Context

Niti Aayog had earlier floated the ‘National Health Stack’ paper as “implementation framework” for Ayushman Bharat. After holding consultations on it, the Ministry of Health formed a committee under former UIDAI chairman and former MeitY secretary, which drafted the ‘National Digital Health Blueprint 2019’.

About

• Recently, the National Digital Health Blueprint (NDHB) Committee submitted the final “National Digital Health Blueprint” (NDHB) report to Union Health Minister.
• NDHB will help in providing a common platform for integration of existing applications in health domain and data which has existed in silos, either in public health facilities, or, in private healthcare facilities, in India.
• Building on the initial document of “National Health Stack” (NHS) by NITI Aayog, Ministry of Health and Family Welfare has defined clear timelines, targets and the resources required for digital convergence of healthcare programmes in India.
  • The priorities of the central government of India were included in the “National Health Policy 2017” and NDHB shows the implementation angle for achieving the same.
  • The National Health Policy 2017 (NHP 2017) envisages the goal of attainment of the highest level of health and well-being for ALL at ALL ages, through increasing access, improving quality and lowering the cost of healthcare delivery.
  • The key principles of NHP 17 include universality, citizen-centricity, quality of care and accountability for performance.
  • Leveraging digital technologies for enhancing the efficiency and effectiveness of delivery of all the healthcare services.
• Creation of district-level electronic databases, establishing registries for all diseases of public importance
• Establishing ‘Federated National Health Information Architecture’, to roll-out and link systems across public and private health providers at State and National levels consistent with Metadata and Data Standards (MDDS) & Electronic Health Record (EHR).
• Leveraging the potential of digital health for 2-way systemic linkages between primary, secondary and tertiary care to ensure continuity of care.
• This can be considered as the biggest leap of towards achieving the goal of Universal Healthcare Coverage (UHC) with impetus on the digital healthcare component.

National Health Stack

• NHS objective: The NHS envisages a centralized health record for all citizens of the country in order to streamline the health information and facilitate effective management of the same.
• NHS mechanism: The proposed NHS is an approach to address the challenge and seeks to employ latest technology including Big Data Analytics and Machine Learning Artificial Intelligence, a state of the art Policy Mark-up Language and create a unified health identity of citizens - as they navigate across services across levels of care, i.e. Primary, Secondary and Tertiary and also across Public and Private.

Why is there need of NHS?

• India today is witnessing significant trends in health: increasing prevalence of non-communicable diseases for instance, as well as marked demographic shifts. Climbing out-of-pocket costs is becoming difficult for most households.
• Ayushman Bharat: To address the health needs of citizens, the Government of India had announced comprehensive policy response – the Ayushman Bharat Yojana. This flagship health programme is to develop a wellness focused strategy, ensuring cost effective healthcare for all. The program leverages a two-pronged approach:
  • On the supply side, substantial investments will be made to build 1.5 lakh health and wellness centers offering preventive and primary care; and
  • On the demand side, the Pradhan Mantri-Rashtriya Swasthya Suraksha Mission (PM-RSSM) will create a national insurance cover of up to 5 lakhs per year per family for over 10 crores households, towards secondary and tertiary care.
• Need for technology backbone: Achieving such scale requires core technology backbone of our system and leverage cutting edge digital solutions to tackle the challenge. Though technology deployment for healthcare has been continuous and widespread but the benefits have been highly localized and fragmented.
  • The citizen cannot access his health records speedily nor store them conveniently.
  • In the absence of an integrated system, the service providers undertake diagnostic tests afresh and create isolated medical records enhancing the burden on the citizen significantly.
• Health and policy interventions: Health service providers in the public and private sectors do not have an aggregated and complete view of the data for providing efficient health services to the citizens.
• Governments, Central and State alike, also do not have reliable and complete data for policy analysis and evidence-based interventions.
• Benefits of NHS: Once implemented, the National Health Stack will significantly bring down the costs of health protection, converge disparate systems to ensure a cashless and seamlessly integrated experience for the poorest beneficiaries, and promote wellness across the population.

National Digital Health Blueprint

• NDHB Objective: NDHB objective is to create an ecosystem which can integrate the existing disparate health information systems and show clear path for upcoming programmes.
  • Establishing and managing core health data, and the infrastructure for its exchange.
  • Establishing National and Regional Registries to create “Single Source of Truth” relating to clinical establishments, healthcare professionals and health and pharmacies.
  • Adopt open standards.
  • To create Personal Health Records based on international standards, which are easily accessible to citizens and services providers, based on consent.
  • To promote enterprise-class health application keeping in mind Sustainable Development Goals related to health.
  • To ensure private sector participation.
  • To ensure national portability in the provision of health services.
  • To promote the use of Clinical Decision Support (CDS) Systems by health professionals and practitioners.
  • To leverage health data analytics and medical research for better management of the health sector.
  • To enhance Governance digital tools in the area of Performance Management.
  • To support steps taken for ensuring quality of healthcare.
• NDHB key features: Key features of the blueprint include a Federated Architecture, a set of architectural principles, a 5-layered system of architectural building blocks, Unique Health Id (UHID), privacy and consent management, national portability, EHR, applicable standards and regulations, health analytics and above all, multiple access channels like call centre, Digital Health India portal and MyHealth App.
• NDHB recommendations: The formation of ‘National Digital Health Mission’ as an implementing body recommended in this report is a balanced combination of designing, developing and realizing certain pure-play Technology Building Blocks and the essential Domain (Health) Building Blocks.

Conclusion

The need of the hour is to elevate the existing systems from providing disparate electronic services to integrated digital services. We need to clearly adopt the principles of Enterprise Architecture, if we must leverage the digital technologies to achieve the vision of NHP 2017.