An open protocol approach will be taken to build the Unified Health Interface (UHI), the National Health Authority (NHA) recently announced in a press release.
The approach will involve a Decentralised Health Protocol (DHP) that will be “developed and improved by a community of contributors” in order to provide interoperability, it added. The NHA has also renamed Unique Health IDs (UHIDs) to Ayushman Bharat Health Accounts (ABHAs).
The UHI is a layer of the Ayushman Bharat Digital Mission (ABDM) that allows teleconsultations and other services while making use of online registries like Health IDs, Health Professionals Registry, Healthcare Facility Registry, etc. These health services would essentially be provided through ‘gateways’ to which third-party health service providers can link their End User Applications. However, during consultations, various stakeholders had raised multiple issues with the UHI’s proposed design.
Why is the proposed UHI a cause for concern?
Pricing could restrict business models, increase costs, and promote monopolies: The proposed pricing mechanism for teleconsultations consists of: Health Service Provider (HSP) charge for service + UHI Gateway charges (if any) + End-User Application (EUA) service charges.
By allowing transactional pricing, the mechanism restricts the businesses model of applications like Practo and 1MG who help customers discover Health Service Providers online through subscriptions, said Practo and industry bodies (such as Confederation of Indian Industries (CII), National Association of Software and Service Companies (NASSCOM), and Internet and Mobile Association of India (IAMAI)). IT For Change, a Bengaluru-based think tank, submitted that it could make healthcare more expensive and promote monopolisation by large players that can absorb these costs.
Practo, CII, and NASSCOM suggested that the pricing mechanism be subscription-based or offer payment plans.
Multiple UHI gateways could lead to lack of government oversight: The NHA has proposed to manage and operate the UHI gateway and, while initially one gateway will be operational, once the initial stages are completed, scaling to multiple gateways will be considered.
IT For Change cautioned against multiple UHI gateways as it could lead to the creation of a digital health infrastructure that goes beyond the oversight of the government, without the accompanying transparency requirements. This would make it difficult to regulate overpricing or other exclusionary practices that may adversely affect citizens if an alternate digital infrastructure were to achieve dominance in the field, ITfC said.
Meanwhile, Amazon recommended creating a privately-managed gateway so that Health Service Provider Applications could choose to onboard either with the government-run UHI gateway or “a feature-rich private sector built UHI gateway.”
Ratings mechanism one-sided, mandatory disclosure policy faulty: The NHA has proposed subjecting all health service providers, services, and users to a ratings system. This would include checks and balances like mandatory disclosure of the name of the person providing such feedback and chance of rebuttal to be given by the healthcare provider.
HSPs should be allowed to rate patients as well instead of just the other way around, the Federation of Indian Chambers of Commerce and Industry (FICCI) said in its response. The provision of mandatory disclosure of the reviewers’ name could lead to retaliation, negatively impacting their experience on the system. It could also potentially allow aspects of patient data to be inferred, such as their locality of residence, and/or socio-economic attributes, ITfC cautioned.
Unique Health IDs and the ensuing controversy
Under the ABDM, over 14 crore UHIDs (now ABHAs) have been issued across the country. In October, the ABDM was rolled out nation-wide, transitioning from its pilot stage in six Union Territories. It proposes a multi-tiered digital health architecture which will generate longitudinal electronic health records (EHR), facilitate tele-consultations, and so on. The ABHAs will essentially work as a unique identifier for such EHRs and will be linked to patients’ Aadhaar as well as driving licenses.
The government has been criticised for enrolling individuals into ABDM through Aadhaar-enabled vaccine registrations without obtaining their informed consent. It has been reported that individuals falsely believed that Aadhaar is mandatory for authentication through CoWIN and thus, unknowingly signed up for UHIDs.
- UHI to go live this week, reveals NHA CEO RS Sharma at conference
- Unified Health Interface: IT For Change warns against oligopolies, raises privacy concerns
- NDHM Consultation: Practo says UHI could enable healthcare monopolies
- Over 96% Health IDs linked with Aadhaar: New details emerge from ABDM webinar
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