Digital Health |

National Landscape of
Healthcare IT in India

Ajay Vamadevan
PGDM – HCM | Term 3
Telemedicine

• Delivery of healthcare services, where distance is a critical factor, by

all healthcare professionals using information and communication
technologies for the exchange of valid information for diagnosis,
treatment and prevention of disease and injuries all in the interests of
advancing the health of individuals and their communities [WHO]
 eHealth
• The cost-effective and secure use of
information and communications
technologies in support of health
and health-related fields,
• including health-care services,
• health surveillance,
• health literature and health
education, knowledge and
• research.

(WHO)
mHealth

• Medical and public health practice

supported by mobile devices, such
as mobile phones, patient
monitoring devices, personal digital
assistants (PDAs), and other
wireless devices. (WHO)
Rapid Rise in
Mobile
Subscriptions per
100 Population,
by Region, 1960–
2021
Reasons?
 mHealth: Unique Capabilities?
• Communication and • Data Collection
• SMS/Soc Media
Computing Capability
• Software – App
• Nutrition
• Portable • Wellness
• Behavior Change
• Cheaper
• Built-in Sensors
• Least investment on • GIS/GPS
• Camera (AI)
Infrastructure
• Attaching Point-of care Devices & Wearables
Digital health
• The field of knowledge and practice associated with the development
and use of digital technologies to improve health (WHO). Encompasses
• e-health,

• use of advanced computer sciences (e.g. big data, genomics and AI/ML)

• smart and connected devices (Internet of Things), and

• robotics

Telemedicine || eHealth || mHealth

Potential of Digital Health in Care Delivery
Use of Digital
Technologies
during Pandemic

Digital-in-Health: Unlocking the value for everyone. World Bank (2023)

How Digital Technology Can Support Universal
Health Coverage
How Digital
Health
Reduces
Fragmentati
on in Health
Care
Delivery

Digital-in-Health: Unlocking the value for everyone. World Bank (2023)

Advances in Digital Health for a better Health

Digital-in-Health: Unlocking the value for everyone. World Bank (2023)

Digital
Health
Investment
Estimates, by
Priority Area
2022
Assessments

Digital-in-Health: Unlocking the value

for everyone. World Bank (2023)
Digital-in-health: technology and data become
indistinguishably embedded and assimilated in
transformed health systems and healthcare
Digital-in-health:
technology and data
become
indistinguishably
embedded and
assimilated in
transformed health
systems and
healthcare
Digital-in-Health: Unlocking the value for everyone. World Bank (2023)
Areas in which Digital Health adds Value in Healthcare
Challenges ?
• Basic infrastructure challenges (electricity, internet connectivity,
functional IT infrastructure)
• Lack of long-term planning, challenges arising from fragmentation
• Lack of sustainable financing after the initial investment
• Lack of norms and standards for interoperability
• Lack of capacity and digital literacy
• Annual maintenance cost of the system
• At around 30% of the total initial upfront investment
National Landscape of Healthcare IT
Public health system at the grassroot level
Primary Community
Sub-Centre Health Centre Health Centre
(PHC) (CHC) There are over 5
ANM/JPHN/MPW,
million healthcare
1 Doctor, 15 Staff
ASHAs Caters to 120,000 professionals
population

Caters to 5000 Caters to 30,000 1.2 million healthcare

population population facilities serving the
Specialist care:
Gynecologist, population
Pediatrician,
Deliver National Supervise Sub- Surgeon, Anesthetist,
Health Programs centres Gen Medicine
Structure of
Information
Flow in Public
Health Care
system in India
Note: SC: Sub Center, PHC: Primary Health Center, CHC: Community Health Centre, HQ: Head Quarters

Structure of Information Flow in Public Health Care system in

India.... | Download Scientific Diagram (researchgate.net)
Pandemic Impact and Digital Transformation
in Healthcare in India
Existing Digital Public Infrastructure
• The current strong public digital infrastructure—including that related
to Aadhaar, Unified Payments Interface and wide reach of the
Internet and mobile phones (JAM trinity) —provides a strong platform
for ABDM

• The existing ability to digitally identify people, doctors, and health

facilities, facilitate electronic signatures, ensure non-repudiable
contracts, make paperless payments, securely store digital records,
and contact people provide opportunities to streamline healthcare
information through digital management.
COVID Vaccine Intelligence Network (CoWIN) ?
• Aarogya Setu Application: A contact tracing app that provided real-
time data on active cases, containment zones and helped more than
175 million citizens assess risk in their areas
• Booking of COVID-19 vaccinations
• Provided individuals with vaccine certificates
• Register for a Digital Health ID, telehealth consultations
• Transforming into an Electronic Medical Record so that individuals can
access digital lab reports, prescriptions, and diagnosis
Digital Infrastructure that supported CoWIN
• 572,000 villages out of 597,000 have mobile or network connectivity

• 1.2 billion mobile subscribers, 800 million internet users, and 510
million smartphone users

• 1.24 billion unique Aadhar digital IDs

• 36 Crore Daily UPI transactions

• 50 Crore ABHA IDs

 National • Sets specific goals for Digital Technologies

Health Policy • Federated Architecture

• Data Standards & Electronic Health Records
2017 • Development of Registries

Pilot National
Digital Health National • Defines Components of Digital Health
• Electronic Registries
Mission
(NDHM) Health Stalk • Claims & Coverage platforms
• Federated Personal Health Records Architecture
Launched on 2018 • Health Analytics
15 Aug 2019

National • Implementation Guidelines

• Layered Framework of digital infrastructure
Digital Health • Building Blocks
• Standards & Regulations
Blueprint 2019 • Institutional Framework for implementation
 Healthcare Ecosystem
Health Healthcare Pharmacies
Citizens | Facilities Professionals Diagnostic
(Standalone |
Government Laboratories
• Small | Medium| • Docs | Para- Online)
Tertiary medics | Ayush

Research
Insurance Telehealth | Tech Providers Consent
(Academia &
Companies Aggregators (EHR/PHR) Managers
HCB)

Ayushman Bharat
Digital Mission (ABDM)
• https://abdm.gov.in/

• https://www.youtube.com/@AyushmnaNHA
Ayushman Bharat Digital Mission (ABDM)
Ayushman Bharat Digital Mission Countrywide
launch by Prime Minister on 27 SEP 2021
• ABDM aims to develop the backbone necessary to support the
integrated digital health infrastructure of the country

• It will bridge the existing gap amongst different stakeholders of

Healthcare ecosystem through digital highways

• Under ABDM, a digital health ID would be created for all Indians

• Additionally, a repository for healthcare professionals, health facilities

and drugs will also be made
ABDM: Vision
• Universal Health Coverage
• ABDM shall create a seamless online platform “through the provision
of a wide range of data, information and infrastructure services, duly
leveraging open, interoperable, standards-based digital systems”
while ensuring the security, confidentiality and privacy of health-
related personal information.
OPEN-SOURCE APPLICATIONS
• Applications built on publicly available source codes that can be
accessed, modified, and distributed by anyone, are free to use,
encourage collaboration, and contribute to innovations by allowing
developers to contribute to the code base

• They can be used by developers to build new solutions that leverage

the health stack (initiative by government of India to improve digital
health infrastructure) or other open-source tools, and they can be
customized to meet the needs of different health care providers and
patients
API: Application Programming Interface
• API provides a way for two or more computer programs to
communicate with each other

• It is a software interface, offering a service to other pieces of

software. It enables multiple software components to “talk to each
other” using a set of definitions and protocols, such as a data
dictionary. APIs are an accessible way to extract and share data within
and across organizations.
API: Application Programming Interface
Standards
• ICD-10
• SNOMED-CT
• LOINC
• HL7-FHIR
ABDM: Objectives (1)
• To establish state-of-the-art digital health systems, to manage the core digital
health data, and the infrastructure required for its seamless exchange;
• To establish registries at appropriate level to create single source of truth in
respect of clinical establishments, healthcare professionals, health workers, drugs
and pharmacies;
• To enforce adoption of open standards by all national digital health stakeholders;
• To create a system of personal health records, based on international standards,
easily accessible to individuals and healthcare professionals and services
providers, based on individual’s informed consent;
• To promote development of enterprise-class health application systems with a
special focus on achieving the Sustainable Development Goals for health;
• To adopt the best principles of cooperative federalism while working with the
States and Union Territories for the realization of the vision;
ABDM: Objectives (2)
• To ensure that the healthcare institutions and professionals in the private sector
participate actively with public health authorities in the building of the ABDM,
through a combination of prescription and promotion;
• To ensure national portability in the provision of health services;
• To promote the use of clinical decision support (CDS) systems by health
professionals and practitioners;
• To promote a better management of the health sector leveraging health data
analytics and medical research;
• To provide for enhancing the efficiency and effectiveness of governance at all levels;
• To support effective steps being taken for ensuring quality of healthcare; and
• To strengthen existing health information systems, by ensuring their conformity
with the defined standards and integration with the proposed ABDM.
ABDM
Architecture
Major Implementation Milestones of ABDM
1. Launch of a Real-time HMIS through an online portal

• Under MoHFW
• HMIS collects, stores, and analyzes health service delivery and
utilization data
• Uses all applicable government standards, such as standardized
facility UIDs, entity names, geographic boundaries (up to the level of
villages), population data and other relevant information, including
Geographic Information System (GIS) based layers that are used in the
Integrated Health Information Platform
2. Formation of Registries

• Under ABDM, a digital health ID for all Indians

• A Registry for Healthcare Professionals [HPR]

• A Registry of Healthcare facilities [HFR]

 ABHA
• A randomly generated 14-digit identification number created using the
individual’s mobile number and Aadhar number / Driving License

• After obtaining the citizen’s consent, a digital version of the health record is
uploaded to the ABHA account that allows users, insurance companies and
hospitals across the country to access and share health records through the
web application
• Contains details of every test, every disease, doctors visited, medicines taken, diagnosis
• All health records of an individual would be stacked in one place
• Instead of restricting the health records of a person to just the hospital where they
undergo treatment, they can be accessed from anywhere in the country digitally

• Enables citizens to compile a comprehensive medical history across various

healthcare providers, thereby improving clinical decision-making
Healthcare Facility Registry
• 14-digit UIDs
• A single centralized repository of all the health facilities in the country

• Facilitate storage and exchange of standardized data from both the public
and private health facilities in the nation

• Health facilities would have provision of electronic processing of

documents for various purposes such as empanelment, claims processing,
e-signature etc.

• Verified digital identities to large and small public and private health
facilities
Health Professional Registry (HPR)
• A single, updated repository of all healthcare professionals enrolled in
nation

• Compiles details such as such as name, qualifications, name of the

institutions, qualifications, specializations, registration number with
State medical councils, years of experience, etc.

• Verified digital identities for professionals

ABDM Building Blocks ?
ABDM Architecture
Unified Health Interface (UHI)
Citizen Needs ?
• Booking OPD appointments at hospitals / clinics
• Booking Tele-Consultation
• Discovering availability of critical care beds
• Discovery of lab and diagnostic services
• Booking of home visits for lab sample collections
• Booking an ambulance
• Discovery of nearby pharmacies
 UHI Participants
User: End User Application (EUA):
Patients seeking digital health services User-facing applications offering digital
through UHI health services

UHI Gateway:
Routing the initial service/provider
discovery requests and responses involved
in UHI transactions between HSPAs and
EUAs

Health Service Provider Application (HSPA):

Health Service Provider (HSP): Provider-facing applications allowing health service
Providers of healthcare services providers (doctors, health facilities etc) to respond to
EUA requests and fulfill digital health services
Role of UHI
Gateway
 SINGLE SOURCE OF TRUTH
Facilitate the identification/ discovery of healthcare facilities and allow health
professionals to build an online presence and offer their services more effectively
• https://sandbox.abdm.gov.in/abdm-docs/Bahmani
 Milestones
M1
1.Create ABHA number - using Aadhaar / Mobile / Demographic / Driving License
2.Collect and Verify ABHA address during patient registration

M2
• Link health records with ABHA address
• Allow users to discover their health records

M3
• Developing Health Information User (HIU) services to provide view of patient’s
medical history to authorized healthcare workers with complete consent

Sumasoft
3. Integration of EHRs for Pradhan Mantri Jan
Arogya Yojana (PM-JAY)

• To ensure timely insurance payments, EHRs are maintained for each

beneficiary enrolled under PM-JAY

• Provides real time reports of transactions and analyzes utilization

trends, hospital registration, beneficiary identification, and
transaction management system
• https://nrces.in/ndhm/fhir/r4/hcx-profile.html

• https://pib.gov.in/PressReleasePage.aspx?PRID=1976957#:~:text=The
%20National%20Health%20Authority%20(NHA,developed%20by%20
National%20Health%20Authority.
4. Expansion and integration of Telehealth Services
“eSanjeevani” with ABDM
• 5. Health Information Exchange and Consent Manager (HIE-CM)
• Facilitates the exchange of health information between healthcare
providers, patients, insurance companies and public health agencies
• Ensures that the identity of persons intending to share information is first
verified, consent of the person/patient is taken and logged, and only after
that are the health records shared

• 6. Implementation of health analytics

• The data collected through both the HMIS and EHRs is being analyzed to
identify patterns, trends, and opportunities for improvement in the
healthcare delivery system
Health Information Exchange
ABDM Sandbox
• https://sandbox.abdm.gov.in/sandbox/v3/

• A sandbox environment allows you to test new software applications

and updates without affecting the live environment.

• Develop, Test, QA Test

• Production Environment
 Minimum Viable Product (MVP) Guidance:
1. Core ABDM Requirements: 2. Core Functional Modules/Functionalities:
• Creation and verification of ABHA • Patient Registration
• Profile sharing via QR Code • OPD services, including digital prescription
• Health record linkage with ABHA address • Laboratory services
• Receiving/viewing health records from other • Radiology services
ABDM-enabled solutions • Billing functionality
• Device and mobile-responsive website for all • IPD, including discharge summary
users
• Compliance with ABDM Consent Manager • Operating Theatre (OT)
• Unified Health Interface – Service Discovery • Pharmacy services
• Unified Health Interface – Appointment • Inventory management
Booking • MIS Reports (exportable formats), such as
Analytical and Business reports
 Minimum Viable Product (MVP) Guidance:
3. Compliance to Medical Data Standards: 5. Subscription and Usability Features:
• SNOMED CT integration • Availability of the solution as a Software
• ABDM supported FHIR (R4) Standard and as a Service (SaaS) model
Profiles in 'Structured' and 'Unstructured' • Online purchase and activation for user
formats convenience
• Capturing of Data in Still Image (JPEG) 6. Technical Support Features:
and PDF A2 Format • Installation and technical support to
4. Privacy and Security Standards: Clients
• Data encryption protocols • End-user training at the time of
• Role-based access control (RBAC) Deployment
• Audit trails for data access and • Customer Support available via ticketing
modifications tool, call center support, and dedicated
account managers
• Two-factor authentication (2FA)
• Regular security assessments and
updates
Opportunities that ABDM Offers
Stakeholders ?
• Policy makers/Program Managers
• National Health Authority: State Health Agencies
• Ayushman Bharat Digital Mission

• Citizens

• Healthcare Provides/Professionals

• Insurance Companies

• Technology Providers

• Healthcare Industry

• Researchers
Stakeholders
• Policy makers and program managers: Access to quality macro and
micro-level data and advanced analytics for geographic and demography-
based program monitoring and preventive healthcare
• Facilitates informed decision-making to improve policy design, strengthen
program implementation, and increase the accountability of healthcare providers
• Citizens: Can securely store and access their medical records
(prescriptions, diagnostic reports, and discharge summaries) and share
them with healthcare providers for treatment and follow-up
• Helps in teleconsultation and e-pharmacy
Stakeholders
• Healthcare professionals: Full access to a patient’s medical history
after obtaining informed consent to ensure they can prescribe the
right interventions
• Improved continuum of care, digitizes insurance claims that can be processed
for faster reimbursement, and overall enhances service provision

• Researchers: Aggregated data to study and evaluate the effectiveness

of various programs and interventions facilitating a comprehensive
feedback loop between researchers, policymakers, and providers
Business Opportunities ?
Citizen/Patient Services
• Single, Secure Health ID for all citizens
• Personal Health Record
• National Health Portal
• App Store
• Specialized Services for Remote Areas/ Disadvantaged Groups
• NDHM Call Centre
• Digital Referrals & Consultations
• Online Appointments
• e-Prescription Service
• Digital Child Health
• National “Opt-out” (for privacy)
Healthcare Providers/ Professionals
• Hospital Digitization
• Technology for Practitioner (GP) Transformation
• Summary Care Record
• Open Platform to access Emergency Services
• Digital Referrals, Case Transfers
• Clinical Decision Support
• Digital Pharmacy & Pharmacy Supply Chain
• Digital Diagnostics
Technical Digital Services
• Architecture & Interoperability
• Health Information Exchange
• Standards
• Health Network
• Data & Cyber Security
• Insurance Claim Exchange
• Research Information systems
• Information Governance
Other Opportunities

• Emerging technologies such as artificial intelligence, the internet of

things (IoT), Blockchain and cloud computing
• additional opportunities for facilitating a more holistic digital health
ecosystem

• Medical Research & Innovations

What are the hesitations of stakeholders to
onboard ABDM ?
• Patients
• Doctors
• Hospitals
• Health Tech Companies
 Possible scenarios
Citizen Governments

Small Clinics Medium Hospitals | Large Hospital

Chains
Patient Care – Remote Monitoring Health-Tech [EHR | Analytics ]
| Self-Management
Pharma Industry – Sales | Products Med Device Industry- Sales |
Products
Pharma – Medicine Research Academic Research

Wellness Ayush/other systems of Medicine

Public Health Lab – Diagnostic Biz