It’s fitting that the launch of the National Digital Health Mission (NDHM) was the centrepiece of Prime Narendra Modi’s speech on the country’s 74th Independence Day. With comorbidities — most of them lifestyle diseases that Indians have become increasingly prone to in the past 15 years — emerging as one of the main causes of mortality in the ongoing COVID-19 pandemic, the salience of a repository that can alert the physician to a patient’s medical history at the click of a computer key cannot be overstated. “Every Indian will be given a health ID that will work like a health account. This account will contain details of every disease, the doctors you visited, the medicines you took and the diagnosis,” PM Modi said. The health ID will allow patients to virtually share files between hospitals and doctors. The creation of a digital ecosystem for healthcare and the attempt to leverage IT to enhance the well-being of people in the country will, however, require surmounting challenges, including correcting some of the medical sector’s longstanding problems.
In 2017, the National Health Policy underlined the need for a repository of medical information of the country’s citizens. A year later, the Niti Aayog proposed the creation of a National Health ID “to reduce the risk of preventable medical errors and significantly increase the quality of medical care”. This urge to create a patient-centric system has, by all accounts, informed conversations on the NDHM in the past three years. The welcome endeavour has, however, not given adequate attention to a fundamental problem of the country’s healthcare system — the shortage of medical personnel. Despite improvements in the past six years, at 1:1,450, the country’s doctor-population ratio does not meet the WHO’s norm of one doctor for 1,000 people. The situation is compounded by the poor state of primary health centres in much of the country. There are fears, therefore, that tasking the already strained medical system with digital documentation would affect the success of the health ID scheme. In fact, physician burnout is one of the main reasons for the digital health ecosphere remaining a work in progress in technologically advanced countries, such as the US.
The core building blocks of the NDHM — the Health ID and Health Facility Registry —shall be owned, operated and maintained by the government. However, private operators will have equal opportunities to integrate with these systems and create products for the market. Such linkages across public and private players could enhance medical efficiency and improve the patient’s experience. Patients can choose the documents they would like to share, with whom and for how long. Even then, given the asymmetrical relations between health service providers — doctors, hospitals, insurance companies — and medical care seekers, apprehensions of privacy breaches are not unfounded. The country’s data protection law — in the works for almost three years — will have to factor in such concerns, arm patients with safeguards. In the coming months and years, the government and the country’s legal, IT and medical systems will have to come together to translate the NDHM’s patient-centric vision into reality.