Moderated by Dr. Biren Chauhan, Group COO, Sunshine Global Hospitals. The other eminent panelists who took part in the discussion were Dr. B.K. Mishra, State Programme Officer (Tuberculosis & AMB), State Health Society, Government of Bihar, Dr. Ravi Gaur, Director & Chair Medical Advisory Committee, Oncquest Laboratories Ltd, Maj. Gen. S C Pareek, Executive Director, Bhagwaan Mahaveer Cancer Hospital & Research Centre, Dr. Pankaj Gupta, Head, Access Health Digital and Angshuman Sarkar, Principal Consultant, ThoughtWorks India.
Initiating the discussion at the day two of the 10th edition of Healthcare Leadership Forum (HLF) Dr. Biren Chauhan, Group COO, Sunshine Global Hospitals, asked the panelists at this juncture the Indian healthcare scenario how do they see the National Digital Health Mission (NDHM) and what will be the future scenario as its objectives being realized?
Informing that eHealth’s 10th edition HLF is one of the informative forum Dr. Ravi Gaur, Director & Chair Medical Advisory Committee, Oncquest Laboratories Ltd, said, “The NDHM is aiming for five different things one is creating a unique Health ID for every individual, second is Digi Locker that means the repository of healthcare facilities, third is Health Facility Register, fourth is the personalized health record which is a very significant part of NDHM, fifth is Electronic Health Record (EHR). Indian healthcare digitalization and bring them into one platform is a mammoth task but it is fundamental. It is a time to think big but start small and scale fast.”
Answering how effective NDHM will be once established, Maj. Gen. S C Pareek, Executive Director, Bhagwaan Mahaveer Cancer Hospital & Research Centre, said, “It is a good scheme as each individual have their own card and also they will have access to the digi record and it will reduce the cost as the repeat of the investigation will reduce. The digital health mission will lead to healthcare data efficiency, efficacy, and transparency. At the national level leaders will be able to form nation policies as they will have exact data. When we deal with a clearance of billing in TPA and empaneled segment we have manual records with NDHM it will fasten the process. The mission will have a lot to utilities to deliver for patients, providers and more Public-Private Partnerships (PPP).
After the inputs from the diagnostics and healthcare provider, the moderator asked Dr. B.K. Mishra, State Programme Officer (Tuberculosis & AMB), State Health Society, Government of Bihar about is learning to run a TB program a the state level and addressing the public health challenges of the country and how he sees NDHM mission.
Giving inputs Mishra, said, “More or less 50 percent of the TB patients are taking treatment from the private healthcare providers and less than 50 percent is from the public healthcare providers. The money, resources that are invested for the treatment of TB in government facilities at the national and state level we realized it is not going to help us reach the goal of elimination of TB by 2025. We are talking about the evidence-based standard practice since 2006, MNDT drugs are put in schedule one. There are a lot of efforts being done but we are segregated between government and public hospitals. NDHM concept should be expedited so that we can work together and make the clinical support system robust.”
Talking about digitization, Dr. Pankaj Gupta, Head, Access Health Digital, said, “ The National Digital Health Blueprint (NDHB) is the reference architecture and the related health standards that were published by the government of India as a compendium, there was a mandate given that the further deliberations on digital health will be based on this blueprint.”
Adding that there are three different levers of change in healthcare, Gupta said,” One is the health insurance or financial lever. Due to Ayushman Bharat, the entire health insurance ecosystem is shifting from the pay-out-pocket model to the payor user model. Before Ayushman Bharat only three percent was covered by private health insurance and 10 percent by the government, put together 13 percent. After Ayushman Bharat’s implementation, it has covered 40 percent so total health insurance coverage is about 53 percent. Consolidating all other state government health insurance the number of claims is going to 10 to 20 times so we will have to make it digital. So we need a model to make it digital ie why NDHB urges to create an e-claim standard. As we proceed this will be implemented and it will have a standard format with a fast turnaround time. The second lever change will be on epidemiology, the COVID-19 exposed the broken healthcare system so if we have a national ecosystem will help in such pandemic outbreak and epidemiology analysis. The third lever of change is the e-governance which promotes portability of health services.”
Giving the private sector on NDHM Angshuman Sarkar, Principal Consultant, ThoughtWorks India, said, “Digital health is not just about going paperless it is all about strategic, holistic technology intervention on a real-time basis. Healthcare has different layers to it and right at the bottom is the primary healthcare in this layer is about population-level data for monitoring, implementing, and evaluating health interventions. Second level sub-divisional or district hospital we can do clinical reporting but none of these layers talk to each other. Across states, we have fragmented structure, and there is no assimilation, analysis of patients’ information. Few states particularly southern states are better. India is in an advantageous position as we can start as a greenfield from ground zero though we are fragmented stage widely we need to move ahead and NDHM will provide us the push.”
The moderator Dr. Biren moving forward the conversation further informed that India is a technology powerhouse of the global countries, asked the panelist how to leverage technology and any best practices from the other countries can be adopted if we need to fast base the NDHM goals.
Taking up the question, Dr. Gaur said,” I’m very optimistic about the implementation of NDHM, as I’m from diagnostic segment there are one lakh labs only about 20-25 percent is owned by structured segment there are only about 2000 accredited there are no standardization protocols. It is too early to comment on the mechanism of NDHM but definitely, it will help if the following is handled well viz – database on disease and healthcare monitoring, provision of healthcare research, prediction of the epidemic, hot spots of disease and control, mapping of patient behavior, budget planning. We need to address all the challenges as we will benefit multi fold by the mission.”
Talking about digitization Pareek said, “With the digital health and digitalization there is the speed in diagnosis. The unique identity card will fasten the digitization, instill transparency and cost will reduce.”
Gupta talking about the x-factor of NDHM said, “India is so diverse and unique and in my opinion, the x-factor is the jugaad factor technology. In telecom, we found unique ways to revolutionize. Similarly, in fintech, we had a different approach and showed that we can transform the world. In healthcare, a completely new digital healthcare model will come up in India, and no need for us to copy the west.”
Giving his comments on the x-factor Sarkar said, “NDHM is trying to create a horizontal background as a platform for healthcare. It will be a layered innovation and government working on the core is going to a differentiator and this is going to be the breaking point.”