Modi’s push for digitisation of citizen health records: What does it mean

Aditi Tandon

Tribune News Service

New Delhi, August 15

Prime Minister Narendra Modi’s Digital Health Mission push involves an ambitious

government plan to digitise health records of all Indians by 2022.

The mission structure will flow from a plan drafted last year by the National Institute for Transforming India which provides for the creation of a national digital health framework usable by the Centre and the states across government and private sectors, a framework resting on two pillars — national health registry and personal health records of citizens.

Titled “National Health Stack: Strategy and Approach”, the paper’s objective is articulated by VK Paul, member (Health), NITI Aayog, says: “The National Health Stack (NHS) 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 poised for rapid, disruptive changes and unforeseen twists. It is now conceivable to aim for digital health records for all citizens by the year 2022.”

The Aayog says the immediate use of NHS is to provide financial protection of Rs 5 lakh annually to 10.74 crore poor families under the Prime Minister’s Jan Aarogya Yojna, adding that it would gradually go beyond the NHPS to enable healthcare provision and data sharing digitally.

The mission proposes National Health Electronic Registries “to create a single source of health information and manage master health data of the nation” and personal health records to allow “consent-based flow of citizens’ health records to stakeholders who require this data to deliver value-added services to the user”.

Another pillar of the NHS is Personal Health Records (PHR) of health users to be stored, as explained on Saturday by the Prime Minister, who said the digital health card or citizens would contain all health-related information and would reduce physical interface with the help from digital technologies.

“Personal Health Record refers to the integrated view of all data related to an individual across various health providers, comprising his medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics such as age and weight, demographics and billing information, and multiple health applications. Because health data is sensitive, the design and implementation must ensure the right level of privacy and security for health data, thus, the PHR is maintained in a secure and private environment, with the individual determining rights of access,” says the paper which is the basis for the Digital Health Mission.

Personal data privacy is proposed to be ensured through health data fiduciaries (trustees) that will facilitate consent-driven interaction between entities generating health data and those wanting to consume data for better service delivery.

The document reads: “The NHS design is geared to generate vast amounts of data resulting in some of the largest health databases with secured aggregated data that will put India at the forefront of medical research in the world.”

About the paper, VK Paul says: “Various layers of the NHS will seamlessly link to support national health electronic registries, a coverage and claims platform, a federated personal health records framework, a national health analytics platform and other horizontal components. The stack will embrace health management systems of public health programs and socio-demographic data systems. The population-level base of such an IT system would be individual health record logged through the health and wellness centres in rural areas and corresponding primary health care in urban areas.”

Under the NHS, NITI Aayog proposes unique digital health IDs for everyone who registers and also electronic registries of healthcare providers (hospitals, clinics, labs), beneficiaries, doctors, insurers and ASHAs.

The paper also reads: “All registries will have open Application Programming Interfaces for publishing and consent-based access by authorised entities.”

Niti Ayog’s consultation paper on National Health Stack on privacy

“Data privacy is important and will be a critical part of the design of the Stack. All data access must be through API calls to ensure centralized management of security controls. Direct access will be prohibited for internal modules. Sensitive health data about individuals will be encrypted at rest. Tools to enable breach investigations will be present.”

Proposed to be stored

Personal health records of users — their medical history, medication and allergies, immunisation status, laboratory test results, radiology images, vital signs, personal statistics such as age and weight, demographics and billing information.

Benefits cited for people

• Improved affordability of health services through justified pricing, instant adjudication and on-time payment of claims
• Increased access and availability of service providers through “faster adjudication of claims feature” for service providers

Benefits cited for government

• Potentially place India at the forefront of medical research globally as the design is geared to generate vast amounts of data resulting in some of the largest health databases with secured anonymised aggregated data
• Adopt data-driven policymaking through real-time analytics
• Reduce the cost of healthcare through improved fraud detection

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