Huge idea, weak links

Digital Health

By Dr Oishee Mukherjee

Prime Minister Modi launched the Ayushman Bharat Digital Mission (ABDM) last month, which is envisaged as a complete digital health ecosystem with a health ID for every citizen, digitised personal health records, as well as registry of doctors and health facilities across the country. Though Modi said the digital mission will play a big role in eliminating problems in providing medical treatment to the poor and the middle class, the question remains how much of the country is digitised and what percentage of the population is likely to benefit.
The ABDM launched on 27 September aims to develop the backbone necessary to support the integrated digital health infrastructure of the country. It is expected to bridge the existing gap amongst different stakeholders of Healthcare ecosystem through digital highways. The Mission it is said will connect the digital health solutions of hospitals across the country with each other; it will not only make the processes of hospitals simplified but also increase ease of living. The Digital Ecosystem will also enable a host of other facilities like Digital Consultation, Consent of patients in letting medical practitioners access their records, etc. With the implementation of this scheme, old medical records cannot get lost as every record will be stored digitally.
Simply put, people will be provided with the digital ID, which will contain health records of the person and enable inter-operationability within the digital health system. Any public hospital, community health centre or health and wellness centre across the country or any healthcare provider included in the health infrastructure registry, will be able to support an individual in obtaining a health ID. Patients can also obtain a health ID by self-registration from a mobile or web registration.
However, the reality is that 90 percent of hospitals in developing countries, including India, do not have Electronic Medical Records (EMR). Obviously, EMR will help document real-time events happening around a patient, inside the hospital with seamless movement of data between patients, technicians and doctors on a mobile platform. Doctors are under tremendous pressure due to the fear of possible human error, which can adversely affect a patient’s life.
More than anything else, well-designed intuitive EMR built with inputs from the doctor community is expected to open the door for Indian digital health start-ups to dominate the global digital health industry. Data analytics will build clinical decision support systems on EMRs, which will suggest alternative diagnosis based on the patient’s condition virtually like offering second options from senior doctors. Quackery it is believed will be abolished since only registered doctors will be allowed to prescribe medication on digital prescription pads.
The Unified Health Interface (UHI) by the Mission should help India leapfrog into a new realm of digital health services. Today UPI is used to pay anyone, but now it is envisaged that through this app one can connect with any doctor, book an appointment, make payment, share health records and get the prescription added to health records. The Mission announced it will set the digital standards for health claims processing. Meanwhile, with health insurance moving from covering just in-patient incidents to comprehensive outpatient care, India possibly requires a new health claims exchange that can bring greater transparency and new auto adjudication technology.
But though all this appears quite impressive, the most important question that arises is to identify the priority and take necessary action in this regard. No doubt this step would bring healthcare to the doorstep of the upper and middle classes, but what will happen to the poor and economically weaker sections for whom digitisation has no meaning. One may mention here that various surveys reveal that online education has not helped the rural masses as they do not have basic internet connection.
In such a situation, the priority is obviously to create more rural health centres and block level hospitals and ensure that an adequate number of doctors and nurses are posted. This means that resources for the health sector has to be significantly increased. Also the private sector should be persuaded to set up not nursing homes but charitable hospitals in backward blocks and sub-divisions of the country.
While the Constitution doesn’t explicitly recognise health as a fundamental right, our judiciary and a large majority of people see healthcare as a right and doctors as performing the hallowed duty of saving lives. But 70 per cent of patient care in our country today is handled by private hospitals, which have a reputation of having and making profit as their main motive. The problem is not with privatisation per se, but how healthcare has become a seller’s market in India.
It is thus not surprising that private hospitals are increasingly being questioned by our courts. On July 27, the Supreme Court issued notices to the Centre and all State governments on a PIL that alleged that private hospitals were fleecing patients. Again on July 19, the apex court, while hearing a case about fire safety in hospitals in Gujarat stated: “These hospitals have become like a huge real estate industry instead of serving the cause of humanity in the face of human tragedy”. The underlying message is clear – healthcare’s sole motive cannot be profit. Besides, at least 10 different State governments across the country have capped Covid-19 treatment rates at private hospitals, often after being prompted by high courts.
It is indeed a shame that we spend 1.3 percent of our GDP on healthcare. India’s population grew by more than 13% between 2011 and 2020 but governments, both state and Centre, spent less than 1 percent of healthcare during that period. The Human Development Report 2020 stated India has just five beds per 10,000 people, ranking 155th among 167 countries in bed availability. Even Bangladesh has eight beds per 10,000 people.
Thus, while modernisation and digitisation of the system is, no doubt necessary, to meet global standards and attract people from neighbouring countries to avail facilities here, the focus has to be on upgrading the health care system in rural India. The dichotomy in health care between metros and big towns and backward districts cannot continue. To start with, the so-called aspirational districts may be singled out for revamping the rural health centres and upgrading facilities at the block levels with equipment, doctors and support staff and with the Mission in mind internet connectivity.
One should not forget the fact that the country lives in villages and the huge population there has a right to get the same facility as their urban counterparts. Voices are being raised to make health a fundamental right and the government cannot ignore this any longer. Education has already got the status of a fundamental right and health should also be given this Constitutional status.
The government must remember that it’s not enough to launch missions, but do its homework well so that it turns out to be success. Time will tell, whether this National Digital Health Eco-system will, despite practical difficulties, achieve its target, or close to it i.e. to support Universal Health Coverage in an efficient, accessible, inclusive, affordable, timely, and safe manner. — INFA