Why is this initiative significant?

As the Prime Minister highlighted , the initiative has the potential to “increase the ease of living” along with “simplifying the procedures in hospitals”.

At present, the use of digital health ID in hospitals is currently limited to only one hospital or to a single group, and mostly concentrated in large private chains. The new initiative will bring the entire ecosystem on a single platform.

For instance, if a patient is getting treated at AIIMS, Delhi, and wants to move to another hospital in a different city, and if that hospital is also on the centralised ecosystem, the patient does not have to carry physical health records or files of several years of treatment, as the medical history is readily available.

The system also makes it easier to find doctors and specialists nearest to you. Currently, many patients rely on recommendations from family and friends for medical consultation, but now the new platform will tell the patient who to reach out to, and who is the nearest. Also, labs and drug stores will be easily identified for better tests using the new platform.

When this project was announced?

The pilot project of the Mission had been announced by the Prime Minister from the ramparts of the Red Fort on 15th August 2020. Personal health Records is a simple self-declared username, which the beneficiary is required to sign into a Health Information Exchange and Consent Manager (HIE-CM). Each health ID will require linkage to a consent manager to enable sharing of health records data.

An HIE-CM is an application that enables sharing and linking of personal health records for a user. At present, one can use the health ID to sign up on the HIE-CM; the National Health Authority (NHA), however, says multiple consent managers are likely to be available for patients to choose from in the near future. Currently, ABDM supports health ID creation via mobile or Aadhaar. The official website states that ABDM will soon roll out features that will support health ID creation with a PAN card or a driving licence. For health ID creation through mobile or Aadhaar, the beneficiary will be asked to share details on name, year of birth, gender, address, mobile number/Aadhaar.

If the beneficiary chooses the option of using her Aadhaar number, an OTP will be sent to the mobile number linked to the Aadhaar. However, if she has not linked it to her mobile, the beneficiary has to visit the nearest facility and opt for biometric authentication using Aadhaar number. After successful authentication, she will get her health ID at the participating facility. The NHA says ABDM does not store any of the beneficiary health records. The records are stored with healthcare information providers as per their “retention policies”, and are “shared” over the ABDM network “with encryption mechanisms” only after the beneficiary express consent.

Where this project was first enrolled?

The project is being implemented in the pilot phase in six States & Union Territories.

Features of the Mission:

Health ID:It will be issued for every citizen that will also work as their health account. This health account will contain details of every test, every disease, the doctors visited, the medicines taken and the diagnosis. Health ID is free of cost, voluntary. It will help in doing analysis of health data and lead to better planning, budgeting and implementation for health programs.

Healthcare Facilities & Professionals’ Registry: The other major component of the programme is creating a Healthcare Professionals’ Registry (HPR) and Healthcare Facilities Registry (HFR), allowing easy electronic access to medical professionals and health infrastructure. The HPR will be a comprehensive repository of all healthcare professionals involved in delivering healthcare services across both modern and traditional systems of medicine. The HFR database will have records of all the country’s health facilities.

Ayushman Bharat Digital Mission Sandbox: The Sandbox, created as a part of the mission, will act as a framework for technology and product testing that will help organisations, including private players intending to be a part of the national digital health ecosystem become a Health Information Provider or Health Information User or efficiently link with building blocks of Ayushman Bharat Digital Mission.

Who is the implementing agency?

National Health Authority (NHA) under the Ministry of Health and Family Welfare is the implementing agency.

NHA

• National Health Authority (NHA) is the apex body responsible for implementing India’s flagship public health insurance/assurance scheme called “Ayushman Bharat Pradhan Mantri Jan Arogya Yojana” & has been entrusted with the role of designing strategy, building technological infrastructure and implementation of “Ayushman Bharat Digital Mission” to create a National Digital Health Eco-system.
• National Health Authority is the successor of the National Health Agency, which was functioning as a registered society since 23rd May, 2018. Pursuant to Cabinet decision for full functional autonomy, National Health Agency was reconstituted as the National Health Authority on 2nd January 2019.
• NHA has been set-up to implement PM-JAY, as it is popularly known, at the national level. An attached office of the Ministry of Health and Family Welfare with full functional autonomy, NHA is governed by a Governing Board chaired by the Union Minister for Health and Family Welfare. It is headed by a Chief Executive Officer (CEO), an officer of the rank of Secretary to the Government of India, who manages its affairs. The CEO is the Ex-Office Member Secretary of the Governing Board.
• To implement the scheme at the State level, State Health Agencies (SHAs) in the form of a society/trust have been set up by respective States. SHAs have full operational autonomy over the implementation of the scheme in the State including extending the coverage to non SECC beneficiaries.
• NHA is leading the implementation for Ayushman Bharat Digital Mission ABDM in coordination with different ministries/departments of the Government of India, State Governments, and private sector/civil society organizations.

Expected Benefits:

• Ensure ease of doing business for doctors and hospitals and healthcare service providers.
• Enable access and exchange of longitudinal health records of citizens with their consent.
• Create integration within the digital health ecosystem, similar to the role played by the Unified Payments Interface (UPI) in revolutionising payments.
• The initiative, will “increase the ease of living” along with “simplifying the procedures in hospitals”. “At present, the use of technology in hospitals is currently limited to only one hospital or to a single group… The entire ecosystem related to treatment and healthcare policy-making is going to become more effective with this modern platform.
• Doctors and hospitals will be able to use this platform to provide remote health service. “With effective and reliable data, this will improve treatment and also save patients.
• Through the digital health ID, the patient himself and the doctor can also check old records if needed. Not only this, there will also be registration of colleagues like doctors, nurses, paramedics. The hospitals, clinics, labs, medicine shops in the country, all these will be registered.
• The initiative will create a seamless online platform to access treatment records, and enable faster and effective treatment.
• We often see that many people do not have their medical records at the time of going to the hospital. In such a situation, the medical consultation, investigation has to be started from absolute zero, it has to be started afresh. Due to the lack of medical history records, it also takes more time and increases the cost and sometimes the treatment becomes contradictory.
• The initiative is designed to benefit the poor and middle class, specifically in finding the right doctor and a hospital.
• Doctors don’t advertise themselves in the newspapers. Only after someone visits a doctor, we hear that a doctor is good. However, with this initiative, information on doctors will reach everyone; it will tell you about doctors who are knowledgeable about a speciality; it will tell you who to reach out to; who is the nearest, where you can reach at the earliest.
• It would be easy for the patient to find a doctor anywhere in the country who knows and understands his language and is experienced in the best treatment of his disease. This will increase the convenience of patients to contact specialist doctors present in any corner of the country. Not only doctors, but labs and drug stores will also be easily identified for better tests,

Concerns:

• The lack of a data protection bill could lead to the misuse of data by private firms and bad actors.
• Exclusion of citizens and denied healthcare due to faults in the system are also a cause of concern.

How do private players get associated with a government digital ID?

The NHA has launched the NDHM Sandbox: a digital architecture that allows helps private players to be part of the National Digital Health Ecosystem as health information providers or health information users. The private player sends a request to NHA to test its system with the Sandbox environment. The NHA then gives the private player a key to access the Sandbox environment and the health ID application programming interface (API). The private player then has to create a Sandbox health ID, integrate its software with the API; and register the software to test link records and process health data consent requests. Once the system is tested, the system will ask for a demo to the NHA to move forward. After a successful demo, the NHA certifies and empanels the private hospital.

The beneficiary can create a health ID for her child, and digital health records right from birth. Third, she can add a nominee to access her health ID and view or help manage the personal health records. Also, there will be much inclusive access, with the health ID available to people who don’t have phones, using assisted methods.

Deletion of Health ID

• Two options are available: a user can permanently delete or temporarily deactivate her health ID.
• On deletion, the unique health ID will be permanently deleted, along with all demographic details. The beneficiary will not be able to retrieve any information tagged to that health ID in the future, and will never be able to access ABDM applications or any health records over the ABDM network with the deleted ID.
• On deactivation, the beneficiary will lose access to all ABDM applications only for the period of deactivation. Until she reactivates her health ID, she will not be able to share the ID at any health facility or share health records over the ABDM network.