NDHM’s proposed Health ODE will enable a more inclusive framework for digital health services by Anusha Ashwin, @ashwin_anusha

Introducing

Anusha Ashwin, Consulting Editor

In her first artcile as the Consulting Editor of the Healthcare IT Experts’ Blog, Anusha shares a review of the NDHM’s proposed Health ODE to create a future ready digital health system.

The need for a future-ready digital health system has become even more urgent than ever before with the COVID-19 pandemic hitting us with a big bang. And to be future-ready, experts say that global healthcare systems need to be more open. Most countries around the globe are already convinced with this open source model, so is India.

The NITI Aayog, in 2018, had brought out the blueprint of the National Health Stack (NHS), which is a shared digital healthcare infrastructure, with a view to implement the Centre’s flagship scheme Ayushman Bharat and other public healthcare programs in the country.

In a nutshell, the National Health Stack (NHS) is a visionary digital framework usable by centre and state across public and private sectors. It represents a holistic platform that supports a multitude of health verticals and their disparate branches, and is capable of integrating future IT solutions for a sector that is poised for rapid, disruptive changes and unforeseen twists. When this was proposed in 2018, the aim to create digital health records for all citizens by the year 2022 was earmarked.

FICCI-BCG Analysis on the benefits of Health ODE

The Federation of Indian Chambers of Commerce & Industry (FICCI), in partnership with BCG, has brought out an extensively analyzed report titled “Leapfrogging to a Digital Healthcare System: Re-imagining Healthcare for Every Indian”.

This report aims to highlight the various aspects of the revolution that the implementation of an open digital health ecosystem (ODE) will bring in India’s healthcare sector.

With the honorable Prime Minister (PM) Narendra Modi announcing the launch of National Digital Health Mission (NDHM) on 15th August 2020, this revolution is expected to become a reality soon, finds the FICCI-BCG report.

Building the Open Digital Health Ecosystem in India

The government has laid out the principles for building an open digital health ecosystem (health ODE) in India. The seeds for such a health ODE were sown at the Sustainable Development Summit in 2015.

India, along with other United Nations (UN) Member States adopted the 2030 Agenda for Sustainable Development, which includes the target of achieving universal health coverage by 2030.

This was followed by the National Health Policy (NHP) in 2017 that recognized the key role that digitalization can play in improving healthcare delivery in India. It envisaged the creation of a digital health ecosystem that serves the need of all healthcare stakeholders and improves efficiency, transparency, and patient experience.

In 2018, Niti Aayog presented the idea of a “National Health Stack” that is based on principles similar to India Stack. It called for the creation of a set of building blocks or “common public goods” for the development of diverse solutions in healthcare.

Based on Niti Aayog’s recommendation, the government drafted a report in 2019 titled, ‘National Digital Health Blueprint (NDHB)’. It laid out the architectural framework for a comprehensive, integrated, and nationwide digital health ecosystem.

With the PM announcing the NDHM on 15th August 2020, it is believed that we are not far from the moment when a health ODE in India becomes a reality. NDHM will take forward the implementation of NDHB and establish a health ODE in India.

Road to NDHM: A Public Digital Healthcare Infrastructure to help Meet the Sustainable Development Goals

The National Digital Health Mission Government entity entrusted to implement NDHB and health stack Sustainable Development goals (2015)

  1. Achieve universal health coverage, with democratized access to quality healthcare
  2. National health policy (2017) Outlines specific goals for adoption of digital technologies, and lays down the building blocks required to achieve it
  3. National health stack (2018) Laid out fundamental components for digital health
  • Electronic registries
  • Claims and coverage platforms
  • Federated PHR framework
  1. National digital health blueprint: Implementation guidelines for digital health; Layered framework relating to digital health infra, building blocks, standards and regulations, for implementation

Similar to how the UPI and the India Stack paved the way for creating a cashless economy and improved financial inclusion, the analysts who prepared the report believe that a health ODE, implemented by NDHM, will drive healthcare inclusion and create benefits for all players in the ecosystem.

The three components of health ODE

The report indicates that there will be three components of the health ODE that will guide its creation, implementation, and day-today functionality.

  1. Digital Platforms: These platforms will facilitate co-creation for building healthcare solutions for the healthcare community. They will further consist of three components:
  • The underlying technology infrastructure such as data exchanges, data sources, etc.,
  • A set of tools such as open Application Program Interfaces (APIs), standards and protocols, etc., that will enable the optimal use of this technology infrastructure.
  • End-user solutions that will be created by leveraging the technology infrastructure and publicly available tools. Examples of these solutions include Applications (apps) that connect patients with doctors.
  1. Community: It will consist of three types of stakeholders:
    • The builders that will build the digital platforms and further leverage it to create new user-centric solutions.
    • The end-users who will use these solutions to deliver or avail health services.
    • The facilitators that will be responsible for financing, governance, research, etc.
  2. Governance: A set of laws and rules that will govern the ecosystem and ensure data privacy, fair and equitable access, and accountability of all stakeholders. These laws will also naturally incentivize the community to adopt the digital platforms.

The six pillars on which digital health architecture rests

The FICCI-BCG report clearly describes the different building blocks of the underlying technology infrastructure of the digital platforms that will enable an integrated digital health ecosystem in India.

Analysts say that there are six pillars upon which the NDHM’s digital health architecture rests.

  1. Personalized health identity (ID): Single identifier to track individual across health providers & map digital health records
  2. Standardized health registries: A Unique identifier for each doctor/provider/drugs and other health data archetypes
  3. Federated health records: Health records to be stored in a federated format using common schema for nomenclature
  4. Coverage and claims platform: Digital claim processing to enable end-to-end standardization & visibility to stakeholders
  5. Open telemedicine and e-pharmacy network: Core gateway with fully interoperable ecosystem of public/ private end-user & provider apps
  6. Health data analytics: Aggregated data from all HIPs along with advanced analytics tools for consolidated reports/research

1 Personalized Health ID

A personal health ID allows for immediate and easy identification of the care receiver. Today, a person has multiple IDs across different diagnostic centers, providers, and other healthcare touchpoints. The creation of a universal ID will allow the patient to be identified across disparate data systems, thereby enabling an end-to-end view of the patient’s health. It will also act as a conduit for identifying beneficiaries for different health programs and policies, facilitating the improved implementation of these programs.

2 Standardized Health Registry

Currently, India does not have a reliable master data for identifying health facilities, healthcare workers, drugs, procedures etc. The healthcare workers and health facilities need to register with individual state councils for regulatory approvals and other services. Additionally, the absence of a central registry means that when the doctors move across states or get associated with a new provider, the provider has to validate and verify the details across disparate systems that don’t talk to each other.

The analysts of this report believe that standardized health registries will facilitate the creation of a master data set across all the different stakeholders in the ecosystem (such as doctors, hospitals, labs, pharmacies, insurance providers, etc.), and introduce a common vocabulary across drugs, procedures, reagents, and other consumables.

Existing databases at the center and state level (for example, ROHINI registry for hospitals, doctor registries with state medical councils, etc.), can be leveraged to build these registries, instead of creating them from ground up. These registries will significantly reduce the inefficiencies caused due to lack of reliable and interoperable information. Concerns around dated and low-quality data will be addressed by incentivizing the stakeholders to maintain updated information and building the necessary safeguards for data validation.

For example, self-maintainability of data will be ensured with the registries enabling the providers and health workforce convenient access to services such as regulatory approvals, government services, and empanelment. Similar registries for procedures and drugs will allow for a common vocabulary across providers and geographies ensuring information transparency. Overall, open access to the data in these registries will lead to a single source of truth for the ecosystem, thereby building trust and credibility in the system.

3 Federated Health Records

Personal Health Records (PHR) enable a holistic view of the patient’s health history and allow for its consented access across multiple health stakeholders. This framework, laid down under NDHM, relies on two building blocks:

  • Registries to identify and log the source of the data and
  • A health identifier to identify the owner of the data.

Additionally, it lays down a standardized set of guidelines and protocols for the ecosystem players to function as Health Information Users (HIUs), Health Information Providers (HIPs), or even as health information repositories to effectively manage the personal health records.

The platform also follows a federated structure which will facilitate the seamless exchange of data amongst disparate health data systems with minimal changes to the existing health record mechanisms. Tagging of the unique personal health ID to the different IDs across systems will create a comprehensive view of the health records linked to a particular ID.

The open APIs built on top of existing health data systems and new intermediaries in the form of Software as a Service (SaaS) providers will drive the implementation of this framework and pave the way for the interoperability of health records. Another class of intermediaries known as consent managers (similar to the one used for UPI) are also expected to emerge.

These consent managers will help route the data flow such that patient consent is recorded, and the subsequent transaction is logged. An additional advantage of interoperability will be that the patients will be able to access services across providers while maintaining a single view of their health records.

This feature will create immense value for patients. By giving consent to the provider to access their historical health records patients will be able to receive improved health service quality from the provider.

The report indicates that patients should finance this digitization as they stand to benefit the most from the electronic storage of their medical records. By charging the patients a nominal fee for providing a digital record basis the standard guidelines, providers can partially recover the cost of upgrading their digital capabilities and become a part of this federated framework.

4 Coverage and Claims Platform

Currently, different insurers and Third-party Administrators (TPAs) have different claim processing forms and data requirements. With the implementation of the health ODE by NDHM, a common standardized e-claim form will be established that will capture the minimum data required for claim processing.

If adopted by both private and public insurers and the payor groups, it can help streamline the claim process, allowing for the faster and cheaper settlement of claims and subsequently, reduced administrative burden for TPAs and providers.

A standard e-claim form along with standardized e-discharge reports facilitated by the PHR framework as described above, will allow for a quick and efficient means to initiate claims, validate patient details, and process claims.

Furthermore, a standard policy mark-up language adopted by insurers to specify policy details in a machine-readable format will aid auto-adjudication and fraud prevention.

New intermediaries in the form of health claims platforms will help drive this standardization across insurers and providers. It will also enable the monitoring of claims Key Performance Indicators (KPIs) for the overall improvement of system processes, indicates the report.

The health claims platform along with the health registry will provide multiple benefits.

  • Route claims to the appropriate insurer
  • Allow providers access to the full breadth of insurers and TPAs
  • Facilitate easy empanelment of insurers and TPAs
  • Provide hospitals / patients with visibility on the claim status
  • Enable real time monitoring to drive minimum Service Level Agreements (SLAs) for the overall claim process.

5 Open Telemedicine and E-Pharmacy Network

According to the report, a health ODE will enable a more inclusive framework for digital health services such as telemedicine platforms.

Health ODE will ensure that every doctor who wishes to provide teleconsultation has an opportunity to participate and be discovered by patients seeking care.

The interoperability feature will allow patients to seamlessly move between end-user apps along with their historical health records. The telemedicine gateway, as described under NDHM, will bring this process to life.

It will provide a set of open APIs and specifications upon which patient-centric solutions will be built by innovators to allow discovery, search, appointment, modifications, and fulfillment of various health services related to telehealth.

When patients request for telehealth services through any of their chosen apps, the telemedicine gateway will relay the search request to Healthcare Service Providers (HSP) platforms. Provider platforms will be able to respond with their intent of servicing that request and other parameters (price, rating, specialization, etc.), offered by the various health providers on their platform. The gateway will then relay the responses back to the patient apps.

The gateway will also take care of end point registries, key management, tokenization, etc. Upon the completion of this process, patient apps will be able to connect directly with the HSP for the service without having to go through the gateway.

With the centralized registries providing a digital ID and the ability to e-sign, any provider or practitioner will be able to access a digital platform to provide teleconsultation services. The gateway will also develop metrics that will help monitor the quality of care across teleconsultations and ensure that patients can find the right quality of care.

With full interoperability at play, telemedicine platforms will compete on stitching enhanced end-to-end experiences for the users and providing better clinical care.  

6 Health Data Analytics: Over the medium to long-term, as the ecosystem starts adopting digital platforms for care delivery, there will be significant amount of data generated which previously was limited and available only in silos. NDHM’s envisioned health data analytics platform will allow studies on the aggregated and anonymized data sets that can in turn be leveraged in several ways.

  • Firstly, it will enable the creation of improved policies and better disease control programs.
  • Secondly, it will allow for improved monitoring of clinical and non-clinical operational KPIs, thereby ensuring accountability across stakeholders.
  • Thirdly, it will create new opportunities for research and clinical advancements based on Indian demographics for which so far, our country has primarily relied on western countries.

Implications of health ODE

The FICCI-BCG report on “Leapfrogging to a Digital Healthcare System: Re-imagining Healthcare for Every Indian” concludes and infers that the advent of a health ODE will have immense implications upon all stakeholders in the healthcare sector.

The analysts and the contributors foresee potential threats to some of the existing business models and strategies, the creation of new opportunities, market expansion with the entry of new players, as well as a change in the roles and dynamics of all stakeholders.

AUTHOR

Anusha Ashwin

While with CyberMedia, I have worked for  BioSpectrum magazine, Voice&Data – India’s foremost business magazine in the telecom vertical that has been instrumental in bridging the gaps in India’s communications sector.

While being part of Voice&Data as a Consulting Editor, I also had the opportunity to cater content to the Association of Biotech Led Enterprises (ABLE).

I consider my career to take a solid shape during this phase, as I set shot to work in times of the digital era. Today, I am able to resonate on the demands of writing content tailored to meet the requirements of the new age consumer that is driven by SEO and SEM.

The blessing here is that, through the writings I am on a constant self-discovery mode. I have found a passion, which is writing in focus on digital healthcare, communication tech startups, and health-tech entrepreneurs. Somewhere down me, there is this strong educational foundation in Microbiology and Biotechnology that had to play a part!

As India becomes more Atmanirbhar, I am destined to stay focussed in aligning my content contribution passion with Digital India plans, where I interact with numerous startup entrepreneurs and other organizations that are going to be part of the ambitious Make in India and Make for India programs.

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