approved by the Government of
India (Gol) had defined the vision of ‘health and well-being 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
Citizen-centricity, quality of care, better access, universal
health coverage, and inclusiveness are some of the key principles on which
the Policy is founded.
The realization of all these aspirations can be facilitated by
leveraging the power of the digital technologies.
In the context of India, with its size and diversity, this mammoth
task requires that a holistic, comprehensive and interoperable digital
architecture is crafted and is adopted by all the stakeholders.
In the absence of such an architecture, the use of technology in
the health sector continues to grow in an uneven manner and in silos.
Ecosystem, not System
In the above context, a Committee constituted by the Ministry of
Health and Family Welfare, Gol in November 2018, to take forward the concept
of National Health Stack designed under the aegis of Niti Aayog, recognized
the need for creating a framework for the evolution of a
National Digital Health Ecosystem (NDHE) - an Ecosystem and NOT a System!
The result is the National Digital Health Blueprint (NDHB), which
is more than an architectural document, as it provides specific guidance on
its implementation as well. This report describes the salient features of
NDHB. The report on NDHB submitted by the Committee is under the
consideration of the Ministry. It will go through the process of a series of
consultations with the States, the Industry and other stakeholder groups,
before its formal adoption.
The Blueprint keeps the overall vision of NHP 2017 in perspective
and recommends a pragmatic agendato start with, adopting the principle of
‘Think Big, Start Small, Scale Fast.’
The Objectives of NDHB are aligned to the Vision of NHP 2017 and
the SDGV relating to the health sector.These include:
Establishing and managing the core digital health data and the
infrastructure required for its seamless exchange;
Promoting the adoption of open standards by all the actors in the
National Digital Health Ecosystem,
for developing several digital health systems that span across the
sector from wellness to disease management;
Creating a system of Personal Health Records, based on
international standards, and easily accessible to the citizen, and to the
service providers, based on citizenconsent;
Following the best principles of co- operative federalism while
working with the States and Union Territories for the realization of the
Promoting Health Data Analytic and Medical Research;
Enhancing the efficiency and effectiveness of Governance at all
Ensuring Quality of healthcare.
Leveraging the Information Systems already existing in the health
An Ecosystem cannot be built - it must evolve. Given this, a set
of Principles - rather than specificationshavc been recommended to enable
the evolution of the NDIIE. The key principles of the Blueprint include,
from the domain perspective, Universal Health Coverage, Inclusivcness,
Security and Privacy by Design, Education and Empowerment of the citizens;
and from the technology perspective, Architectural Building Blocks,
Interoperability through adoption of a condensed set of health information
standards, a set of Registries as Single Sources of Truth, Open Technology
Standards, Open APIs and above all, a minimalistic approach.
In the context of the evolution of a digital Ecosystem, as is the
case of NDHE, building blocks are reusable frameworks or artifacts that most
stakeholder groups need to rely upon for designing, developing and
delivering their services.
The Blueprint identifies the Minimum Viable Set of Building Block
required for the NDHE to evolve, and describes their capabilities at a
high-level. Conformance to the NDIIB Principles on the one side and to the
NDIIB Standards and Regulations on the other side, are critical for an
efficient design and development of the Building Blocks.
Architectural Building Blocks constitute the core of NDIIB. These
are represented schematically in the. While the Blueprint has 23 Building
Blocks, a few of the critical requirements and capabilities of NDHE,
addressed by appropriate combinations of the Building Blocks, are explained
Identification: Unique identification of Persons, Facilities, Diseases
and Devices is a key requirement and challenge as well in the evolution of
NDHE. The Blueprint handles this requirement through 2 Building Blocks,
namely, Personal Health Identifier (PHI), and Health Directories &
Registries. The uniqueness in identification of Persons (citizens) required
as an essential attribute of PHI is sought to be achieved through a
combination of Aadhaar-based Identification/Authentication for schemes
notified under the Aadhaar Act, and through other specified types of
identifiers in respect of the rest. However, the design of the PHI is to be
finalized by the Ministry, in consultation with MeitY and UIDAI duly taking
into consideration the regulatory, technological and operational aspects.
PHI in tandem with Health Locker will facilitate the creation and
maintenance of Personal Health Records.
Citizen to be in Control: The need for maintaining the confidentiality,
security and privacy of the health records cannot be over-emphasized. These
requirements are built into the design of NDHB a priori, rather than being
retrofitted later. The Blueprint achieves these complex and mandatory
requirements through a combination of a few Building Blocks, namely. Consent
Manager. Anonymizer and Privacy Operations Centre. Besides these Building
Blocks, application specific features and relevant international standards
defined in the Blueprint fortify the privacy regime.
Service Access/ Delivery: Omnichannel access/delivery is an important
capability required in NDHE. This is achieved by a combination of Web (India
Health Portal). Mobile (MyHealth App) and Call Centres besides Social
Media Platforms. The Command Control and Communication Centre enables
real-time monitoring and real-time interventions needed in the NDHE. Given
the significant spread of smartphones and the prospects of its further
growth, the Blueprint emphasizes the 'Mobile First’ principle for majority
of stakeholder-facing services.
Interoperability : Interoperability is a pre- requisite not only for the
development of integrated digital health services and continuum of care but
also for the autonomous development of innovative value added services by
entrepreneurs.Two Building Blocks, namely, the Health Information Exchange
and the National Health Informatics Standards enable and promote the
interoperability of various building blocks. Digital Health is but a small
lever in the evolution of the overall national health Ecosystem. A
substantial impact in the health sector is possible only through a posse of
reforms and enhancements in the sector. These include improving the ratios
like Doctor : Population, Specialist: Doctor, Bed: Population: enhancing the
spread and quality of health infrastructure and improving knowledge and
skills among the health professionals and workers.
In conclusion, NDHB forms the foundation on which the edifice of
an entire National Digital Health Ecosystem can be built in a phased manner.