a power point presentation on NDHM as a part of academic activities in PGT courses of Community Medicine in a Medical College in Assam, India

1. National Digital Health
Mission
Presenter : Dr Dhruba Jyoti Bora
PGT, 3rd year. Community Medicine
Moderator: Dr Kaberi Mech
Associate Professor. Community Medicine,
Jorhat Medical College

2. Learning Objectives
• Background
• Objectives
• Guiding principles
• Scope of the Mission
• Implementation of the Mission
• Risk and outcome of the Mission
• Way forwards
• Conclusion

3. NHP goal 2017
• “The attainment of the highest possible level of
health and wellbeing for all at all ages, through a
preventive and promotive health care orientation in
all developmental policies, and universal access to
good quality health care services without anyone
having to face financial hardship as a consequences”

4. • MoHFW constituted a committee to develop an
implementation framework for the National Health
Stack
• The committee submitted the National Digital Health
Blueprint(NDHB) on 24th April 2019
• As the implementation is envisioned to be in a
Mission mode, the initiative is referred to as National
Digital Health Mission(NDHM)

5. • Strategy guidelines of NDHM was released by
National Health Authority in July 2020
• Honb’le Prime Minister Sri Narenda Modi had
launched NDHM in the 15th August 2020
• At present, the Mission is in phase 1 of
implementation comprising pilot project in six UTs
with 5 services

6. Vision of NDHM
• To create a national digital health ecosystem(NDHE)
that supports universal health coverage in an
efficient, accessible, inclusive, affordable, timely and
safe manner
• To provide wide range of data, information and
infrastructure services, duly leveraging open,
interoperable standard based digital systems
• Ensures the security, confidentiality and privacy of
health related personal information

7. Objectives of NDHM
• To establish state –of- art digital health systems, to
manage core digital 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 establishment,
health care professional, drugs and pharmacies
• To enforce adoption of open standards by all national
digital health stakeholders

8. • To create a system of personal health records based
on international standards, easily accessible to
individuals HCPs and service providers
• To promote development of enterprise-class health
application systems with a special focus on achieving
the SDG goals for health
• To adopt the best principles co-operative federalism
while working with the states and UTs

9. • To ensure that the private sector participate actively
with public health authorities in the building of
NDHM
• To ensure national portability in the provision of
health services
• To promote the use of clinical decision support(CDS)
systems by health professionals and practioners

10. • To protect a better management of 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 health care

11. Opportunity for the NDHM
• Current strong digital public infrastructure including
that related to Aadhaar and wide reach of internet
and smart phones
• The experience of AB- PMJAY can be leveraged to
expand the reach of digital health to all residents
• Emerging technologies such as artificial intelligence,
the internet of things(IoT), and cloud computing
provide additional opportunities

12. Benefits and Impact
• Improve the efficiency, effectiveness and
transparency of overall health service delivery
• Provide choice to individuals to accepts both public
and private health services, facilitate compliance
with guidelines and protocols and ensure
transparency
• Better access to patients history and helps to
digitalize claim process and faster reimbursement

13. • Policy makers and program managers will have better
access to data, advanced analytics and uses of
health bio-markers
• Enable geography and demography based
monitoring and appropriate decision making
• Facilitate a comprehensive feedback loop between
researchers, policymakers and providers

14. Reference:
https://www.nhp.gov.in/NHPfiles/National_Digital_Health_Blueprint_Report_com
ments

15. Guiding principles
 Health Domain principles
• Wellness-centric and wellness driven
• Educate and empower individuals to avail a wide range of
health and wellness services through appropriate
platforms and health apps
• Designed to be inclusive- to reach digitally illiterate and
residents of remote, hilly and tribal areas
• Will ensure security and privacy by design in accordance
with PDP bill 2019

16. • Designed to measure and display the performance
and accountability of all health service providers
• Will enable seamless portability across the country
through a Health ID
• Ecosystem of NDHM will be based on the principle,
“think big, start small, scale fast”

17. Technology Principles
• NDHM will be developed by adopting India
Enterprise Architecture framework (IndEA)
• Conform to open standards, be interoperable and
based on Open Source Software products
• Federated architecture will be adopted in all aspects
• Open API based ecosystem

18. • All major legacy systems will be assessed for
conformance to NDHB principles
• All the components, building blocks, registries of
NDHM will be designed adopting a minimalistic
approach
• All the registries and master databases will be built
as single source of truth on different aspects and
backed by strong data governance

19. Ref. National Digital health blueprint. MoHFW, e-Health section.

20. Scope of the Mission
• NDHM will implement the core and common digital
building blocks required for health care and make
them assessable as digital public goods
• Building blocks will be available as a collection of
cloud based services
• Helps to realize the vision of interoperable to both
public and private health ecosystem

21. Health data
• Personal health data: data related to an individual
containing detailed health information ,data with
personally identifiable information of various
stakeholders
• Non-personal heath data: includes aggregated
health data like number of CoVID-19 cases, dengue
cases etc and anonymized health data

22. • Electronic Medical Records (EMR): systems that
are used within a hospital to support diagnosis
and treatment and are transaction focused
• Electronic Health Record (EHR): contains records
for a patient across multiple doctors and
providers and is used within a health care system
• Personal Health Record (PHR): enable person to
compile, update and keep a copy of their own
records

23. Formats and adoption of standards of
data
• NDHB has recommended several health data
standards for adoption and use including FHIR-
R4, SNOMED-CT, ICD10/11
• HIPs must share with patients, a digital version of
any document already being given to patient
• Documents in standards complaint with FHIR-R4

24. Data Anonymization and Aggregation
• Anonymization is the irreversible process of
transforming personal data to a form in which a data
principal cannot be identified
• NDHB recommends providing anonymization as a
service that can be used by HIPs to anonymize data
as close to the source as possible
• Data aggregation is the process of gathering data and
presenting it in a summarized format

25. Health Data Legal Framework
• Laws, rules and regulations pertaining to personal
health data are predominantly covered under the
PDP bill, 2019
• Health records under NDHM are digitally signed
• They are equivalent to paper records under IT act
2000 and can be used in legal scenarios

26. Principles of Health Data Management
• Individual owned
• Consent driven sharing
• Revoke consents
• Partial sharing
• Voluntary
• Record from govt
schemes
• Update of an issued
health record
• Sharing health data
• Grievance
• Forget my data

27. Health ID
• Health ID standardize identification process of an
individual across health care providers
• National Health ID is a repository of all health
related information of a person
• Every person who wishes to have their health
records available digitally must start by creating a
Health ID

28. • For individuals intending to seek benefits of govt
subsidy schemes unique health ID will be generated
based on Aadhaar
• Each health ID will be linked to a health data consent
manager
• Any public hospital, community health centre or HWC
included in health infrastructure registry will be able to
support an individual in obtaining an health ID

29. • Health IDs will need to be digitally authenticable to
enable patients to provide their informed consent
• All health programs notified under statutory
provisions are required to integrate with the service
and issue Health ID
• Possibility of linking every Health ID with family
members Health ID will be explored within legal
framework

30. Health registries
• Heath registries are the key building blocks of NDHM
• They are the master data of all the entities in health
eco-system
• Each master registry will have a domain owner for
defining the rules and policies for addition and
modification of data

31. Principles of Health Registries
• Unique and complete values
• Self-maintainability and non-repudiability
• Layered access
• Extensible scheme
• Open APIs
• Aligned benefits

32.  healthcare Facility Registry
• Consist of one record and a unique identifier for each
HCF
• HCP will enable to apply online licences and paperless
empanelment to govt schemes
Health Workforce Registry
• Health workforce registry will cover doctors , nurses,
paramedic and FLW (DigiDoctor platform)
• To be successful, the registries have to be useful to the
entities listed on the registry as well as be useful to
other members of ecosystem

33. Health Claims
• NDHM will define and adopt a standard e-claim form
that can be used for any health insurance claim
• Create a Health Claim Platform(HCP) where health
providers submit their e-claim and payers receive e-
claim via standard APIs
• Ensure that HCP adhere to the set of designed
principles

34. Health Data Analytics
• Every HIP is expected to generate aggregated
data, managed by them in the federated
architecture
• Health data analytics platform are developed
• Advanced analytics tools like GIS visualizations
capabilities will be available

35. Open Telemedicine and e-Pharmacy
Network
• NDHM will expand access to care services via a
model enabling public and private sector Apps
• Standardization and institutionalization of the
digital health services like tele-medicine and e-
pharmacy
• Ensure accountability and also increase consumer
choice through multiple consumer apps

36. Implementation of the mission
• NDHM is a collaborative initiative between many
ministries and departments
Mission Steering Group- Chaired by Hon’ble Minister,
H&FW
Empowered Committee- Chaired by Secretary, Health
MoHFW and Meity
Legal and Regulatory Framework
National Health authority
Implementation of NDHM

37. • Mission Steering Group: will oversee and guide the Mission
• Empowered Committee:
 will take the necessary policy level decisions, helps the
Mission co-ordination with different stakeholders
,ministries and departments
 will supervise the roll-out of the Mission to all part of the
country
• Ministry of Health and Family welfare:
 provide overall supervision and guidance to NHA for
implementation of NDHM
 Co-ordinate states/ UTs and private sectors to ensure
participation

38. • Ministry of Electronics and Information Technology:
 will work with MoHFW for legal and regulatory
framework for NDHM
 Provide guidance on technological framework,
leveraging digital services in proper fashion and
emerging technologies across the globe
• National Health authority:
 will lead the implementation and co-ordinates GOI,
state govt and private sectors/ Civil society
organizations

39. Federated architecture-NDHM

40. References:
https://ndhm.gov.in/assets/uploads/NDHM_Strategy_Overview.pdf

41. Phased Implementation Methodology
• Phase 1: started as a pilot in 6 UTs (15 th
August 2020)
• Phase 2: will taking forward the pilot in
additional states and expand the service
bouquet
• Phase 3: nation wide roll out and converging
with all health schemes

42. Health infrastructure
• Privacy by design requires an infrastructure layer to
be established for management of key data services
in a compliant manner
• Infrastructure and networks available with NHA on
govt community clouds are used for implementation
• Separate domain, VLAN and cluster will be created
entirely for NDHM later on

43. • NDHM will be built to work on public networks by
default
• Wherever access to sensitive or aggregated data
is involved, secure connectivity is used
• Specific applications like telemedicine, tele-
radiology requires strong data link to systems like
PACs, low latency, high bandwidth network
systems

44. • Health clouds are build on the Meity initiative
with stronger security and privacy policies and
infrastructure
• Key data hub management services of the
Mission will be deployed on the H-cloud
• All events on the H-cloud and health network
will be under 24x7 security surveillance

45. Resources and support
• A dedicated division of NHA are working on the
operationalization and roll-out of NDHM across the
country
• NHA s current team working on PM-JAY will be
leveraged wherever appropriate to expedited
implementation of NDHM
• Budget allocation for NDHM is 144 cores rupees

46. NDHM: Organogram
Ref: National Digital Health Mission, strategy overview. July 2020

47. Way forward for NDHM
• Continuation at NHA: the mission may
continue to operate by NHA
• Another entity related to NHA: a new
functionally and autonomous entity under
NHA may be created after evaluation of initial
phases
• Distinct entity not linked to NHA: NDHM may
be transferred to a new entity as finalized by
mission steering group

48. Risks
• Striking the right balance between service
orientation, financial models and not diluting
public good nature
• Clarity of components and building blocks of
NDHM and there timeline of implementation
• Keeping pace with technological advances and
adopting latest standards
• Cyber security and fraud control risks, data
migration between cloud servers

49. Expected Outcomes
• All individuals will be able to conveniently access
their personal health records
• Individuals will able to aggregate their health data in
a single application (PHR)
• Leveraging longitudinal health record data will
reduce the occurrence of repeated diagnostic test
• Assure the continuum of care for individuals

50. • NDHM will support national portability of health care
services
• Enable evidence- based interventions in public
health
• Analytical capabilities of NDHM will support data
driven decision-making and policy analysis

51. Conclusion
• Digital health interventions can accelerate progress
towards UHC and improve population health
outcomes
• NDHM will contribute significantly to achieving goals
of NHP-2017
• Will mark a new beginning for the Indian digital
healthcare ecosystem, enabling more effective
delivery of healthcare services

52. References
• National Digital Health Mission, strategy overview. July 2020 National
Health Authority. Available from: [Internet]
https://ndhm.gov.in/assets/uploads/NDHM_Strategy_Overview.pdf
• National Digital health blueprint. MoHFW, e-Health section. Available
from: [Internet]
https://www.nhp.gov.in/NHPfiles/National_Digital_Health_Blueprint_Rep
ort
• National Health Stack. Strategy and approach. NITI Aayog, GOI. Available
from [Internet]
http://niti.gov.in/writereaddata/files/document_publication/NHS-
Strategy-and-Approach-Document-for-consultation
• Taneja DK. Health Policies& Programmes in India. 15th ed. New Delhi India:
Jaypee Brothers Medical publishers pvt ltd

53. THANK YOU
For your pleasant listening