National Digital Health Mission (NDHM) UPSC

​National Digital Health Mission (NDHM)

NDHM is a voluntary healthcare programme that aims to reduce the gap among stakeholders such as doctors, hospitals, citizens etc by connecting them in an integrated digital health infrastructure. 

Vision: 

To create a national digital health ecosystem that supports universal health coverage in an efficient, accessible, inclusive, affordable, timely and safe manner.

The scheme will be initially rolled out in the Union Territories of Chandigarh, Ladakh, Dadra and Nagar Haveli and Daman and Diu, Puducherry, Andaman & Nicobar Islands and Lakshadweep. 

Idea of NDHM is based on Niti Aayog's 2018 report on National health stack (NHS)

• The National Health Stack (NHS) is a visionary digital framework of NITI Aayog which can be used both by the centre and state governments across public and private sectors. The document was released by NITI Aayog in July2018. 

• NHS represents a holistic platform that supports a multitude of health verticals and their different branches and is capable of integrating future IT solutions for the health sector. 

• National Health Stack (NHS) is a digital infrastructure built with a deep understanding of the structures prevalent in the Indian healthcare ecosystem. 

• So, National Health Stack is a set of building blocks which are essential in implementing digital health initiatives which would be built as a Common Public Good to avoid duplication of efforts and successfully achieve convergence. 

• Aim of the National Health Stack (NHS) is to facilitate collection of comprehensive healthcare data across the country. NHS will help in data analysis which will allow policy makers to experiment with policies, detect fraud in health insurance, measure outcomes and move towards smart policy making. 

• It will also engage market players (NGOs, researchers, watchdog organizations) to innovate and build relevant services on top of the platform and fill the gaps. 

• The design is geared to generate vast amounts of data resulting in some of the largest health databases with secured aggregated data that will put India at the forefront of medical research in the world. 

Features of NDHM 

Building blocks or digital systems: 

• HealthID - a repository of all health-related information of a person, such as medical tests, previous prescriptions, diagnosis, treatments etc. It can be created voluntarily by every Indian citizen. 

• DigiDoctor – a single, updated repository of all doctors enrolled in nation with relevant details such as name, qualifications, specializations, registration number, years of experience, etc 

• Health Facility Registry (HFR) - a single repository of all the health facilities (both public and private) in the country. 

• Personal Health Records (PHR) - an electronic record of health-related information on an individual that can be drawn from multiple sources while being managed, shared, and controlled by the individual. 

• Electronic Medical Records (EMR) - a digital version of a patient's chart which contains the patient's medical and treatment history from a single health facility. 

• Consent Manager and Gateway - The exchange of health information is enabled by the consent manager and gateway where Health records can only be issued / viewed with patient consent.

National Health Authority, attached office of MoHFW, will design, build, roll-out and implement the NDHM. 

Federated Architecture: 

The Government of India will own, operate and maintain the core building blocks of NDHM such as Health ID, Digi-Doctor and HFR. 

• All other building blocks will be designed to be operated in a federated model that factors regional, state-level and institution-level platforms and systems to function independently but in an interoperable manner. 

• Components, like PHR and EMR solutions can be developed by private players, in line with the official guidelines issued by the government.

NDHM sandbox has been setup to enable any software to integrate with the digital building blocks and test their compliance to the guidelines and digital health standards. 

NDHM will be developed by adopting India Enterprise Architecture Framework (IndEA) notified by MeitY. 

• IndEA is a set of citizen-centric, efficiency-focused and event-driven architectural patterns, reference models and standards for designing Enterprise Architectures.

Benefits associated with a Digital Health Infrastructure 

• Inclusive Healthcare: Technological interventions such as telemedicine can bridge the urban-rural healthcare divide and achieve portability not just for the beneficiaries but also for practitioners. 

• Better utilization of data: NDHM would facilitate convergence of data and a comprehensive feedback loop between researchers, policymakers, and providers. 

• Effective implementation of schemes and policies: Access to health data will enable government to strengthen implementation of health programmes and policies through geography and demography-based monitoring and decision making. 

• Enabling citizens to make informed decisions: Through correct information and sources, citizens can overcome challenges such as finding the right doctors, seeking appointment, payment of consultation fee etc. to avail the best possible healthcare. 

• Improved health care services: The integrated ecosystem will also enable better continuum of care, faster reimbursements and effective health interventions. A digital health ecosystem will also help in improving consumer experience and accountability of healthcare providers 

• Reduced risks for government and healthcare providers: by improved price discovery mechanism and better fraud detection. 

• Boost to Medical tourism: A national digital ecosystem can attract a globally competitive healthcare insurance and service provision industry with potential increase in medical tourism. 

• Achieving Sustainable Development Goals (SDGs): NDHM can be a major stride towards achievement of the SDG 3.8 of Universal Health Coverage, including financial risk protection.

Challenges 

• Federal nature of Healthcare: Health in India is responsibility of the States which leads to fragmentation of policy formulation, implementation and regulation. 

• Digital divide: Digital systems can lead to exclusion of digitally illiterate and unconnected remote, hilly and tribal areas. 

• High cost of developing digital infrastructure: Providing unique ID and encoding data for the use of medical professionals along with developing and securing data network is a costly process. 

• Huge requirement of skilled labour: India faces shortage of skills in areas such as cyber security, business analysis, clinical resources and software development and systems engineering. 

• Inadequate primary health system: It faces myriad of issues such as poor data collection, use of obsolete technology, shortage of healthcare facilities, shortage of staff etc. 

• Apprehension among healthcare providers: due to fear of litigation, use of new technology, increased administrative burden etc. 

• Privacy, security and sovereignty issues: Health IDs will contain sensitive personal data which can be accessed by a third party. With involvement of private players from across the globe, safeguarding of medical data will become essential.