To incorporate private health facilities into the Ayushman Bharat Digital Mission (ABDM), the central government has announced the creation of 100 microsites across India in a phased manner.
What is the Ayushman Bharat Digital Mission or ABDM? The ABDM, previously known as the National Digital Health Mission or NDHM, is an initiative by the National Health Authority to establish digital health systems that manage core digital health data and the infrastructure required for its seamless exchange. It seeks to create registries to create a single source for information regarding clinical establishments, healthcare professionals, health workers, drugs and pharmacies, across India. Among its many goals, the ABDM also aims to create a system of personal health records that is “based on individual’s informed consent.”
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What is a microsite? According to the ‘Operational Guidelines for Activating Microsites in the Country,’ a microsite is a focused region comprising all small-medium private facilities like clinics, hospitals, labs, etc. to include them in the ABDM ecosystem. Further, microsites digitise these healthcare providers to have them join the open digital health ecosystem.
A “successful microsite” will encourage all patients and physicians to “voluntarily engage” with ABDM. Specifically, it wants patients to generate ABHA accounts and operate, link and manage records on an ABDM-enabled Personal Health Record (PHR) application. Similarly, all private physicians and healthcare providers will also generate and demand digital health records in the long term.
“It is intended that through these microsites, as many small-medium scale healthcare providers are made aware of ABDM and its benefits, registered on ABDM’s core registries, use ABDM certified digital solutions, and eventually begin to link digital health records – all contributing towards a wider adoption of ABDM,” said the National Health Authority (NHA).
Why it matters: In its own words, the NHA has defined microsites as “small-scale, focused implementation and adoption of ABDM.” While of course there are benefits to digitising health records under this mission, it cannot be forgotten that it is also creating pools of very sensitive data. The guidelines are talking at length about encouraging participation in the ABDM but where are the safeguards for these microsites? The AIIMS incident from 2022 is a good example of how such large data can be exploited. Even the US reported a breach of over 20 million health records last year. Where are the security measures to make sure this doesn’t happen at the microsite level where people are even more unlikely to understand the need for such safeguards? The government needs to answer these questions, especially considering the microsites are to link with other centralised databases as well.
Which central databases will include data from these microsites?
Health providers under these microsites will have to “onboard” the ABDM ecosystem by maintaining a ‘private facilities register’ under various centralised datasets. This includes:
Health Facility Registry (HFR): This registration enables the identification and verification of the health facility. This registry mandatorily requires the facility contact person details, facility details, the type of service provided, ownership type, etc.
Healthcare Professionals Registry (HPR): Healthcare professionals working at the microsite facilities will have to register under this dataset for identification and verification. It may be noted that when this registry was first introduced, doctors, professional bodies and registered medical societies worried about the digital infrastructural gaps like internet connectivity issues, etc. that complicate the process.
Both the HFR and HPR are flagged as ‘core building blocks’ of the ABDM process.
Records for Digital Health Solution: This involves the implementation of an ABDM-enabled digital health solution at the health facility. It digitizes and manages health records at the facility and is meant for daily use by healthcare providers. It can also link health records generated at the facility with the patient’s ABHA address.
Nudging citizens for creating personal health record application
The microsite is also a means to create awareness among patients about personal health records or health lockers (PHR). It will allow facilities to view, manage and share health records of patients.
“While a PHR application may not be required for facilitating adoption of healthcare providers onto the ABDM ecosystem, but engaging with PHR Application providers may be helpful from the end-user standpoint,” said the government.
Unique identifiers for each microsite for monitoring/tracking
After news of registries like ABHA to keep track of patient data and health professionals registries to maintain healthcare providers’ data, the NHA said it will also assign a unique identifier for each microsite. This identifier will be provided when the project begins in the region and will be used to fill in the relevant registration forms. As per guidelines, this is to track the registrations completed in each Microsite.
“It is important to track and monitor the progress of each microsite for course correction or assessing impact/ success. Hence, the NHA will build a microsite specific dashboard, to track the progress at State/UT-wide level,” said the government.
The guidelines also recommended that state-level and union territories-level ABDM offices set up an internal tracking mechanism to monitor the progress in specific microsites within their region. It referred to PATH, a development partner for a microsite in Mumbai that set up an internal dashboard for monitoring the progress of the microsite.
Microsites established in Maharashtra and Gujarat
As mentioned above, PATH worked with the government to set up a microsite near Mumbai, Maharashtra. As per the government website, over 600 doctors have registered on HPR and HFR and have started using ABDM-enabled HMIS for generating over 5000 ABHA-linked electronic health records since October 2022.
Similarly, two microsites have been underway in Gujarat’s Ahmedabad and Surat, with 800 and 600 healthcare professionals mapped at each location since mid-March. As per government data:
“Through 25th May 2023 the progress has been thus:
- Approached 515 healthcare professionals across 449 health facilities.
- Of these 515 healthcare professionals, 391 have shown interest in digitisation
- 141 Healthcare professionals have initiated their HPR registration (104 completed)
- 55 facilities have initiated their HFR registration (52 completed)
- 11 Healthcare facilities have adopted an ABDM enabled HMIS”
Other efforts to integrate state health databases into ABDM
In February 2023, the Telangana government also floated a tender that called for the digitisation of health records under the Aarogyasri Healthcare Trust (AHCT). Here too the government talked about creating unique identifiers for “beneficiaries,” with an ID tagged to the Unique Health Identification (UHID) number under ABDM. However, experts had pointed out at the time that forcing local healthcare facilities to digitise records leads to additional costs sans adequate returns. Not to mention there is still much confusion regarding the policies and legislation looking into health data in India. With the removal of sensitive data from the ambit of the Digital Personal Data Protection Bill, 2022 and the inclusion of deemed consent, the status of health data security in India is more precarious than ever.
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