Dr. Hari Prasad, President, Apollo Hospitals Group in an exclusive interaction with Prathiba Raju elucidates about National Digital Health Mission (NDHM) and how it will help create an integrated healthcare ecosystem to enable healthcare providers to deliver prompt and structured care to every patient.

What are the major challenges the ambitious National Digital Health Mission (NDHM) will need to tackle initially? How will this mission revolutionize healthcare in India?

The National Digital Health Mission (NDHM) is a significant step in India’s journey towards creating a healthier future. It will bring in an integrated and systematic health infrastructure that can allow medical practitioners to efficiently access real-time health records of the patients and immediately provide informed decisions to finalize a logical line of management of the ailment. The various modules under this will help create an ecosystem to enable healthcare providers to deliver prompt and structured care to every patient. Through the universal health ID, patients can share their data easily with hospitals and doctors and enable access through a mobile application. To make this mission a success, the government will have to ensure that the set universal guidelines are followed at every layer of the system. At the same time, there will have to be a proactive and detailed approach to ensure that each healthcare organization has access to the required technology and tools. All this needs to be backed by a well – structured and secure healthcare tech ecosystem.

“To make this mission a success, the government will have to ensure that the set universal guidelines are followed at every layer of the system. All this needs to be backed by a well – structured and secure healthcare tech ecosystem.”

A major challenge could come in the form of digital literacy, especially among the rural and older population. Some sections of the population could find it difficult and confusing to navigate the app if it isn’t made extremely user-friendly. Connecting to the system could be very difficult in rural areas as compared to urban regions. In addition, the expenses for training, support, and physical infrastructure could be some key barriers. India is so culturally diverse, it will be important to have the application be available in vernacular languages, which will increase acceptance.

What are the potential pitfalls of digitization of health data that must be addressed before moving ahead?

One major aspect that will need to be kept in mind is that the digital systems would need to be made such that it can be easily accessed and navigated by anyone while simultaneously ensuring that the data and information of the citizens are secure. Furthermore, there could be the possibility that some patients and providers might reject the digital systems or outright reject it if there are initial technical malfunctions. Plus the training to adapt to this setup could take a lot of time, effort, and resources which certain practices may not be able to afford.

How will NDHM accelerate the country’s progress towards Universal Health Coverage (UHC)?

The policy will bring in a unified healthcare system in India which will allow citizens and healthcare professionals to access the correct and updated medical records on a single platform. A synthesized database will enable cost-effective, efficient and prompt delivery of services as well as help in framing future policies and guidelines to address the existing gaps in the system. Even those places where healthcare facilities are not easily available, a digital system will allow access to quality healthcare. It will leverage technology to provide quality healthcare at a more universal level. The NDHM will revolutionize the way the Indian healthcare industry functions and boost a lot of segments in the industry.

Notably, teleconsultation and e-pharmacies getting boost under NDHM will further enable doctors to provide proper care, medication, and timely diagnosis to more patients. We have already seen the benefits of digitizing healthcare. Apollo Hospitals initiated the telemedicine journey in India in 1998 with its first V-SAT enabled rural hospital at Aragonda in Chittoor District of Andhra Pradesh. Today, the Apollo Telehealth division manages over 10,000 tele-consults a day and runs the world’s largest Tele Emergency along with many PPP projects.

Moreover, earlier in June this year, over 100 leading private hospitals, health-tech startups, technology companies, and investors came together to launch a free telemedicine consultation app ‘Swasth’ to combat the pandemic’s spread in India, with Apollo Hospitals being one of the partners. In the long-term Swasth will evolve into the Bharat Health Stack, an open-source and interoperable technology framework for healthcare built by iSPIRT, a software product industry body.

With the outbreak of the pandemic, the gaps in India’s healthcare system have been highlighted further and this mission aims to fill those gaps. The NDHM’s success will bring much better access to health and healthcare to every citizen.

PMJAY had cybersecurity issues and it had to be tackled by the National Anti-Fraud Unit (NAFU) team regularly. With such a big scheme again with sensitive data, what are the measures that should be taken for data sharing? How will the data from Health Facility Registry (HFRs) and PM-JAY be used?

The biggest concern among most people is the leaking of information, hackers, and the loss of data. The policy includes consent-based provisions for the security and privacy of data. Each citizen will own their data and accessing this information would require consent from the individual. Even the government won’t be able to access the data without the person’s permission. The citizens will also be allowed to revoke their consent to restrict any sharing of personal data and the portal will also encrypt the entered information before it is shared. The government has assured that they will take all the necessary data privacy measures in order to effectively safeguard the confidentiality of sensitive health-related information of individuals. Data collected across the National Digital Health Ecosystem (NDHE) will be stored at the central level, the state or Union Territory level, and at the health facility level. A framework will be developed throughout the NDHE in order to safeguard the privacy of the collected, confidential health data.

Also read: ‘NDHM needs well-defined pathway to on-board private sector into the program’

As per a government report – India has over 350 internet service providers but broadband penetration is around six percent? With low internet penetration and a digital health resources divide – How can such a massive mission be executed?

The digital aspects and concerns around the reach have been taken into account by the government when building this scheme. Under the NDHM, the government is building specialized systems and offline modules that are being designed to better reach the unconnected, digitally illiterate sections, especially the remote, hilly, and tribal regions. The project will be executed with the help of all the stakeholders including the government, medical practitioners, and citizens. There will also have to be a digital literacy program or initiative to ensure that roadblocks at the initial levels are eliminated and more people can access the benefits that the mission provides.

With a lack of standard, health information exchange seems to be difficult? With NDHM execution do you think interoperability of health information and standardization of nomenclature across the Health Delivery system between patients, payers, and providers will be streamlined?

A synthesized database will enable cost-effective, efficient, and prompt delivery of services as well as help in framing future policies and guidelines to address the existing gaps in the system. Even places where healthcare facilities are not easily available, a digital system will allow access to quality healthcare across every region in India. The NDHM’s main aim is to connect healthcare providers with patients across every region in a manner that is quick, information-driven, and systematic. Over time exchange of information and delivery of care will become more standardized and streamlined under this.

A 2018 report by the ministry of electronics and information technology, titled Adoption of EHR: A Roadmap for India – pointed out that there is a lack of basic needs to implement the EHR system. Do you think with limited information and communications technology infrastructure with only public hospitals having computers and connectivity — The NDHM can be implemented?

In India, only a certain number of major public hospitals have computers and connectivity. With a large number of public healthcare facilities in India, major investments in hardware and software will be a concern for implementing NDHM. This is one challenge that will need a lot of planning to navigate through and will be one of the main technological roadblocks in the initial stages. The cost factor among smaller players is also something that could prevent a lot of healthcare providers to stay away from being a part of this. It will be a challenge that will need a lot of planning to bring the systems and technology to every player in a cost-effective and simple manner.

How important is an investment in hardware and software? How will it be done?

Investment in hardware and software is essential to ensure that the NDHM is implemented at every level in India. Given the level of diversity and disparity in the country, navigating through this is tricky as electronic health records are essential to NDHM. Such investments are costly and that is also a barrier in terms of implementing and bringing in new software.

What will be the role of private stakeholders and how do you see to integrate with the core system of NDHM?

The NDHM will see a significant contribution from private stakeholders to contribute towards public healthcare. Private stakeholders will integrate with the various modules of the NDHM in order to better service the patients and deliver the necessary treatment across all parts of the country.

Why do you think creating electronic health records similar to UID (Aadhaar) is necessary?

As a part of the mission, the citizens will get a separate health ID which will allow the patients to store their health records as well as share these records with healthcare professionals and be an all-access card for all their health requirements. Being separate from Aadhaar, the information can only be accessed through the health ID and this won’t be linked to other systems and only be used for the NDHM portal. Additionally, unlike Aadhaar, this health ID is not mandatory and patients can voluntarily opt-out of sharing information any time they want. The ID will also store your records of admissions for treatment and discharge on the cloud. In the future, there are also plans to use the health ID for accessing teleconsultation and e-pharmacy facilities. Even insurance companies can get the details of the client’s healthcare records through the individual’s health ID. A separate ID will make it easier to access these facilities and benefits and will entail a voluntary opt-in system with an opting-out option as well. The government has made provisions in the initial model through which participants can request the deletion of their data.

Can you draw global examples similar to NDHM which have been successful or failed? What measures should the central and state government take to make this project a success?

There are a lot of countries that have successfully created various digital healthcare models and India can take some inspiration from a few of these to create a robust ecosystem. These include countries like Denmark, Israel, and Australia among others. Denmark has a concise national digital health strategy and is working towards building a digital system with enhanced safety for patient data and a framework for coordination across platforms. The model also outlines the importance of patients taking an active role in their care and enables them to understand their health better, thereby encouraging proactive participation in their treatment.

The digital healthcare in Israel aims to boost telemedicine, facilitate collaboration between various healthcare institutions, and improve emergency rooms. The country also aims to unify the existing database of the digital medical records of the last 20 years which holds the medical files of over 98 percent of the country’s population. Australia’s digital system outlines a framework to improve patient pathways and overall experience and build a more efficient, digitally savvy system to provide extensive access to care while ensuring full data security. India can take inspiration from such examples to build a strong framework that includes strategies for the coming few years as well in order to build a system that will successfully sustain in the long term.

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