With the launch last year of Ayushman Bharat, the world’s largest state-funded health insurance programme, and the slow but certain progress towards Universal Health Coverage (UHC), the challenge of making quality and affordable healthcare accessible to every one of India’s 135 crore citizens has acquired an altogether new dimension. Effective use of technology is critical to this project — this is where the National Health Stack and its rulebook of sorts, the National Digital Health Blueprint, drawn up by a committee led by the former UIDAI chairman and Communications and I-T secretary J Satyanarayana, comes in. The Committee submitted its final report to Health Minister Harsh Vardhan last week.
So, what is the National Health Stack (NHS)?
Unveiled by the NITI Aayog last year, NHS is digital infrastructure built with the aim of making the health insurance system more transparent and robust, while factoring in the uniqueness of India’s health sector, and the political realities of federalism. There are five components of NHS:
*An electronic national health registry that would serve as a single source of health data for the nation;
* a coverage and claims platform that would serve as the building blocks for large health protection schemes, allow for the horizontal and vertical expansion of schemes like Ayushman Bharat by states, and enable a robust system of fraud detection;
* a federated personal health records (PHR) framework that would serve the twin purposes of access to their own health data by patients, and the availability of health data for medical research, which is critical for advancing the understanding of human health;
* a national health analytics platform that would provide a holistic view combining information on multiple health initiatives, and feed into smart policymaking, for instance, through improved predictive analytics; and
* other horizontal components including a unique digital health ID, health data dictionaries and supply chain management for drugs, payment gateways, etc., shared across all health programmes.
And what is the National Digital Health Blueprint (NDHB)?
The NDHB is the architectural document for the implementation of the NHS. Its vision is “to create a national digital health ecosystem that supports universal health coverage in an efficient, accessible, inclusive, affordable, timely and safe manner, through provision of a wide range of data, information, and infrastructure services, duly leveraging open, interoperable, standards-based digital systems, and ensuring the security, confidentiality and privacy of health-related personal information”. The key features of the blueprint include a federated architecture, a set of architectural principles, a five-layered system of architectural building blocks, a unique health ID (UHID), privacy and consent management, national portability, electronic health records, applicable standards and regulations, health analytics and, above all, multiple access channels like call centres, Digital Health India portal, and the MyHealth app. A total of 23 such building blocks have been identified in the blueprint for the NHS to become a viable reality. NDHB recognises the need to establish a specialised organisation, called the National Digital Health Mission (NDHM) that can drive the implementation of the blueprint, and promote and facilitate the evolution of a national digital health ecosystem.
But why is the NHS necessary?
Currently, apart from Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana, there are many secondary and tertiary care schemes running in the states — such as Swasthya Sathi in West Bengal, Aarogyasri in Telangana, Chief Minister’s Comprehensive Health Insurance Scheme in Tamil Nadu, Mahatma Jyotiba Phule Jan Arogya Yojana in Maharashtra, etc. West Bengal has opted out of Ayushman Bharat, and Telangana and Odisha have never been a part of the scheme. Also, there is an urgent need for integration of the two arms of Ayushman Bharat — health and wellness centres which constitute the primary care arm, and PMJAY, which is the secondary and tertiary care arm under which the target is to provide 10.74 crore families with an annual health cover of Rs 5 lakh each. Without integration, the goal of continuum of care cannot be met — and that would mean PMJAY might end up becoming a perpetual drain on resources. Hence, the need for a common digital language for the operationalisation and inter-operability of various health schemes, which the NHS seeks to provide.
Is all the data going to be safe/secure?
One of the biggest concerns following the high-profile rollout of Ayushman Bharat has been regarding data security and privacy of patients. The concerns were aggravated after an Assam minister and a senior official of the National Health Authority posted patient details on Twitter. More than a year after the Justice Srikrishna Committee prepared a draft data privacy law, there has been little meaningful movement on it. Critics have argued that in the backdrop of the Supreme Court’s privacy judgment, the data privacy law should ideally have preceded the implementation of Ayushman Bharat. The NDHB says: “The consent of the citizen plays a major role in ensuring that collection of data is done in a manner consistent with legal rights… It is also important to ensure that… the data captured is used and disclosed (in an identifiable or anonymised shape) in a manner appropriate in law and preserving the citizen-directed constraints.”