Instead of carrying their medical records in polythene bags, Indians will be able to use IT-enabled tools to share prescriptions, blood test reports and X-ray diagnostics with doctors, irrespective of where they were generated. That’s the thinking behind the Ayushman Bharat Digital Mission launched by Prime Minister Narendra Modi on Monday. It involves the creation of a unique health ID for every citizen and a digital registry that aims to facilitate seamless interactions between healthcare experts. This is a much-needed intervention given that management of chronic diseases has become a critical public health challenge in the past 15 years. Data portability could expedite the treatment of the critically ill, especially those who suffer from more than one ailment. The severity of Covid-19 effects amongst those with comorbidities has highlighted the need for a repository that alerts a doctor to a patient’s medical history at the click of a computer mouse. In the long run, the creation of a health record system could improve public health monitoring and advance evidence-based policymaking. The attainment of these objectives will, however, depend on the manner in which policymakers navigate challenges that stem from the longstanding failings of the Indian healthcare sector. It will also require them to be mindful of the ethical issues germane to the use of digital data.
Globally, the tryst with e-health innovations has been a mixed one. The UK’s National Health Service was one of the first to deploy a digital system to make patients’ records accessible to doctors across the country. The programme did not earn the trust of doctors and failed to adequately address issues related to data confidentiality. Aborted in 2011, the project is regarded as amongst the most expensive failures in IT history. In the US and Australia, where digital healthcare has enjoyed a relatively better outing, the creation of a patient and physician-centric e-healthcare ecosystem remains a work in progress. The US medical system has witnessed regular debates on what must be jotted down in hospital records and prescriptions. The task of data entry — a lot of which might not always be relevant to clinical care — has added to the American doctor’s burden and is seen by experts as one of the major reasons for the high rate of physician burnout in the country. Evolving a language of communication in the digital health ecosphere could pose unforeseen problems in India given the country’s diversity and its chronic shortage of doctors, especially in public health centres — the main source of medical care for a vast number of people in the country. Poor internet speeds could make data entry an onerous proposition for the rural healthcare provider.
The Ayushman Bharat Digital Mission gives patients the option to choose the records they want to share. However, given the asymmetrical relations between health service providers — doctors, hospitals, pharma and insurance companies — and the absence of a data protection law, breaching of patient confidentiality cannot be ruled out. In the coming months and years, policymakers will be watched for how they address these challenges.
This editorial first appeared in the print edition on September 29, 2021 under the title ‘A click away’.