The Fact Maker

The Road to a Digitized Healthcare Landscape in India @100

Written By: Dr. Nitendra Sesodia, Senior Director, Medical Communication & Corporate sales, Thieme

Like most industries and spheres of life, healthcare too is undergoing digitization in India at many levels. Even as the government has led from the front with its landmark National Digital Health Mission (NDHM) and now rechristened Ayushman Bharat Digital Mission (ABDM), the private sector is also embracing digitization with equal vigour. At least in metro cities and big towns apart from a few in smaller towns, several private hospitals as well as public hospitals providing tertiary care have been engaged in setting up (or upgrading) some form of digital infrastructure and allocating resources and personnel in recent past. This would also involve the implementation of healthcare IT application in terms of Hospital Information System, Hospital Management Information System and Electronic Medical Records (EMR) etc. to manage the patient data in electronic format. Likewise, the patients too are evolving into more digital technology-savvy healthcare receivers increasingly using smartphones and other devices to not just store diagnostic reports and doctors’ prescriptions but also to make appointments, consult, use home-based diagnostics and testing facilities and order medicines.             

In the backdrop of India having celebrated its 75th anniversary of its independence only last month, how has the digitization of healthcare evolved so far and with what achievements? And what does the next 25 years hold for the country’s healthcare digitization journey, the challenges that we might face along the way and the shape and form in which India’s healthcare digitization would emerge at the time of the hundredth Independence Day?

The government’s ABDM is a work in progress       

The NDHM was launched as a pilot in six UTs in 2020 when three principal registries such as Health ID, Health Professional Registry (HPR), Health Facility Registry (HFR) and digital infrastructure for data exchange were developed and implemented.Building on this success, the programme was expanded in a country-wide rollout in September 2021 focusing on key components such as Ayushman Bharat Health Account (ABHA) No., Health Facility Registry, ABHA App, Healthcare Professionals Registry and Unified Health Interface (UHI). Within a year, the programme has registered considerable success. As of 12th Sep 2022 according to ABDM website, an impressive over 24 crore ABHA numbers have been created with 1,44,371 Health Facilities and 69,312 Health professionals having registered, along with over 7 lakh health records App downloads.In a similar vein, by July this year, as many as 52 digital health services/applications have integrated with ABDM including 32 private entities.This includes a range of technology stakeholders including Hospital Management Information Systems (HMIS), Personal Health Records (PHR) apps and Healthtech apps. Furthermore, as reported till late July, there are as many as 919 healthtech innovators are participants in the ABDM Sandbox, a digital space for experiment of integration before a digital app or health product is made live for the actual use.

The challenges likely to persist, apparently

While the over 24 crore ABHA numbers may already constitute one-sixth of India’s population, the truth remains that a large part of the healthcare value chain remains outside the government-driven ABDM initiative. According to the government’s own data, of nearly 12 lakh healthcare facilities, a mere 1.4 lakh have joined the ABDM platform. Similarly, of the 50 lakh healthcare professionals today, only 69,000 joining the platform is again a insignificant number. According to National Health Profile 2019, only 65% of primary health centres in rural India has computers. And the fact that over 65% of rural India still has no internet as of now doesn’t quite paint a very bright picture for the future. Add to this the digital discomfort if not illiteracy for a substantial number of people even today.

Picture not as bleak, will catch up in next 25 years

However, it has only been a year since the nation-wide ABDM launch was done. If one-sixth of the population has been covered in one year, there is no reason why the rest can’t be covered in the next 25 years. Similarly, the foundations for a country-wide infrastructure for internet and digital connectivity will ensure a far better internet-penetrated India in the next 25 years setting the stage for digital healthcare to be available for patients in the remotest and the rural parts of the country too. It is likely that initially the healthcare facilities in tier I and II towns will take the digital path for delivery of healthcare services. And in time, the smaller towns and the hinterland would follow suit.

What the government needs to do now

Creating a country-wide integrated healthcare delivery network first requires getting all the stakeholders in the entire value chain reach some kind of consensus in order to achieve that desired goal. As such, the readiness as well as interest of every stakeholder including regulators and agencies in states, healthcare service providers, hospitals, healthcare professionals, diagnostic labs, healthcare software vendors, digital consent solution providers, EHR/EMR/PHR solution providers, hardware makers and insurance companies must be assessed thoroughly. At the same time, given that more than 75% of outpatients and 60% of inpatients get treatment in private facilities, it is important to incentivize the private players sufficiently for them to join the common network. Accordingly, suitable PPP models need to be worked out. Moreover, the patient record makers and the software providers need to be convinced to design interoperable systems, a prerequisite for any integrated health network. In this context, free and open source software is highly desirable. Similarly, hospitals would need to upgrade their systems from merely being billing and registering platforms. Importantly, privacy and confidentiality of data must be ensured through legal framework as well as technological innovations.

Already, India has seen the emergence of an incredible number of healthtech startups with innovative solutions which were inconceivable before. In a world of IoT getting increased traction, the advent of AI, machine learning and robotic process automation (RPA) is not only catalyzing better clinical decision-making and personalization of treatment but also helping authorities in terms of healthcare research, affordable drug discoveries, disease surveillance and even prediction of diseases. So, digitaisation is vastly improving our public health delivery mechanism. The mammoth Covid-19 vaccination exercise carried out successfully through the digital platform in a country-wide operation is illustrative of this improvement even as we continue to work on and refine the ABDM. By 2047, the healthcare network will be far more efficiently digitalized with a far more number of participants and covering nearly whole of India.