Like most industries and spheres of life, healthcare is undergoing digitisation in India at many levels. Even as the government has led from the front with its landmark National Digital Health Mission (NDHM) and now rechristened Ayushman Bharat Digital Mission (ABDM), the private sector is also embracing digitisation with equal vigour. At least, in metro cities and big towns, apart from a few in smaller towns, several private hospitals, as well as public hospitals providing tertiary care, have been engaged in setting up (or upgrading) some form of digital infrastructure and allocating resources and personnel in the recent past. This would also involve the implementation of healthcare IT applications in terms of Hospital Information System, Hospital Management Information Systems, & Electronic Medical Records (EMR), etc, to manage patient data in electronic format. Likewise, the patients too, are evolving into more digital technology-savvy healthcare receivers increasingly using smartphones and other devices to not just store diagnostic reports and doctors’ prescriptions but also to make appointments, consult, use home-based diagnostics and testing facilities, and order medicines.

Government’s ABDM is a work in progress

The NDHM was launched as a pilot in six UTs in 2020 when three principal registries such as Health ID, Health Professional Registry (HPR), Health Facility Registry (HFR), and digital infrastructure for data exchange were developed and implemented. Building on this success, the programme was expanded in a country-wide rollout in September 2021 focusing on key components such as Ayushman Bharat Health Account (ABHA) No., Health Facility Registry, ABHA App, Healthcare Professionals Registry, and Unified Health Interface (UHI). Within a year, the programme registered considerable success. According to the ABDM website, an impressive over 24 crore ABHA numbers have been created with 1,44,371 health facilities and 69,312 health professionals registered, along with over 7 lakh health records, and app downloads. This includes a range of technology stakeholders including Hospital Management Information Systems (HMIS), Personal Health Records (PHR) apps, and Health tech apps. Furthermore, as reported there are as many as 919 health tech innovators who are participants in the ABDM Sandbox, a digital space for experimentation of integration before a digital app or health product is made live for actual use.

Challenges likely to persist

While over 24 crore ABHA numbers may already constitute one-sixth of India’s population, the truth remains that a large part of the healthcare value chain remains outside the government-driven ABDM initiative. According to the government’s own data, of nearly 12 lakh healthcare facilities, a mere 1.4 lakh have joined the ABDM platform. Similarly, of the 50 lakh healthcare professionals today, only 69,000 are joining the platform, which is again an insignificant number. As per the National Health Profile 2019, only 65 per cent of primary health centres in rural India have computers. And the fact that over 65 per cent of rural India still has no internet as of now doesn’t quite paint a very bright picture for the future.

Picture not as bleak, will catch up in the next 25 years

However, it has only been a year since the nationwide ABDM launch was done. If one-sixth of the population has been covered in one year, there is no reason the rest can’t be covered in the next 25 years. Similarly, the foundations for a country-wide infrastructure for internet and digital connectivity will ensure a far better internet-penetrated India in the next 25 years setting the stage for digital healthcare to be available for patients in the remotest and the rural parts of the country too. Initially, healthcare facilities in Tier I and II towns will take the digital path for the delivery of healthcare services. And in time, the smaller towns and the hinterland would follow suit.

What the government needs to do now?

Creating a country-wide integrated healthcare delivery network first requires getting all the stakeholders in the entire value chain to reach a consensus in order to achieve that desired goal. As such, the readiness, as well as the interest of every stakeholder including regulators and agencies in states, healthcare service providers, hospitals, healthcare professionals, diagnostic labs, healthcare software vendors, digital consent solution providers, EHR/EMR/PHR solution providers, hardware makers, and insurance companies, must be assessed thoroughly. At the same time, given that more than 75 per cent of outpatients and 60 per cent of inpatients get treatment in private facilities, it is important to incentivise private players sufficiently for them to join the common network.

Accordingly, suitable PPP models need to be worked out. Moreover, the patient record makers and the software providers need to be convinced to design interoperable systems, a prerequisite for any integrated health network. In this context, free and open-source software is highly desirable. Similarly, hospitals would need to upgrade their systems from merely being billing and registering platforms. Importantly, the privacy and confidentiality of data must be ensured through a legal framework as well as technological innovations.

Already, India has seen the emergence of an incredible number of health tech startups with innovative solutions which were inconceivable before. In a world of IoT getting increased traction, the advent of AI, machine learning and robotic process automation (RPA) is not only catalysing better clinical decision making and personalisation of treatment but also helping authorities regarding healthcare research, affordable drug discoveries, disease surveillance, and even prediction of diseases. So, digitaisation is vastly improving our public health delivery mechanisms. The mammoth Covid-19 vaccination exercise carried out successfully through the digital platform in a country-wide operation is illustrative of this improvement even as we continue to work on and refine the ABDM. By 2047, the healthcare network will be far more efficiently digitalised with a far more number of participants and covering nearly the whole of India.

Views expressed by Dr Nitendra Sesodia, Senior Director, Medical Communication & Corporate Sales, Thieme

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