Cabinet approves implementation of Ayushman Bharat Digital Mission
Part of: GS-Prelims and GS-2:
In News: The Union Cabinet has approved the national roll-out of Central Sector Scheme, Ayushman Bharat Digital Mission (ABDM) of Ministry of Health and Family Welfare, Government of India, with a budget of Rs.1,600 crore for five years.
The National Health Authority (NHA) will be the implementing agency of Ayushman Bharat Digital Mission (ABDM).
Based on the foundations laid down in the form of Jan Dhan, Aadhaar and Mobile (JAM) trinity and other digital initiatives of the government, Ayushman Bharat Digital Mission (ABDM) is creating a seamless online platform through the provision of a wide-range of data, information and infrastructure services, duly leveraging open, interoperable, standards-based digital systems while ensuring the security, confidentiality and privacy of health-related personal information.
Digital health solutions across healthcare ecosystem have proven to be of immense benefit over the years, with CoWIN, Arogya Setu and eSanjeevani further demonstrating the role technology can play in enabling access to healthcare. However, there is a need to integrate such solutions for continuum of care, and effective utilization of resources.
Under the ABDM, citizens will be able to create their ABHA (Ayushman Bharat Health Account) numbers, to which their digital health records can be linked. This will enable creation of longitudinal health records for individuals across various healthcare providers, and improve clinical decision making by healthcare providers.
The mission will improve equitable access to quality healthcare by encouraging use of technologies such as telemedicine and enabling national portability of health services.
The growing need to introduce electronic health records
In the current form, ABDM lays little emphasis on the use of this health data by the public health research community.
Electronic health records are most useful to public health research. In the absence of electronic health records, data for public health research studies is usually collected by public health agencies or research institutes as part of an ongoing or new study.
This requires time to plan the study, recruit participants, and train field staff before the actual data collection.
To facilitate longitudinal analysis, such data collection also needs to be carried out at pre-decided future intervals that could be months or years apart.
The limitations to this include high cost and lengthy durations of time. Having access to pre-collected data will address both these limitations. Most importantly, data from the health ID is likely to be more complete as compared to most hospital records in India, which comprise of paper prescriptions or manual register entries.
The COVID-19 pandemic has made it clear that to obtain evidence-based findings real-world data needs to be available. While there is no doubt that with prior health records, a doctor or physician can flag the severity of COVID-19 for someone who has a history of diabetes or blood pressure, the reverse of this is also true.
Using medical history and disease end-point data, unknown risk factors of the disease can also be identified. This would require that electronic health records be made available and supplemented with additional information of the patient such as lifestyle.
For western countries, electronic health records are maintained at the hospital level, and they commonly store responses to basic lifestyle questions as part of the patient’s health record.
Technological Infrastructure
The involved digital infrastructure for storage and accessing this data will be built on the National Health Stack.
The stack is a collection of pre-written code (or commonly referred to as APIs) specific to interface with the ABDM system.
This will be one platform where those interested (and approved) file for insurance claims, can perform analytics in addition to storing individual health data and hosting the repository of various medical agencies.
This health stack will also integrate with payment gateways.
Currently, around 14 crore users have enrolled for a health ID with the ABDM and the programme has been piloted for a year in six union territories in India.
What are the challenges?
Although ABDM is visionary and can be the much-needed digital intervention to improve healthcare access in India, its implementation and overall objectives need more thought. There are some issues that can be foreseen. These include patient-physician trust, technological challenges, and data protection.
Public Trust: In instances where remote or specialised consultation is being sought, a new physician or a doctor will need to gain the patient’s trust for obtaining consent of the patient to share their electronic health records.
Internet Connectivity Problems: The public sector IT systems lack faster internet speed, robust websites, and lags in providing a seamless user experience. For a country where rates of computer illiteracy are high, interfaces need to be kept simple and should be more user friendly.
Training Personnel in Rural Areas: There is the issue of citizens living in rural areas accessing such a facility digitally. These citizens would need to rely on their treating doctor or physician, who is local to them, to register them for the health ID.
This treating doctor or physician would also need to be trained in dealing with patients’ personal details and, most importantly, the fact that enrollment into the ABDM Health ID is voluntary, and not mandatory.
Explanation on how the system works and the involved intricacies would also need to be communicated to allow citizens, especially in rural areas, to make an informed decision.
Data protection: In the absence of data protection laws, both storage of one’s health data and its use will need to be governed by well laid down rules, even if there is consent by the individual/patient.
Currently, there is a Data Empowerment and Protection Architecture (DEPA) drafted by the NITI Aayog in 2020 to govern access of such data by public and private agencies.
For ABDM, the DEPA entails that if the individual/patient provides consent then their data can be shared to the agency requesting access.
Granting of ‘consent’ to a doctor or any other involved agency such as insurance companies should not mean that the data can be used for any other purpose than what the consent was granted for or be stored by them locally.
Informed Consent: ABDM claims that the individual is at liberty to deny consent in sharing their data; however, this may lead to some penalisation of the individuals who do not provide consent. For example, an insurance company may incentivise those who consent to share their electronic health data and make processes more rigid for those who do not.
Additionally, in some cases, consent may be sought from the organisation and not the individual. This would bypass individual consent for each request and needs another set of data governing rules, which are well-advertised and explained to the individual providing consent.
