Figure 2: No Copyright Infringement Intended

Context

• National digital health mission inaugurated by Prime Minister of India.

 

Background

• MoH&FM set up a committee under J. Satyanarayana to develop an implementation framework for the National Health Stack.
• The Satyanarayana committee recommended drafting a National Digital Health Blueprint to lay down the building blocks and action plan for a digital health mission.
• National Digital Mission Blueprint recommended the establishment of an entity called National Digital Health Mission to provide for a digital healthcare ecosystem for healthcare services across the country.

 

Objectives of the Mission

To strengthen the accessibility and equity of health services, including continuum of care with citizens as the owner of data, in a holistic healthcare programme approach leveraging IT & associated technologies and support the existing health systems in a

‘citizen-centric’ approach, the NDHM envisages the following specific objectives:

• To establish state-of-the-art digital health systems, to manage the core digital health data, and the infrastructure required for its seamless exchange.
• To establish registries at appropriate level to create a single source of truth in respect of clinical establishments, healthcare professionals, health workers, drugs and pharmacies.
• To enforce adoption of open standards by all national digital health stakeholders.
• To create a system of personal health records, based on international standards, easily accessible to individuals and healthcare professionals and services providers, based on individual’s informed consent.
• To promote development of enterprise-class health application systems with a special focus on achieving the Sustainable Development Goals for health.
• To adopt the best principles of cooperative federalism while working with the
• States and Union Territories for the realization of the vision.
• To ensure that the healthcare institutions and professionals in the private sector participate actively with public health authorities in the building of the NDHM, through a combination of prescription and promotion;
• 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 promote a better management of the health sector leveraging health data analytics and medical research.
• To provide for enhancing the e ciency and e ectiveness of governance at all levels.
• To support e ective steps being taken for ensuring quality of healthcare
• To strengthen existing health information systems, by ensuring their conformity with the defined standards and integration with the proposed NDHM.

Health Data

Health data is critical for creating holistic views of individuals, personalizing treatments, improving communication between caregivers and individuals, and delivering better health outcomes. Health data can be classified into the following categories:

• Personal Health Data - Data related to an individual containing detailed information of various health conditions and treatments. It includes any data with personally identifiable information of various stakeholders, e.g. healthcare professionals. 2.
• Non-Personal Health Data - Includes aggregated health data like the number of dengue cases and anonymized health data where all personally identifiable information has been removed. This will also include information about health facilities, drugs etc. which do not involve personally identifiable information.

 

Principles of health data management

• Individual Owned: All records and their components will be owned and controlled by individuals —HIPs will be data fiduciaries.
• Health Lockers: Patients will have the choice to keep a copy of their records in their own cloud store called Health Lockers. Patients will have the ability to store all records through their lifetime in these lockers. Several Health Lockers will exist giving patients adequate choice & security. DigiLocker initiative of NeGD, MeitY shall
• be the prioritized choice for Health Lockers, while the individuals will be able to consider other options too, with appropriate compliance as defined in NDHB.
• Digilocker will provide access to users of their electronic health records and will also provision an instance of Digilocker as Health Locker and storage infrastructure for this purpose, in case required by MoHFW.
• Consent Driven Sharing: Health records will be accessible and shareable by the patient with appropriate consent, and complete control of the records will remain with the patient.
• Revoke Consents: HIUs are expected to implement the rules specified in consent including time limitations. Individuals will have the right to review and revoke any consent that has been issued. HIUs are required to implement the revocation and provide a confirmation back to the user.
• Partial Sharing: Individuals will have the right to share only a part of their record with doctors as per their will. However, in such a case, doctors will be informed that they are being provided with partial information and can advise the patient that treatment ability may be limited due to lack of full information.
• Voluntary: Sign-up for PHRs will be voluntary and even after sign-up, a patient will have the right to opt-out. Links to their documents across HIPs would be deleted.
• Records from Govt Schemes: Government schemes—such as PMJAY, NIKSHAY—will act as HIPs and issue any medical records from the scheme into patient PHRs.
• Update of an Issued Health Record: If a health provider decides to update an already issued health record, the original record and an audit trail of the change will be available to the patient.
• User Generated Data: Users can add reading from IoT and other devices like wearables to their PHR. The data will be stored in the Health Locker which can act as a HIP for the user. All user added data will be clearly and separately labelled to ensure care providers can di erentiate the data generated by other providers vis a vis those added by the user.
• Sharing Health Data: Patients will be allowed to share health data to any HIU with consent.
• Grievance: Users will be provided options to complain about misuse and have any issues resolved.
• Forget My Data: Users can opt out from linking their records across HIPs but cannot ask HIPs to delete their data. HIPs are required to store the data for users for the period as required by law. Users can only delete user uploaded data or the copy of the records they have in their Health Locker.

 

Challenges

• One big challenge is how to bring undiagnosed or untreated ailments(an illness, typically a minor one) into account.
• Unless healthcare is a ordable to the poor, it is di cult to bring people to seek treatment for all ailments.
• Data misuse – It is a challenge to secure the health data of the citizens along with other personal information to avoid a breach of the right to privacy.
• Leakages from health repositories – Technological advancement and high security to avoid any leakage of the data.
• Risk of Online Fraud
• Issue of Health Literacy
• Addressing Out-of-pocket Expenditure
• Profiteering by pharma companies
• Foreign surveillance