3. INTRODUCTION
• In July 2018, the National Institution for Transforming India (NITI Aayog) proposed the development of a
digital platform called ‘National Health Stack (NHS)’with the aim to create digital health records for all the
citizens of India by the year 2022.
• In July 2019, NITIAayog came up with a report ‘National Digital Health Blueprint (NDHB)’which outlines
the action plan to realize the development of National Health Stack.
• The National Digital Health Blueprint acts as a strategic and technical foundation of the National Digital
Health Mission.
• 15th August 2020: Launch of National Digital Health Mission.
• At present, the programme is renamed asAyushman Bharat Digital Mission(ABDM)
4. VISION
To create a national digital health ecosystem that supports universal health coverage
in an efficient, accessible, inclusive, affordable, timely and safe manner, that
provides a wide-range of data, information and infrastructure services, duly
leveraging open, interoperable, standards-based digital systems, and ensures the
security, confidentiality and privacy of health-related personal information
5. OBJECTIVES
Establish state of art digital health systems and managing health
data
Improve the quality of health data collection, storage and
dissemination
Provide a platform for interoperability of healthcare data
Fast track creation of updated and accurate Health Registries for
the entire country
Create provision to measure quality of care, progress against policy
initiatives and Sustainable Developmental Goals.
6. Principle Guidelines
• Signing up for digital health accounts and generation of records will be
voluntary and an option of opt-out after signup
• PHR will be accessed and shared only after the consent of the Health
ID holder.
Voluntary Participation
• Zero TrustArchitecture
• Personal Data Protection Bill 2019, ITAct 2008 and theAadhaarAct
2006
• Security Operations Centre (SOC).
Privacy and security
• There will be provision of specialized systems and off-line modules to
reach out to the unconnected, marginalized, remote, tribal, hilly and
digitally illiterate populations.
Inclusive
7. • Comprehensive information, education and communication (IEC)
strategies shall be deployed through appropriate communication. For
e.g.ASHAs andAWWs.
Educate and empower
• Real-time monitoring of the Service Levels and health sector KPIs
will be the key driver to measure and publish performance of all
health institutions and professionals.
Performance Management
• All the design and development efforts will adopt theAgile IndEA
Framework notified by the Ministry of Electronics and
Information Technology (MeitY). Other national and
international standards will be adopted.
India EnterpriseArchitecture
Framework (IndEA)
8. • All the building blocks and components of NDHB shall conform to
open standards, be interoperable and based on Open Source
Software products.
Open Source Development
• Only the identified Core Building Blocks will be developed and
maintained centrally.All other building blocks shall be designed to be
operated in a federated model that factors regional, state-level and
institution-level platforms and systems to function independently but
in an interoperable manner.
FederatedArchitecture
• All the building Blocks will be architected adopting the Open API
Policy notified by MeitY, GoI and will share data as per standards as
defined in NDHB
OpenAPI-based Ecosystem
9. Key
Components
Health ID Personal Health Record
(PHR)
Healthcare Professional
Registry (HPR)
Health Facility Registry
(HFR)
Unified Health Interface
10. Unique Health Identity (UHiD)
It is important to standardize the process of identification of an individual across
healthcare providers.
Health ID will be used to uniquely identify persons, authenticate them, and
threading their health records (only with the informed consent of the patient)
across multiple systems and stakeholders.
HID will be created using a person’s basic information and mobile number or
Aadhaar number
Can be obtained with the support of healthcare provider who is in the national
health infrastructure registry or it can be obtained by self-registration from a
mobile or a web application.
11. Personal Health Record (PHR)
Electronic application for an individual’s health related information that conforms to nationally recognized interoperability
standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.
Key Features: Option to create a unique Health ID.
Option to link the health ID with various health care facilities including Hospital, Clinic and
Labs.
Option to request the health data from the linked health care facilities on to the phone and
have a longitudinal view of the health data at the fingertips.
Option to deny or grant permission, if any doctors, labs or clinics request to view the health
data
Option ‘Forget my Data’
12. • Each Health ID will be linked to a health data consent manager.
• Consent Management Framework: to ensure that citizens /patient data is in complete control of what
data is collected and how/whom it is shared and for what purpose and how it is processed.
• Individuals will have right to share only a part of their record with doctors as per their will.
• Individuals will have the right to review and revoke any consent that has been issued including time
limitations.
• NDHM will institutionalize an Informed Consent Policy to standardize the processes related to
consent management
13. Healthcare Professional Registry
DigiDoctor
Comprehensive repository of all healthcare professionals involved in delivery of
healthcare services across both modern and traditional systems of medicine.
All Health registries will have public data—accessible via open Application
Programming Interface (APIs), and consented data—detailed data available
only on the informed consent of the underlying entity.
Each Master Registry will have a domain owner who will be responsible for
defining the rules and policies.
14. Possible domain owners for key Registries include:
1. Doctors Registry: National Medical Council/Medical Council of
India/Central Council of Indian Medicine
2. Insurers Registry: The Insurance Regulatory and Development Authority
of India (IRDAI)
3. Pharmacy Registry: Pharmacy Council of India
4. Dentists– Dental Council of India
5. AYUSH Doctors – Relevant bodies within the Ministry ofAYUSH
Improvement of the verification process: Online Registration Renewal,
NOC issuance, continuing medical education(CME) credit tracking
Doctors may be able to display their professional work history/journey in their
profiles instilling higher trust amongst individuals.
15. HEALTHCARE FACILITYREGISTRY
A Comprehensive repository of health facilities including both public and private hospitals, clinics, diagnostic
laboratories
and imaging centers, pharmacies, etc. of the country.
These registries provide the basic information about these entities, ensuring the reliability of the health information
generated as a System of Record (SoR) and increased healthcare providers’accountability.
V
erified entry in the registry will enable them to apply online for several licenses like pollution clearance,AtomicEnergy
RegulatoryBoard(AERB), Drug/Pharmacy licenses, Pre-Conception and Pre-Natal Diagnostic Techniques (PNDT),
medical waste management, etc.
The registry will also enable paperless empanelment to government schemes and private insurance as a standardized e-
facility record can be shared from the registry with consent.
16. • The architecture is laid out at: National,
State and Local Level, in a decentralized
manner, following the principle of
minimality at each level
• Each level has the systems designed in 4
Layers, each layer consisting of a set of
building blocks of a particular type,
namely, Infrastructure, Data, Technology
andApplication building blocks.
17. India Stack has repurposed the UPI
technology for healthcare.
Much like UPI, Individuals with
UHiD will able to connect with
doctors of their choice through any
app compatible with it, share health
information and receive health reports.
Unified Health Interface (UHI)
19. IMPLEMENTATION STRATEGY
Health account for everyone
Convergence of different
scheme
Automation benefits
enablement- PMJA
Y etc
All health benefits and
policies- private and public,
linked to health ID
PDF and scanned health
records
Prescription and reports in
PHR
Metadata and E reports with
analytics
Integration with public and
private HIPs
Health Biomarkers
preventive health care
Unique Id for Doctors
E-prescription & e-signature
platforms
Verification with Master
domainAPIs
Updating of qualification
and employment
Real time feedback and
rating of doctors
Unique ID
Validation through NHRR
Provisional verification by
NHA
Audit by Statutory Health
FacilityAuditor
GIS based visualisation
Automatic benefit
enablement
ConvergedAudits
PHASE 1 PHASE 2 PHASE 3
Health ID
Personal
Health Record
DigiDoctor
Health Facility
Registry
20. • The pilot phase of ABDM was successfully conducted between 15th
August 2020 to 27th September 2021 in seven Union Territories -
Andaman & Nicobar, Chandigarh, Dadra & Nagar Haveli and Daman &
Diu, Ladakh, Lakshadweep and Puducherry.
• On 27th September 2021, the national rollout of theABDM has been
announced.
• Till 24th Aug 2022, 23 Cr UHIDs, 1,35,000 Health facilities, 42,000
Healthcare professionals have been registered, and 6 lakh
downloads of Health records applications.
• Sandbox environment: This system allows the testing of the
technologies or products of public as well as private org. by the
NDHM standards, who want to be a part of this ecosystem.
21. Future Implementations
Health Claims Platform:
• Will develop and rolling out for various Government health claim schemes such as PM-JAY, Employees’
State Insurance Scheme(ESIS) etc. The remaining public and private health insurance will be brought
on-board with support of MoHFW and The Insurance Regulatory and Development Authority of India .
• Defining a standard e-Claim form that can be used for any health insurance claim: Public or Private.
These Platforms will act as a public good where health providers submit their e-Claims and Payers
(Insurers and TPAs) receive e-claims via standardAPIs.
Telemedicine and E-Pharmacy:
• Core engine ownership and control with the Government for ensuring accountability
• This will require private sector participation to enable choice of service delivery and enhanced access to
patients to seek teleconsultation or to purchase medication through any NDHM compatible applications
of their own choice
22. • This will take data sets from the health analytics system and produce outputs
that can be consumed by the application layers.
• Help in generating a wide variety of reports that would be useful to the policy
makers, researchers, and public in general
• The GIS services will help in regional/state level planning and monitoring of
health services.
Geographic Information System(GIS)/Visualization:
Anonymizer as-a-service
• TheAnonymizer that will be built by NDHM will take data from the Health
Locker and/or other health data sets, will remove all personally identifiable
information to protect privacy and will provide the anonymized data to the
Health Information User.
23. Expected
Outcomes
Citizens can access their health records within 5 clicks.
Citizen will have to undergo a diagnostic test only once and can follow up
treatments from different healthcare providers.
Health care professionals will have better access to patient’s medical history
(with the necessary informed consent) for prescribing more appropriate and
effective health interventions
All healthcare services are provided at a single point.
Continuum of care is assured at primary, secondary, and tertiary care.
Enable evidence‐based interventions in public health
24. Risks
Acceptance and usage of NDHM building blocks by other stakeholders,
especially private sector.
Clarity on the components and building blocks of NDHM and their timeline of
implementation
Keeping pace with technological advances and adopting the latest standards, e.g.,
those related to changes in anonymization practices, etc.
Cyber security and fraud control risks
Data migration between cloud servers, maintenance of data and core
infrastructure
25. Conclusion
• With increased ease of use, acceptance by the people and adaptation by service providers, digital health
interventions can accelerate progress towards UHC and improve population health outcomes.
• NDHM will contribute significantly to achieving the goals of National Health Policy 2017 and the SDGs
related to health.
• However, the failure of a similar National Health Service (NHS) in the United Kingdom must be a learnt
lesson from and the technical and implementation-related deficiencies must be proactively addressed.
