On August 15, Prime Minister Narendra Modi announced the National Digital Health Mission, a project that has been a long time in the making. Here is everything you need to know about the mission.

What is the National Digital Health Mission?

The mission seeks to create a digital health architecture, using health IDs, unique identifiers for doctors and health facilities, personal health records, and telemedicine and e-pharmacies, among other components.

Under the National Digital Health Mission, “every Indian will be given a health ID”, which will contain a person’s medical history, including “all tests, every disease, which doctor gave you which medicine, when, what were your reports” and will also include doctors’ appointment, payments, and so on, PM Narendra Modi said on August 15. The mission is made of six key components Health ID, DigiDoctor, Health Facility Registry, Personal Health Records, e-pharmacy, and telemedicine, the NHA’s statement said. “All of these digital products except e-pharmacy and telemedicine have been deployed and are up and running,” it added.

The National Digital Health Mission “aims to liberate citizens from the challenges of finding the right doctors, seeking an appointment with them, payment of consultation fee, making several rounds of hospitals for prescription sheets, among several others”, the National Health Authority said in a statement soon after PM Modi’s announcement.

The Mission will let users / patients access both public and private health services. The mission will “have a national  footprint and will enable seamless  portability across the country through a Health ID–Personal Health Identifier”. A digital consent framework will be adopted for consent management, as per standards specified by National Digital Health Blueprint.

Pilots have been launched in six union territories 

The mission was launched as a pilot in six union territories Chandigarh, Ladakh, Dadra and Nagar Haveli, and Daman and Diu, Puducherry, Andaman & Nicobar Islands and Lakshadweep. Based on the initial learnings from these territories, the mission will gradually be expanded in partnership with other states.

The origin of the National Digital Health Mission

The National Health Policy, 2017, had first envisaged the creation of a health information network, which looked at Aadhaar-linked health IDs, a regulator for digital health, scaling teleconsultations, among other things. In 2018, government think tank NITI Aayog opened a public consultation for the National Health Stack – a proposal for multiple building blocks for digital health. The Health Ministry later took over the mandate and put the National Digital Health Blueprint out for consultation.

With the escalation of the coronavirus pandemic, the government notifying the Telemedicine Practice Guidelines in March and the deployment of the contact-tracing app Aarogya Setu, digital health in the country came to a head, and work around building a digital health framework began, with the involvement of the National Health Authority.

What is a Health ID? What is it based on?

It is a “unique” identifier created on the basis of mobile number, Aadhaar, or a government ID. Each Health ID will be linked to a health data consent manager — a set of APIs developed by the iSpirt Foundation along with telemedicine body Swasth Alliance. Multiple health data consent managers will exist, per a strategy document by the National Digital Health Mission. Given the open APIs that have been made public over the past few months, and the size of the Swasth Alliance, multiple players are already building their own consent managers.

Hospitals and labs can look up a health ID through the ID, Aadhaar, or mobile number. The IDs can be created at any public hospital, community health centre, or any provider included in the healthcare infrastructure registry. People may also need to provide their basic demographic and content info to the consent manager, per the document.

Aadhaar may be mandatory for leveraging government schemes via Health IDs

The document says that the unique Health ID will be based on Aadhaar for those seeking to claim benefits under government schemes under the Aadhaar Act, and those “willing to provide Aadhaar”. It is unclear if Aadhaar will have to be provided to leverage any government schemes, or if this is optional. However, the document specifically says that the government will notify the use of Aadhaar for healthcare under the Aadhaar Act [under Section 4]. Health schemes that mandate the use of Aadhaar will also need to notify their schemes [under Section 7] of the Act.

At the same time, the document says that, “Health ID will be offered as a service with a set of APIs. All government health programmes, notified under applicable statutory provisions, are required to integrate with the service and issue Health IDs as part of their programs” and “All Government health insurance schemes as well are expected to adopt and link the Health ID for benefits linkage”. It is understood from the above that health IDs will be mandatory for accessing government health schemes, for which Aadhaar is seemingly mandatory.

The document added that Health IDs will need to be “digitally authenticatable to enable patients to provide their informed consent”. 

This can be done by linking Health IDs with Aadhaar, which will allow authentication via biometrics, face, or OTP. It added that health ID policies will be designed to ensure that nobody is denied a health service and that medical errors do not arise.

The National Health Authority, under the Health Ministry, will implement it. 

The National Health Authority has been given the mandate “to design, build, roll-out and implement” the mission in the country. The National Health Authority is an attached office of the Health Ministry and is the central implementation agency for Ayushman Bharat.

The National Health Authority, which is understood to be backing the development of open APIs around the Bharat Health Stack, is the core body for the mission’s implementation. The mission will be headed by an officer of the rank of a joint or additional secretary.

The NHA will manage the mission’s everyday operations, coordinate between the steering and empowered groups and ministries, and provide administrative and technical leadership to the Mission.

How health data will be shared 

According to the strategy document, health data sharing will be driven by consent, which will be revocable. Individuals will also have the right to share only partial data, and will have the right to opt-out of sharing their records.

  • Records from previous government schemes such as Ayushman Bharat will be integrated with the patient’s personal health record. Users can add data from wearables and other apps to their record as well.
  • Users can also delink their health records across health care service providers, but they cannot ask this data to be deleted, since providers are legally required to store it for certain periods. Users can delete any data they have in the health locker, except but anonymised data.
  • The storage of health data will be decentralised, and HIPs will have to follow minimum standards defined by the mission with regard to privacy, security, and storage. “The storage and security of HIP technology systems willbe a part of the overall certification to be done by STQC, MeitY as explained further in the document.”

Healthcare providers will be mandated to share digital copies of records, have to ask patients for health IDs 

The mission will require healthcare providers to share digital copies of any health reports which are already being physically shared with the patient, “to enable longitudinal health records”, per the strategy overview. This will include diagnostic reports, discharge summaries, clinical notes, prescriptions, and immunisation records. “HIPs will keep a digital copy of both inpatient and outpatient health records they issue to patients as per policy,” per the strategy document.

Healthcare facilities will be expected to adopt software to become Health Information Providers, also known as Health Data Fiduciaries. This will be any entity that is creating health information pertaining to a user and is ready to share it digitally with users, “by adopting software compliant with NDHM standards and policies”. To become a HIP, the health care facility will have to enroll in the Healthcare infrastructure registry by the mission.

  • Until digital services are made mandatory, providers have to maintain physical records, in formats that the mission will lay out. “For an initial period, the design will allow for existing PDF and image files to be shared in a FHIR-R4 resource wrapper.” The Mission also expects that AI can be used to extract relevant information from existing health record formats.
  • A person who does not want to create a Health ID should be allowed to get treatment, the strategy document says.

HIPs will be “required to ask patients for a Health ID, educate and create Health IDs for patients as required, keep a link of the Health ID with the medical documents they produce, and issue the medical documents only with patient’s consent”.

Mission architecture includes Registries, based on open APIs 

Apart from Health IDs, which are identifiers for users, a key component of the mission will be Registries for doctors, insurers, pharmacies, hospitals, etc. They may be owned by a body — which could be National Medical Council, IRDAI, Pharmacy Council of India — which will be responsible for its operation and maintenance.

NDHM will be developed by adopting the MEITY’s Agile IndEA Framework and its Open Standards and Open Source Software. “Only the core components will be  developed and maintained centrally”, others will be federated based on regional, state-level and institution-level  platforms.

The Mission will be overseen and led by two central committees 

The mission will have two separate arms:

  1. Mission Steering Group: Chaired by the Health Minister, this group will guide and oversee the mission. Its members will include ministers from MEITY, Ministry of Women & Child Development (and others), the Principal Scientific Advisor, secretaries, NHA CEO, the NDHM mission director, among other people.
  2. Empowered Committee: Chaired by Health Secretary, this commitee will take the policy decisions and help coordinate the mission, and supervise its rollout. Its members will include NITI Aayog CEO, ministerial secretaris from MEITY, AYUSH etc, NHA CEO, the Director General of Health Services, the Director General of National Informatics Centre, among others.

Non-personal health data to become part of analytics platform 

The Mission’s strategy document acknowledges non-personal health data, stating that it includes data such as dengue case numbers, and any information about health facilities and drugs that do not involve any personally identifiable information. Aggregated data such as this will become part of the National Health Analytics Architecture.

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Also read:

  • Ministry of Health’s public consultation on National Digital Health Blueprint: Legal issues around telemedicine, consent, and ‘egosystems’ in healthcare [read]
  • iSpirt demos a key part of Health Stack — the health data consent manager. Some questions. [read]

**Updated on 16:22 IST on August 17, 2020. Originally published at 14:06 IST.