“…it is estimated that annually, around 6 billion health transactions take place. Our objective is to capture all of them digitally and provide that additional value added service with the support of the developer and the startup community,” said Kiran Gopal, director at the National Health Authority (NHA). He was speaking at the India Stack Developer Conference on January 25, 2023.
In the same speech, he also said that over 30 crore people have been given their Ayushman Bharat Health Account (ABHA) numbers and more than 11 crore records have already been exchanged in this interface. That means about 1 in every 4 Indians has now been assigned an ABHA number, which allows easy sharing of your personal health data with corporates, hospitals, insurance companies, and more.
Some of the companies that have such integrations include SRL Diagnostics, Jio, Practo, PayTM, Edelwwiss Insurance, and eka.care, according to a presentation shared by Gopal. Other than that, DigiLocker, the government of Andhra Pradesh, Aarogya Setu, and the government of West Bengal also have integrations with the health stack.
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Interoperability is at its core
Gopal said the government is working on making the health data of Indian citizens “interoperable”, which will also serve as a “single source of truth”. Here are the government’s future plans regarding the interoperability of health data:
- Interoperability of health data: Gopal said that digitisation has occurred in large hospitals, labs, and some smaller hospitals in silos, and now the government wants to build a system where health data can easily be exchanged. He said without interoperability, the patient has to carry “reams of files” every time she goes to the doctor, and the health stack will make this process much simpler. He also said that doctors may not be able to provide the best diagnosis if they don’t have access to proper longitudinal data of a patient. “ The idea is to create this interoperability of this data”, he said.
- Interoperability of health claims: In the insurance market, “every claim has to be checked manually. It is estimated that a single health insurance claim costs about 500 to Rs 600 to process. So if you were to go to universal health coverage, then this, I mean, such a high processing cost may not help”, he said. He argued that the health stack integration will help in bringing down this cost.
- Easy data exchange to avoid market dominance: Gopal also mentioned how he doesn’t want the health industry to become a market dominated by a few players, as is happening in the tech space. “What we want to do is create an environment where the citizen has a choice of availing a service from any service provider, irrespective of what platform he is in and what platform the provider is on. So the unified health interface and the protocol associated with it (…) helps in (…) interoperability, (…) where you can search for a service, book a service and avail it,” he said.
Why it matters: The government’s focus on a “single source of truth” aims to make it easier for various entities like startups, hospitals, and other businesses to access citizens’ sensitive health data. But without strong digital rights, sensitive personal health data of Indians may be used for unintended purposes like profiling of individuals (by startups or insurance companies), sending advertisements, targeted messages to influence health choices etc if enough safeguards are not provided. Also, when the government is acting as a data fiduciary (data collector), how it obtains informed consent for sharing and using this data remains unclear. Gopal did hint towards a “consent manager” framework but did not give any details on the matter. Plus having a “single source of truth” concept may also lead to problems if the wrong information is recorded and if a patient wants to get a particular detail corrected. Several other questions prevail as well, like will a patient be able to hide certain health records from her profile, will she able to delete her records, or withdraw consent from the data being shared with third parties.
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