Ayushman Bharat Digital Mission (ABDM)

OCT 8

Mains   > Social justice   >   Health   >   Digital India

WHY IN NEWS?

  • Prime Minister launched the Ayushman Bharat Digital Mission (ABDM) via video conferencing on 27th September 2021

ABOUT THE MISSION:

  • The Ayushman Bharat Digital Mission (ABDM) aims to develop the backbone necessary to support the integrated digital health infrastructure of the country.
  • It will bridge the existing gap amongst different stakeholders of Healthcare ecosystem through digital highways.
  • ADBM is implemented by the National Health Authority (NHA) under the Ministry of Health and Family Welfare
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BACKGROUND:

  • In a follow-up of the National Health Policy’s specific goals for adopting digital technologies, the Ministry of Health and Family Welfare constituted a committee headed by Shri J. Satyanarayana to develop an implementation framework for the National Health Stack.
  • This committee produced the National Digital Health Blueprint (NDHB), laying out the building blocks and an action plan to comprehensively and holistically implement digital health.
  • Taking forward the NDHB, a document was published describing the broad context, rationale, scope, and implementation arrangements for a digital ecosystem for healthcare services across the country.
  • Since the implementation is envisioned to be in a mission mode, the initiative is referred to as the Ayushman Bharat Digital Mission (ABDM).

VISION OF ABDM:

  • To create a national digital health ecosystem that supports universal health coverage in an efficient, accessible, inclusive, affordable, timely and safe manner, that provides a wide-range of data, information and infrastructure services, duly leveraging open, interoperable, standards-based digital systems, and ensures the security, confidentiality and privacy of health-related personal information.

OBJECTIVES:

  • Establish state-of-the-art digital health systems
    • To establish state-of-the-art digital health systems, to manage the core digital health data, and the infrastructure required for its seamless exchange
  • Establish health registries at appropriate level
    • To establish registries at appropriate level to create single source of truth in respect of clinical establishments, healthcare professionals, health workers, drugs and pharmacies;
  • Adoption of open standards
    • To enforce adoption of open standards by all national digital health stakeholders;
  • Create a system of personal health records
    • To create a system of personal health records, based on international standards, easily accessible to individuals and healthcare professionals and services providers, based on individual’s informed consent;
  • Development of enterprise-class health application systems
    • To promote development of enterprise-class health application systems with a special focus on achieving the Sustainable Development Goals for health;
  • Cooperative federalism
    • To adopt the best principles of cooperative federalism while working with the States and Union Territories for the realization of the vision;
  • Ensure private sector participation:
    • To ensure that the healthcare institutions and professionals in the private sector participate actively with public health authorities in the building of the ABDM, through a combination of prescription and promotion;
  • Ensure national portability
    • To ensure national portability in the provision of health services;
  • Use of clinical decision support
    • To promote the use of clinical decision support (CDS) systems by health professionals and practitioners;
  • Better governance of health sector:
    • To promote a better management of the health sector leveraging health data analytics and medical research;
    • To provide for enhancing the efficiency and effectiveness of governance at all levels;
  • Improve quality:
    • To support effective steps being taken for ensuring quality of healthcare.
  • Integration of existing mechanism with ABDM:
    • To strengthen existing health information systems, by ensuring their conformity with the defined standards and integration with the proposed ABDM.

OPPORTUNITIES:

  • Existing public digital infrastructure:
    • The current strong public digital infrastructure—including that related to Aadhaar, Unified Payments Interface and wide reach of the Internet and mobile phones (JAM trinity) —provides a strong platform for establishing the building blocks of ABDM.
    • The existing ability to digitally identify people, doctors, and health facilities, facilitate electronic signatures, ensure non-repudiable contracts, make paperless payments, securely store digital records, and contact people provide opportunities to streamline healthcare information through digital management.
  • Past experience:
    • Ayushman Bharat—Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) has successfully used the available public digital infrastructure to provide end-to-end services through an information technology (IT) platform from identification of beneficiaries to their admission and treatment in hospitals to their discharge and paperless payment to hospitals.
    • The experience of AB-PMJAY can be leveraged to expand the reach of digital health to all residents and develop an open and inter-operable health management system that empowers residents, healthcare providers, the Government and researchers.
  • Emerging technologies:
    • Emerging technologies such as artificial intelligence, the internet of things (IoT), Blockchain and cloud computing provide additional opportunities for facilitating a more holistic digital health ecosystem, that can increase the equitable access to health services, improve health outcomes and reduce costs.

BENEFITS:

  • Improves overall health service delivery in the country:
    • The implementation of ABDM is expected to significantly improve the efficiency, effectiveness, and transparency of health service delivery overall.
    • Secure storage and access to medical records:
      • Patients will be able to securely store and access their medical records (such as prescriptions, diagnostic reports and discharge summaries), and share them with health care providers to ensure appropriate treatment and follow-up.
    • Access to information:
      • Patients will also have access to more accurate information on health facilities and service providers. Further, they will have the option to access health services remotely through tele-consultation and e-pharmacy.
    • Informed decision making
      • ABDM will empower individuals with accurate information to enable informed decision making and increase accountability of healthcare providers.
  • Increased choice for people:
    • ABDM will provide choice to individuals to access both public and private health services, facilitate compliance with laid down guidelines and protocols etc.
  • Increased transparency:
    • ABDM will also ensure transparency in pricing of services and accountability for the health services being rendered.
  • Enhance the overall ease of providing services amongst the health care providers:
    • Helps in effective health interventions:
      • Similarly, health care professionals across disciplines will have better access to patient’s medical history (with the necessary informed consent) for prescribing more appropriate and effective health interventions.
    • Enable better continuum of care:
      • The integrated ecosystem will also enable better continuum of care.
    • Enable faster reimbursement of health claims:
      • ABDM will help digitize the claims process and enable faster reimbursement.
  • More informed decision making by the Government.
    • At the same time, policy makers and programme managers will have better access to data, enabling more informed decision making by the Government.
    • Better quality of macro and micro-level data will enable advanced analytics, usage of health-biomarkers and better preventive healthcare.
    • It will also enable geography and demography-based monitoring and appropriate decision making to inform design and strengthen implementation of health programmes and policies.
  • Facilitate research:
    • Finally, researchers will greatly benefit from the availability of such aggregated information as they will be able to study and evaluate the effectiveness of various programmes and interventions.
    • ABDM would facilitate a comprehensive feedback loop between researchers, policymakers, and providers.

BUILDING BLOCKS

  • Health ID
    • It is important to standardize the process of identification of an individual across healthcare providers. This is the only way to ensure that the created medical records are issued to the correct individual or accessed by Health Information User through appropriate consent.
    • In order to issue the UHID, the system must collect certain basic details including demographic and location, family/relationship, and contact details.
    • Ability to update contact information easily is the key. The Health ID will be used for the purposes of uniquely identifying persons, authenticating them, and threading their health records (only with the informed consent of the patient) across multiple systems and stakeholders.
  • Healthcare Professionals Registry (HPR)
    • It is a comprehensive repository of all healthcare professionals involved in delivery of healthcare services across both modern and traditional systems of medicine.
    • Enrolling in the Healthcare Professionals Registry will enable them to get connected to India’s digital health ecosystem.
  • Health Facility Registry (HFR)
    • It is a comprehensive repository of health facilities of the nation across different systems of medicine.
    • It includes both public and private health facilities including hospitals, clinics, diagnostic laboratories and imaging centers, pharmacies, etc.
    • Enrolling in the Health Facility Registry will enable them to get connected to India's digital health ecosystem.
  • Health Records(PHR)
    • A PHR is an electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.
    • The most salient feature of the PHR, and the one that distinguishes it from the EMR and EHR, is that the information it contains is under the control of the individual.
    • The functions that are supported by a Personal Health Record-System (PHR) will enable an individual to manage information about his or her healthcare.
    • This includes viewing of a longitudinal record, comprising of all health data, lab reports, and treatment details, discharge summaries across one or multiple health facilities.
    • Key features of the ABDM Health Records (PHR) mobile application are :
      • Creation of Health ID
      • Discovery of Health Information
      • Linking of health records/ with a given Health ID
      • View Health Records
      • Management of consents

CONCERNS:

  • Privacy concerns:
    • With India still lacking a law on data protection, the digital health mission is expected to trigger privacy concerns in the days to come.
    • The possibility of privacy being violated increases with the centralisation of all information.
  • High initial cost:
    • While technology helps smoothen processes and enhance patient experience, there is a cost attached.
    • Investments have to be made upfront.
    • In the immediate short run, ABDM will increase administrative costs by about 20 per cent, due to the capital investment in hardware and software development, technical personnel and data entry servers.
  • Lack of infrastructure:
    • A large majority of facilities do not have the required physical infrastructure - electricity, accommodation, trained personnel.
  • Operational challenges:
    • Cards getting corrupted, servers being down, computers crashing or hanging, and power outages may seriously affect the functioning of ADBM.
    • The inability to synchronise biometric data with ID cards has resulted in large-scale exclusions of the poor from welfare projects. Such a scenario is not inconceivable and in the case of health, may cause immense hardship to the most marginalised sections of our population
  • Shortcoming of using tele-consultation:
    • In handling chronic diseases that necessitate continuity of care, tele-consultations have been problematic and cannot be substituted for actual physical examination.
    • Continuity of care is central to good outcomes in patient management of chronic diseases.
    • The one serious shortcoming of using tele-consultation for such management is the high attrition rate of doctors within the context of an overall shortage of doctors.
  • Did not recognize health as a justiciable right:
    • The ABDM still does not recognize ‘Health’ as a justiciable right.
    • There should be a push draft at making health a right, as prescribed in the draft National Health Policy, 2015.
  • Health is a state subject:
    • Hence ABDM will need to find ways to accommodate state-specific rules.

GLOBAL EXPERIENCES:

  • Over the past two decades there have been several Digital Health initiatives that were launched globally to improve the quality of health care and bring down the healthcare costs
  • The experiences of NHS Digital in England and the South Korean Model are particularly relevant for India.

PRACTICE QUESTION:

Q. Explain the key components of Ayushman Bharat Digital Mission. Analyse the challenges associated with digitising health sector in India?