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Doctors often have to make crucial decisions for their patients with very little information. Patients and their family members can only provide as much information as they can remember in the moment, and many times they might not be aware enough to give a detailed medical history. For starters, this can lead to misdiagnosis as the doctor does not have a full picture of the patient’s past complaints and treatments. At the worst, it can cause life threatening complications if an inappropriate treatment is prescribed. Further, it can be difficult for doctors to relay information to each other in case of change of health care providers or referrals to specialist. On the 74th anniversary of India’s independence this year, Prime Minister Narendra Modi announced the launch of a National health ID for each and every citizen. This proposed health ID would contain all the information regarding the patient’s medical history regarding prescriptions, diagnostic reports, as well as previous hospital stays and discharge records. The NDHM carries the potential of playing an instrumental role in revolutionizing the healthcare ecosystem in India. This article tells how.
The national health ID is part of the plan to implement the National Digital Health Mission, which can be seen as phase-II to ensure universal and quality health coverage to all citizens, after the launch of Ayushman Bharat in 2018.
It holds promise in making it easier for patients to find doctors in different locations, helping them in seeking appointments, and saving them the trouble of visiting multiple doctors in search of treatments. It is easy to dismiss the idea when one lives in a stable location and regularly sees the same family doctor. However, now more than ever, due to the COVID-19 pandemic, we are seeing that the population that suffers the most from a lack of proper access to healthcare are the underprivileged, including migrant workers. Digitizing healthcare would allow them to be able to obtain their health records anywhere in the country. It would also enable patients in far flung areas to telemedically engage with the doctors, saving them the unnecessary expense and mental stress of travel .
There are plenty of benefits to the health care providers as well. It allows for better access to healthcare information in the form of medical history, lab investigation reports, comorbidity and so on. More data means healthcare providers can make well informed choices regarding disease management. Further, they get a clearer picture about the effectiveness of the ongoing treatment and plan future course of action accordingly.
One of the common complaints from patients is the endless cycles of repeating the same tests when a patient is referred to another doctor or a new hospital. The healthcare providers, on their part, are just trying to cover all bases to avoid mistakes and medico-legal backlash due to incorrect diagnosis or mistreatment. However, the patient often feels taken advantage of by the system, especially when the lab investigations are expensive, such as CT and MRI scans. While this may be inevitable in some cases, it can be avoided if medical records are shared clearly and in entirety.
Hence, interoperable digital health records will enable better doctor-patient relationships as the patients need not go through the frustration of repeated tests and interventions. The Government plans to eventually roll out the following:
The combination of the above systems hopes to take steps in reducing the inequality in healthcare coverage of various populations throughout the country. It is a push in the direction of more democratic and universal health coverage . Further, with decrease in unnecessary interventions, and provision for remote care, it will cut down on costs for the patients. Macro level healthcare data will also enable greater preventative care, which can reduce the disease burden and channelize public health expenditure where it is required the most.
Due to the poor digital literacy as well as lack of internet access in remote areas of the country, it won’t be easy to execute this ambitious program nationwide. In 2005, England’s National Health Service (NHS) attempted a similar task. However, due to technical challenges and data security concerns, they had to shelve the plan. In India, with a larger and more diverse population clubbed with strained resources, there is hesitancy in investment at such a large scale.
Data privacy concern is another aspect to which proper attention must be given. With sensitive health data accessible from a single platform, there are apprehensions regarding hacking and possible misuse of the information. Currently, the health ID is optional, so individuals can take their own call regarding the risks and benefits of the program. But, this might change with a top-down regulatory push. In terms of building trust and confidence in the program, the government has it job cut out. As per reports, third-party apps will also be OTP protected and only data that the patient needs to share with the concerned doctor will be relayed, which should help .
As we are not the first country to go through this ambitious plan, we must learn from the mistakes of others. Anyone in India can see the change that has swept the nation through the last decade. At the beginning of the century, only a privileged few had basic internet access. From 2015 to 2018, we have seen more than twofold increase in smartphone users in rural India, and the number is expected to increase to 820 million by 2022. The Pradhan Mantri Grameen Digital Saksharta Abhiyan is one of the largest campaigns to promote digital literacy. They plan to train 6 crore rural adults. The benefits of this change is multiplied with the push from the government to make apps in furthering education as well as healthcare among countless other services. For example, Arogya Setu has allowed the government to reach 13 crore citizens in response to the COVID-19 pandemic. Our diverse population should be considered an advantage and challenges to be overcome. We have smart minds to come together and innovate in terms of technology.
The next 18-24 months are a crucial test for the government, healthcare providers and tech companies to join hands and solve this complex equation, the importance of which cannot be overstated.