(GIST OF YOJANA) Towards a National Digital Health Ecosystem [JULY-2019]
(GIST OF YOJANA) Towards a National Digital Health Ecosystem
Towards a National Digital Health Ecosystem
- 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 initiatives.
- 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 Vision;
- Promoting Health Data Analytic and Medical Research;
- Enhancing the efficiency and effectiveness of Governance at all levels;
- Ensuring Quality of healthcare.
- Leveraging the Information Systems already existing in the health sector.
- 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.
Building Blocks of NDHB
- 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 briefly:
- 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.