Strong Digital Health Capability Key to Realizing the Goal of Ayushman Bharat

By Dr. Devendra Kumar Punia, CIO, Paras Healthcare

Established in 2006, Paras Healthcare has a unique healthcare delivery model based on the three principles that define its values Accessibility, Affordability and Quality. The company aims to provide specialized tertiary medical care services at affordable prices.

With India launching its most ambitious healthcare scheme ever in the form of Ayushman Bharat or Pradhan Mantri Jan Arogya Yojana (PMJAY), there is both excitement and apprehension over its future. Excitement stems from the huge benefits it promises to deliver towards realizing our goal of universal healthcare while apprehension surrounds our ability (or the lack of it) to make this mammoth project a success. A program that aims to provide substantial health coverage to as many as 10 crore households can be a game-changer if it is rolled out successfully. Not only does it make healthcare more accessible for millions of deprived Indians, it also promises to radically improve primary and preventive healthcare by building 1.5 lakh health and wellness centers.

As our country works towards achieving a uniform and standardized health coverage system, key to its success is building a strong capability in digital health. Digital health is essentially a paradigm that converges healthcare delivery with digital tools in a way that empowers us to better track, manage, and improve our health so that we are able to lead better and more productive lives. A strong digital health system will also address the inefficiencies in healthcare delivery, make healthcare more accessible and cost effective.

An Enabling Digital Infrastructure for PMJAY – National Health Stack
Understandably, a program that envisions provision of paperless and cashless treatment for the poor across a large network of public and private hospitals faces multiple challenges. Earlier initiatives in India include Rashtriya Swasthya Bima Yojana (RSBY), Rajiv Arogyasri in Telangana, Yeshasvini in Karnataka, etc. The challenges faced in implementation of these have been - poor enrolment of entitled beneficiaries, low participation by service providers, poor fraud detection, lack of reliable and timely data and analytics etc. The other major challenge has been portability of health services across the country, as health is a state subject and there is large migration of citizens for employment.

" Availability of clinical data on health has been a major problem for medical researchers in India"

On top of this strong technology foundation, NHS will have healthcare domain focused services like induction of private hospitals and private practitioners into the primary and secondary healthcare ecosystem; focus on Non-Communicable Diseases (NCD); disease surveillance; health schemes management systems; nutrition management; school health schemes; emergency management; e-Learning platform for health, LMS,telehealth, tele-radiology; diagnostic equipment; healthcall centre(s) etc.

Why Digital Infrastructure?
 
A nationwide reach with such massive coverage would need a truly digital, paperless and cashless service delivery with an IT backbone that successfully converges disparate systems and scattered data to make the healthcare experience seamless and hassle free for the poor beneficiaries while serving to bring down costs of health protection by leveraging the benefit of health data.

Experts say that previous health coverage schemes initiated by different governments have failed to take off because of a series of factors such as low enrollment of entitled beneficiaries, low participation by service providers, lack of reliable data and analytics as well as poor fraud detection. If Ayushman Bharat has to succeed, the digital spine behind it has to function in a way that it plugs all these above loopholes. Availability of reliable healthcare data is one of the most important requisites for health insurance providers to assess the healthcare scenario of a region, the dominant diseases and risks. Unfortunately, statistics on health are highly unreliable in India with most experts agreeing to the fact that disease prevalence is significantly under-reported, especially among poorer populations. The NHS must become not just a tool to share information between various stakeholders of the scheme but also a reliable repository of data on health. With time, this consolidated data can provide sufficient information to insurance providers to be able to offer more cost effective coverage.

Improving Accessibility in Primary Healthcare
Digital health tools are critical in realizing this goal. We will have to use tools such as telemedicine and digital health applications to cover up the shortage of human resource. Establishing telemedicine centres where patients can interact with doctors and seek consultation virtually must be done at every primary health centre. The government and private sector must also invest in building digital applications that help monitor nutrition levels among rural populations, and send automated vaccination reminders to parents.

This will also require extensive efforts to improve digital literacy in the country. According to a report by the Internet and Mobile Association of India (IAMAI), urban India with an estimated population of 455 million already has 295 million people using the Internet. However, rural India, with an estimated population of over 900 million has only 186 million internet users. This clearly tells us about the digital literacy gap in India which needs to be bridged.

Big Data Analyses for Better Healthcare Outcomes
 
Availability of clinical data on health has been a major problem for medical researchers in India. Digitization of medical records paves the way for creation of a huge database of disease related statistics which can be utilized for medical research and analysis, thereby helping improve public health outcomes at large. With low-cost access to rich longitudinal data on large populations for epidemiologic research, researchers can use data analytic techniques and predictive analyses to arrive at solutions to public health problems and evolve epidemiologic theory. The large sample sizes and diverse information available in a large database can be very useful for population health research and for overall benefit of public health.

Earlier experiences with platforms and systems in the cases of income tax, GSTN etc. have shown that NHS like platform can be really useful and critical to the success of Ayushman Bharat. All the stakeholders need to come onboard to make the vision of cashless care with improved access to ensure the protection for the poor.

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