In line with India’s commitment towards achieving Sustainable Development Goals, Prime Minister Narendra Modi and the Ministry of Health and Family Welfare launched Ayushman Bharat Digital Health Mission (ABDM) on 27th September 2021. India seeks to establish a healthcare system that is more holistic, inclusive, accessible, and affordable for all citizens of all ages.
In accordance with National Health Policy’s (NHP 2017) goal of integrating the two dynamic and diverse sectors of healthcare and Information Technology, the Ministry of Health and Family Welfare developed a National Digital Health Blueprint (NDHB) envisaging the building blocks and action plan for the implementation of a digital healthcare ecosystem across the country. This initiative was given the name of Ayushman Bharat Digital Mission (ABDM) since its implementation was envisioned to be in a mission mode.
ABDM is a part of the National Health Authority (NHA), which is the main functionary to implement the health insurance scheme—Ayushman Bharat Pradhan Mantri Jan Arogya Yojana. Ayushman Bharat Digital Health Mission will connect hospitals and other healthcare service providers across India and facilitate the exchange of digital solutions and consultations. Under the mission, every citizen will have a digital health ID along with a protected digital medical record.
- 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 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 ABDM, 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 efficiency and effectiveness of governance at all levels.
- To support effective 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 ABDM.
Building Blocks of ABDM
There are four core building blocks of the mission. First, a 14 digit Health ID that can enable you to have your own identity on the national digital health ecosystem and allow you to interact with healthcare providers, receive your digital lab reports, prescriptions, and diagnosis from verified healthcare professionals and service providers in a hassle-free manner. Through the ID, one can also avail benefits of other schemes such as PM-JAY, Rashtriya Bal Swasthya Karyakram, and Nikshay Poshan Yojna. One can create their Health ID from its portal using their basic details, Aadhaar or mobile number, and a self-generated username called the PHR address.
Second, a Healthcare Facility Registry, which is a comprehensive repository of all health facilities of the country available across different systems of medicine. Third, a personal health record is an electronic application through which patients can maintain and manage their health information in a private, secure and confidential manner. Fourth, a Healthcare Professionals Registry that is a comprehensive repository of all healthcare professionals involved in the delivery of healthcare services across private and public sectors and different systems of medicine.
ABDM uses a unified health interface through which anyone can discover hospitals, pharmacies, laboratories, medicines, and other health-related facilities. Patients can simply book physical appointments, telemedicine consultations, ambulance services, or home collection services and get themselves treated and receive medicines in the comfort of their homes. There will also be an NDHM health records app that will compile the health record of a person from multiple sources.
Whenever one wants to access information generated by a Healthcare Service Provider, for instance, a doctor, they can identify themselves using the Healthcare Professionals Registry, seek consent from the electronic consent manager, and view the data through this electronic health information exchange. Once the individual provides consent for using their Health ID, the doctor will be able to see their health records, all this happens in a fraction of a second.
As per the Ministry of Health and Family Welfare, Ayushman Bharat Digital Mission was piloted successfully for one year in the six Union Territories, namely, Andaman & Nicobar Islands, Chandigarh, Dadra & Nagar Haveli and Daman & Diu, Ladakh, Lakshadweep, and Puducherry. As of 17th December 2021, according to the data from the Ayushman Bharat Digital Mission dashboard, more than 145 million Health IDs have been created, 14,978 healthcare facilities and 6,357 doctors have been registered and 2,00,165 health records apps have been downloaded.
Lately, India has been making major advances in the integration of technology into the healthcare sector especially with AarogyaSetu and CO-Win. India achieved a milestone in providing telemedicine services through e-Sanjeevani, by enabling more than 125 crore remote consultations. In 2018, the government had launched the Ayushman Bharat Scheme or the Pradhan Matri Jan Arogya Yojna to achieve the vision of Universal Health Coverage by providing free health coverage of up to 5 lakh rupees per family per year based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas.
Ayushman Bharat Digital Mission, however, was launched at a country-wide scale just about two months ago, making it difficult to assess its performance and the impact that it has created so far due to the lack of availability of the required data. As stated before, the mission was launched as a pilot in six Union Territories of India. In one of the Union Territories, Chandigarh, as of 15th December, the number of registrations from doctors was below optimal level as only 35% of the doctors from the Post Graduate Institute of Medical Education and Research (PGIMER) were registered on the National Digital Health Mission portal. Moreover, the coverage of health IDs by the residents of Chandigarh was also very poor as only 35.7 % population of the city had been covered under ABDM.
While many are already calling it a milestone in the healthcare sector, two months is a very short period of time to ascertain whether it has been successful in the attainment of its goals or not.
One can view Ayushman Bharat Digital Mission as a stepping stone in revolutionizing India’s existing healthcare system, given that it is implemented properly at the ground level. More realistic aims and targets need to be set keeping in mind India’s present healthcare infrastructure, IT infrastructure, literacy rates, and awareness among the masses. There are certain inherent challenges that the ABDM would need to overcome in order to achieve its goal. Out of a population of more than 1.3 billion only 145 million Indians have Health IDs.
- Privacy, Confidentiality, and Trust Related Concerns: It might be due to the lack of trust of the people regarding the privacy, security of their personal medical records, or the overall functioning of the portal. Obtaining consent might become a challenge for the doctor in such a case since consent plays a major role in the working of ABDM. Patients might also find it difficult to develop trust towards a new and unknown doctor especially during remote consultations.
At the moment, there aren’t any data protection laws even though there is a Data Empowerment and Protection Architecture (DEPA) drafted by the NITI Aayog in 2020 to govern access of such data by public and private agencies. Under ABDM, there will be a digital consent manager as an intermediary between the healthcare service provider and then one seeking access to the data. The managers will not be able to access the medical records of the patient, they will simply facilitate the exchange of data once the individual grants the consent to do so.
- Lack of Awareness: A large number of citizens are still unaware about the variety of government schemes that exist for their welfare. People might not even know about the existence of ABDM. Those who know about it, might not know how to use the platform. This can become a challenge for all the stakeholders.
- Inadequate IT infrastructure: India is a developing nation with the second largest population in the world. Our infrastructure is still insufficient and inadequate to cater to the needs of all its citizens. The public IT infrastructure, especially, requires an excellent internet speed, websites that do not crash and function smoothly and a seamless user experience.
- Inaccessibility: A large number Indians do not have access to electronic devices. A lot of healthcare providers, especially the ones in rural and remote areas might not have electronic facilities either, making their integration to the digital ecosystem a major challenge. The ones who do have the devices, might not be well versed with how to use them due to high computer illiteracy. ABDM talks about dealing with computer illiteracy with a ‘special tool’. More light needs to be shed on the same.
ABDM has the potential of becoming a game-changer for India’s healthcare system, but it still needs to overcome the challenges mentioned above and the others that might come up in due course of its functioning. Awareness camps need to be conducted at the ground level to raise awareness about the program, its need, how it works, emphasis should be laid on how the program is voluntary and based on the concept of consent.
Similarly, Healthcare Service Providers need to be trained on how to establish trust with remote patients, how to access and use the data. A smooth portal along with a user-friendly interface needs to be developed. Granting consent should not mean that the data is used for purposes other than what it was granted for. In some cases, the consent may be sought from an organization and not the individual. A well-laid down set of data protection rules, guidelines, therefore, need to be followed, well-advertised, and explained to all the stakeholders. An improved primary healthcare system is the need of the hour.
Ayushman Bharat Digital Mission aims to utilize the existing public digital infrastructure—including that related to Aadhaar, Unified Payments Interface, and wide reach of the Internet and mobile phones (JAM trinity), for establishing the building blocks of ABDM. The existing ability to digitally identify people, doctors, and health facilities, facilitate electronic signatures, ensure non-repudiable contracts, make paperless payments, securely store digital records, and contact people provide opportunities to streamline healthcare information through digital management will further help in the advancement of our healthcare sector.
Researchers will also greatly benefit from the availability of aggregated information as they will be able to study and evaluate the effectiveness of various programs and interventions. Better quality of macro and micro-level data will enable advanced analytics, usage of health-biomarkers, and better preventive healthcare. ABDM has the potential to greatly benefit citizens, doctors, hospitals, pharmacies, laboratories, and health tech companies apart from aiding the ‘Digital India’ campaign.
The vision is to create a state-of-the-art network of digital health solutions, provide ease of living and a simplified hospital system, to enable people living in the remotest areas of the country to avail virtual consultations from doctors of big hospitals in cities. While ABDM is a relatively new program, it does have to overcome certain challenges as discussed before. Proper planning and implementation can go a long way in making it a huge success.
About the Contributor
Sneha Bisht is a Researcher at IMPRI. She is currently pursuing her Bachelor’s degree in Political Science from Lady Shri Ram College for Women, University of Delhi.