The launch of the Ayushman Bharat Digital Mission (ABDM) by the Prime Minister, Shri Narendra Modi, on 27th September 2021, opens multiple avenues for innovation in the healthcare space of the country. As one of the more promising ones among them, let us look at the Health ID, a core building block of National Digital Health Mission (NDHM) and how this idea of digitizing and connecting health solutions has the potential to disrupt the entire healthcare ecosystem of the country.

About Health ID

Health ID is a unique 14-digit health identification number for every citizen that will double up as his or her health account, i.e., a repository of all health-related information of a person. An individual can create a secure Health ID, which allows them to securely access and manage their health data digitally. Such health data, with consent, can be shared with participating healthcare providers and payers. A Health ID can be created using a mobile phone number or an Aadhaar number. Thereafter, one needs to set up a PHR (Personal Health Record) address for consent management, and subsequent sharing of health records. Health ID enables individuals’ interaction with participating healthcare providers and allows them to receive digital lab reports, prescriptions, and diagnosis seamlessly from verified healthcare professionals and health service providers.

Features of Health ID

1. Easy Signup. The health ID can be easily created with basic information using an Aadhaar or mobile phone number.

2. Digital Health Records. Facility to access all the healthcare information in a paperless manner.

3. Voluntary Opt-in & Opt-out.

4. Personal Health Records. Access and link Personal Health Records (PHR) with a Health ID to create a longitudinal health history.

5. Consent-Based Access. Access to an individual’s health data is provided after clear and informed consent. The individual has the ability to manage and revoke consent if needed.

6. Access to doctors. Easy access to verified doctors across the country.

7. Secure & Private. Built with robust security and encryption mechanisms; no information is shared without the individual’s consent.

8. Child Health ID. Start with a Child Health ID and create digital health records from birth.

9. Add a nominee. Add nominee to access an individual’s Health ID and view or help manage the records.

10. Inclusive Access. Available to people with smartphones, feature phones, and even no phones using assisted methods.

Currently, over one lakh unique Health IDs have been created under the National Digital Health Mission (NDHM), which was initially launched across six states and Union territories on a pilot basis on 15 August 2020

Health ID will be connected to:

1. NDHM health records app

2. Health Management Information System (HMIS)

3. Telemedicine

4. E-pharmacy

The ID will be broadly used for three purposes: unique identification, authentication, and threading of the beneficiary’s health records, only with their informed consent, across multiple systems and stakeholders.

How does it work?

Health ID Health Information Provider (HIP) Public Health Program Doctors/Hospitals Diagnostic Centers Pharmacy Health-Lockers Health Information Users (HIU) Public Health Program Doctors/Hospitals PHR Applications Medical Researchers Insurers

How can existing startups benefit from this?

I. Teleconsultation

1. Ram who is suffering from lifestyle diseases such as diabetes and hypertension has created a Health ID and has uploaded all the relevant details — every test undergone and its reports, doctors visited, diagnoses, treatment plans, medications prescribed, and other related information.

2. He has now moved to a different city and is unaware of doctors/healthcare centers of the city and thus opts for virtual consultation through a suitable platform.

3. Consultation platforms (such as Practo) provide a list of expert consultants and their ratings on the basis of which an individual can choose one among them.

4. The history and other relevant details of Ram which are already recorded in his Health ID can now be shared with consent to a new consultant.

5. The consultant may ask for Ram’s advanced lab reports.

6. Ram will automatically get the recommendations of nearby pathology laboratories.

7. Ram can choose one of the laboratories and request for sample collection.

8. After the process, the generated reports are uploaded directly to Ram’s Health ID and the same can be shared with consent to the respective consultant.

9. The consultant can prescribe medications, which is again created/saved in Ram’s Health ID and shared with consent to the pharmacy.

10. The Online Pharmacy delivers the prescribed medicine at the doorsteps and payment is done virtually.

11. Ram may be asked to monitor his vital parameters on a regular basis. He can measure through these remote monitoring devices (such as wearables like Ten3t, HealthSensei, and Cooey) and save it in his Health ID which can later be shared with consent during the following-up.

12. If Ram is suggested for home care by a physiotherapist, a nearby physiotherapist can be suggested, who can then provide the exercise regime online/offline to Ram, which in turn can be recorded in the Health ID.

13. The invoices generated by consultants, path labs and pharmacy can be saved in Health ID and can be shared with consent to claim the reimbursements from the insurer/employer or wherever required.

In this way, the data is generated and managed virtually and the entire healthcare chain can be streamlined digitally and save time and effort. The startups such as Ten3t, HealthSensei, Cooey, etc. that are into remote monitoring in the above chain can play the role of Health Information Provider (HIP) by adopting Electronic Medical Record (EMR) software that is certified to be compliant with NDHM standards. Other telemedicine or online pharmacy startups such as Practo, DocsApp, Pharmeasy, NetMeds, etc. can play the role of Health Information User (HIU) who would access the health records of a user to provide the services.

Startups/companies can also utilize the NDHM Sandbox that allows technologies or products to be tested in the contained environment in compliance with NDHM standards and judge the consumer and market reactions to the same. This will help organizations intending to be a part of the National Digital Health ecosystem to become a HIP or HIU or efficiently link with building blocks of NDHM.

II. Available Opportunities

A. Merging these technologies to contribute as Health Information Provider (HIP).

1. Device Manufacturing Startups: With innovations possible in simple, handheld devices provided with cloud connectivity, a patient can carry out a diagnostic test at home, providing the doctor with the right diagnostic information to make treatment decisions in real-time. For the management of chronic diseases such as heart disease, thyroid monitoring, diabetes monitoring, cancer therapy, warfarin monitoring, etc., such tests may be shifted completely to the home diagnostics segment with device-level innovations.

2. Technology for sharing of Web-based image viewing and management:

a) Image sharing, collaboration, and storage security;

b) Pan, zoom, annotate, generate reports;

c) User authentication and “role-enabled” access;

d) Image analysis plugin available.

B. Startups or companies that can contribute as Health Information Users (HIU).

III. For Hospitalization

1. An individual experiences chest pain and immediately calls for ambulance support.

2. The patient’s relative/nominee can easily share all the information saved in a Health ID to the respective emergency care provider (doctor/nurse).

USE CASE 1

1. During their treatment at the hospital, a strict schedule including regular lab tests and administration of drugs/injections is to be followed.

2. A calendar/logbook/register kind of technology can be built which can accommodate the requirements of patient as well as nurse/care provider as follows:

a. Patient: Schedules, reminders, timely vital parameters (pulse rate, blood pressure, sugar levels, etc.)

b. Nurse/Care provider: Electronic documentation of problems, assessment, goals, nursing care plan, progress notes, alerts, discharge planning, etc., of each patient.

3. This patient-nurse logbook/register can be synced with each other and help with monitoring, timely delivery of medications, attending the sudden emergencies, and the overall patient care.

4. Nurse/care providers can sync their logbook/register with a large mass of patients and the tech algorithms can help in aligning the nurse/care provider’s schedule to attend to a large number of patients providing them the optimal care by saving time and energy in operational activities. This type of tech can be very useful in times of pandemic where there is an immense workload and a huge scarcity of care providers.

USE CASE 2

If the patient is critical and the doctor needs to discuss it with other doctors, this can be done through the platform and the recordings saved in the PHR and Health ID.

IV. Preventive care

Home Diagnostics: With extensive preventive, treatment and health records contained in the Health ID, the insights generated may help as a timely wake-up call to seek early help and proper diagnostics.

V. Patient’s community

1. Creating a community platform wherein patient-patient and patient-doctor interactions can happen.

a. With the help of analytics, Patient A can be connected with similar patients with similar conditions, history, and journeys.

b. Patient A becomes friends with Patient B, Patient C, and Patient D and forms a group to discuss their problems, solutions, and in general share and care.

c. Interested doctors can also be a part of this community and contribute in their professional capacity.

2. Early identification of the individual’s need and connecting with the right health service provider such as geriatric care, pediatric care, online pharmacy, physiotherapy, child care, and so on.

3. Incorporating vernacular languages: A tech development to convert all the features in the vernacular especially to serve the rural segments of the country.

References:

https://pmjay.gov.in/node/3432 https://healthid.ndhm.gov.in/ https://indianexpress.com/article/explained/ayushman-bharat-digital-mission-national-health-id-narendra-modi7540456/

PHR — https://www.youtube.com/watch?v=GZhPXiFLjaE https://www.youtube.com/watch?v=g4iCZVaQ1xg&t=742s https://ten3thealth.com/ https://healthsensei.co.in/ https://www.cooeyhealth.com/ https://health.economictimes.indiatimes.com/news/health-it/india-bullish-on-ai-in-healthcare-without-ehr/73118990