Context: On August 15, Prime Minister Narendra Modi announced plans to give every Indian citizen a unique health ID as part of the National Digital Health Mission (NDHM), which will digitise health records as well as provide a registry of doctors and health facilities. The decision has immense potential to change India’s health infrastructure, while also raising concerns over privacy and efficient implementation. To begin with, the health ID will undoubtedly give a much-needed technological impetus to a sector that has long been found wanting, more so amid the ongoing Covid-19 pandemic. However, unlike Aadhar, the health ID isn’t mandatory and is only one of the components of the Mission, which the government reckons will go a long way in providing universal health coverage to over 1.3 billion people. The NDHM has been rolled out on a pilot mode in six Union Territories. It comprises six areas, including health ID, DigiDoctor, health facility registry, personal health records, e-pharmacy, and telemedicine.

Background

• The National Health Policy (NHP) 2017 had laid significant emphasis on leveraging digital technologies for enhancing the efficiency effectiveness of all healthcare delivery services.

Key Points

• Under the National Digital Health Mission, every Indian will be given a digital health ID which will contain information regarding disease, medical reports, medicine prescribed and consultant doctor details of a person.
• The National Health Authority (NHA), which runs the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, would be designing and implementing the NDHM.
• While the core systems of NDHM like Health ID, Digi-Doctor and Health Facility Registry shall be owned, operated and maintained by the Government of India, Private stakeholders will be given an equal opportunity to integrate with the core system and create their own products.
• The NDHM would be a voluntary programme.

Significance
Patient-centric healthcare

• The National Digital Health Mission (NDHM) aims to empower the citizens and make the health care system more patient centric.
• The system will lead to convenience for the patient, given that the patient will not need to store and carry old records. The digital access to patient data can lead to more effective diagnosis.
• The digital data will also help in providing prompt and accurate treatment, especially in emergencies by avoiding repetition of medical history taking and unwarranted tests.

Affordability

• Digital health can help ensure the delivery of health services to a large population at affordable costs.

Improved accessibility

• NDHM will help improve access by providing a big boost to consultation through telemedicine with specialist doctors for patients in smaller towns and remote locations.
• The introduction of telemedicine and e-pharmacy will bring in more inclusivity. NDHM can help provide quality healthcare to rural masses and bridge the divide between urban and rural India.
• It will lead to quality care and better access to healthcare facilities and doctors.

Quality healthcare

• Providing a unique identification to doctors as well as health facilities can lead to streamlining several issues of quality and accountability.

Integrating the stakeholders

• The NDHM will help revitalize India’s healthcare delivery system. The NDHM will help reduce the gap among stakeholders, such as doctors, hospitals and other healthcare providers, by connecting them in an integrated digital health infrastructure.

Data value

• The use of machine learning and artificial intelligence techniques to analyse the data generated from the records will help learn disease patterns, predict the onset of ailments and suggest seasonal outbreaks, bringing efficiencies and effectiveness in healthcare.

Impetus to entrepreneurship

• The NDHM brings a huge opportunity for digital health start-ups to work with providers and insurers to help build the continuum of patient centric care. NDHM provides opportunities for innovation in the healthcare sector.

Objective of Draft Health Data Management Policy

• One of the main objectives of the draft policy is to provide adequate guidance and to set out a framework for the secure processing of personal and sensitive personal data of individuals who are a part of the national digital health ecosystem.
• It will be in compliance with all applicable laws and international standards that define the set of frameworks of consent for the collection and processing of health data by healthcare practitioners and other entities, and other relevant standards related to data interoperability and data sharing.

Key highlights of the Policy

• Sensitive personal information: The Information that can be collected from citizens includes sexual orientation, sex life, mental health, caste or religious data as well as genetic data.It also includes financial information such as bank account details among others.
• Consent: Any personal data can be collected only on consent from the individuals and they will be allowed to revoke their consent to restrict any sharing of personal data.
• Storage of Data: 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.
• Data Management: Any agency or personnel that have access to personal medical data of people enrolling in the NDHM will have to formulate and implement a personal data breach management mechanism and this will be publicly displayed.
• Breach of Data: Any instance of unauthorised or accidental disclosure or sharing of personal data that compromises its confidentiality and integrity should have to be reported promptly to the NHA and other relevant authorities.The persons responsible for such a breach will be liable to punishment.

Key Points

• The draft is the maiden step in realising the NDHM’s guiding principle of ‘Security and Privacy by Design’ for the protection of individuals’ data privacy.
• It encompasses various aspects pertaining to health data such as data privacy, consent management, data sharing and protection, etc.
• The NDHM seeks to provide a unique health ID to each citizen who wishes to have one and also on-board the healthcare service provides (hospitals, pharmacies and diagnostic labs, among others). It will have an online database of doctors (DigiDoctor) and personal health records (PHRs).
• To access one’s PHR, any doctor or institution would have to seek permission from the health ID owner.
• Access can also be revoked.
• The Centre has now reiterated the same in the draft health data management policy.
• Everyone enrolled for the mission will get a Health ID free of cost and have complete control over his or her data.
• The government has proposed a framework and a set of minimum standards for data privacy protection to be followed across the board in compliance with applicable laws and regulations.

Challenges

Implementational challenges

• To achieve the proposed shift in the storage and retrieval of medical records in the country, the digital integration of interfaces of various stakeholders in the healthcare sector will have to be achieved.
• Given the large participation of the private sector in the healthcare delivery system in India, the challenge would be to bring the private health care sector under the NDHM and ensure both reliability and quality of the information recorded.
• Currently, 66 percent of treatment of all ailments is met by private hospitals and clinics (as per NSS 75th Round: Key Indicators of Social Consumption in India: Health, Ministry of Statistics and Programme Implementation, Government of India, 2017-18).
• A large share of diagnostic centres and pathology labs are run by the private sector.

No digital penetration:

• The low penetration of digital technology in rural areas will be a challenge in ensuring the potential of inclusivity and accessibility offered by NDHM.

Data privacy

• Data privacy and security issues would be a prime concern in the NDHM.
• Dealing with ethical issues, breach of privacy, and dealing with social stigma are significant challenges for the NDHM.

Public health infrastructure

• The digital health mission must be backed up by high-quality public health infrastructure. The absence of a robust public health infrastructure will rob the NDHM of its potential benefits.
• The biggest hurdle for NDHM is the meagre health budget of India.
• Currently, total health expenditure (both private and public) in India is just 3.6 per cent, while public spending on health is just above 1 per cent of the country’s GDP, which is a low compared to the countries that have some of the best digital health systems in the world.

Road Ahead

• It is not something that work overnight i.e. the National Digital Health Mission (NDHM), mission itself has been something that it has been in the work for several years now. The aim of the mission is to address the issue in the health sector through digital technology, Digitising health is a game changer and will be a big boost for digital technology sector but data compliance and data privacy is a major concern that need to be address along the way. Digital technology has been fastrack during the pandemic and has shown great results, it has helped the frontline warriors to carry out their work more efficiently. Infrastructure and last mile connectivity is going to be another big challenge but we should not let be that as deterrent, we should go with what we have and make the most of it.