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NDHM Architecture NDHM is employing a federated architecture for its ecosystem. That means that management and data access occurs in a federated manner where different entities or systems will manage the health data.
There is no central data storage controlling and storing data.
Using the Federated Health Records Framework (FHR), patients can access and view their health records, and provide consent to any HIPs and HIUs to access their data.
To ensure smooth consented data sharing and time-bound data access, it is necessary to make the data traceable and auditable. Therefore the FHR Framework architecture leverages MeitY's Data Empowerment and Protection Architecture (DEPA) electronic consent framework, which is already being used in the financial sector. Here are some interesting technical features of the NDHM ecosystem FHIR for all Medical Data Asynchronous APIs Patient Privacy & Security Features of NDHM - HIPs can only create data if authorized by the Patient: - An HIU(Health Information User) can only get past health records of other HIPs if consented by Patient - Peer to Peer Data Transfer Between HIP & HIU Final Thoughts It is one thing to have a concept and another thing to implement and execute it. So far NDHM seems to be going in the right direction. And there is hope that it will continue to do so.
Technology is being given equal importance to gain the trust of all players involved in this industry.
Privacy and Security have been a prime priority in the project as you can see from the above article, this is an oft-ignored aspect in old projects. Hope it continues to stay this way. read the whole article at http://technology4doctors.blogspot.com/2021/05/an-overview-of-ndhms-technology.html
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The government has invited suggestions as it seeks to roll out the Unified Health Interface as part of the National Digital Health Mission (NDHM). The National Health Authority (NHA), which has been mandated to design and roll out NDHM in the country, said that comments from the public have been invited to ensure that UHI is designed and developed in a collaborative and consultative manner. The consultation paper provides an overview of the proposed design, scope and role of Unified Health Interface. Through UHI, the NDHM aims to transform the way digital health services are rendered in India. Currently, patients and healthcare providers need to be on the same application to avail and provide digital health services, the NHA said. “It is envisioned that the open network created by UHI will serve as the digital infrastructure for patients and healthcare providers to engage in the discovery, booking, payment and fulfilment of a variety of digital health services across applications,” it said. The services include, but are not limited to, teleconsultation and the discovery of pharmacies and hospitals. Over time, the services enabled by the platform will evolve with the market ecosystem. UHI is designed to be similar to the UPI (Unified Payments Interface) ecosystem which has emerged for digital payments. source: https://www.deccanherald.com/national/centre-invites-suggestions-for-unified-health-interface-under-digital-health-mission-1012470.html
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In India, accredited social health activists (ASHAs) are the foot soldiers of the rural healthcare system. During the COVID-19 pandemic, they’ve turned to WhatsApp to combat rampant misinformation in the communities they serve.
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The MediXcel Digital Health platform by Plus91 Technologies has been approved by NDHM after meeting the compliance for all 3 milestones. MediXcel is a versatile and scalable platform used by clinics, diagnostic groups, hospitals, digital health service providers, and government PHCs. The approval to the MediXcel platform from Plus91 was granted after following a stringent process of compliance checks for all 3 milestones released by NDHM which included live demonstrations and an OWASP (Open Web Application Security Project) audit by reputed 3rd party security testing companies. Plus91 is among the first few private companies being provided production access to the NDHM stack. It is also the oldest registered provider of HIS and LIMS solutions to the market in this group so far. MediXcel currently caters to single and multi-specialty clinics, clinic chains, diagnostic groups, and hospitals of various sizes. MediXcel offers its customers an end-to-end clinical and administrative solution that includes an Electronic Medical Record (EMR) and specialized modules for Inventory, Pharmacy, Laboratory Services, Radiology, Billing, and Insurance management. It also includes an in-build Clinical CRM, an Analytics and Reporting Toolkit, and a Patient Portal. MediXcel also offers its customers companion apps for Doctors and Patients, both on Android and iOS. Its inbuilt integrations include a TeleHealth system, Accounting Solutions, and a PACS. Plus91 CEO, Aditya Patkar commented, “We at Plus91 believe that the NDHM framework has many benefits for stakeholders. We hope there is active participation from all to make those benefits a reality. The key central beneficiary is the patient and we believe that NDHM will empower all Indians to better understand their health journey and make the clinical decision process more transparent.” view the PR at https://www.1888pressrelease.com/national-digital-health-mission-approves-plus91-s-medixcel-d-pr-692160.html The release at the Plus91 website - https://plus91.in/media/pr/national-digital-health-mission-approves-plus91s-medixcel-digital-health-platform-for-clinics-labs-and-hospitals/
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With a vision to create a digital healthcare ecosystem, the government of India announced the implementation of the National Digital Health Mission (NDHM) in the country. It addresses the inequalities in healthcare coverage by strengthening rural and urban healthcare infrastructure and improving delivery models. This results in a desirable requirement to ensure universal health coverage where dynamic healthcare systems and models can be regulated for cost-effective and quality care. Considering the scenario, it requires the involvement of healthcare stakeholders to overcome the challenges and fill critical gaps in achieving universal health coverage.
Implementation of NDHM
The development of healthcare in a digitized economy is the need of the hour. It will require an agile and strategized approach to achieve the sustainable goal of NDHM. The implementation of the mission is based on the approach of ‘Think Big, Start Small, Scale Fast’. It will occur in three phases deliberately planned to ensure universal health coverage in the country.
Roll out in Union Territories
This is the pilot phase of NDHM in which all technological platforms were desired to be developed by August 15, 2020. As an initial stage, the implementation of NDHM will be done to build the capacity of stakeholders in selected Union Territories – Andaman & Nicobar Islands, Chandigarh, Dadra & Nagar Haveli, and Daman & Diu, Lakshadweep, Ladakh, and Puducherry.
Expansion – States & Services
NDHM is aimed at ensuring universal health coverage. To enable that, the second phase of the implementation will involve the expansion of the work initiated in UTs to states. To onboard the process in other states, there will be a dedicated team to roll out the management of the mission. Carrying out such an expansive mission on a vast level requires people on every level. From initiation of the rollout to monitoring the mission, it will require extensive support from stakeholders. Nationwide roll-out The final stage of NDHM’s implementation will involve the roll out of the platforms’ components across the country. It emphasizes development, beta testing, and Go Live for components which will be done zone-wise. Since India’s population is highly scattered into rural and urban areas, the implementation of NDHM will be initiated by marking zones.
Agile Implementation Methodology
NDHM is one of the biggest missions in the history of the Indian healthcare sector. It will be based on the principles of the Agile India Enterprise Architecture (Agile IndEA) Framework. These principles involve – identification, definition, and assessment of value, development of Just Enough Architecture (JEA), Just in Time (JIT), adoption of the minimalist approach in all aspects and stages, designing federal architecture model, API-based access and Integration, evaluation and enhancement of individual experience, and following agile procurement methods.
more at https://www.biovoicenews.com/ndhm-the-nationwide-implementation-of-the-ambitious-mission/
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The days of people standing in long queues at health facilities carrying multiple medical reports will become a thing of the past in this digital- and patient-friendly ecosystem NDHM’s implementation
In a country like India, achieving universal health coverage has always been daunting due to its population scattered in urban and rural areas. Concerns such as low digital literacy, low internet connectivity, and accessibility to healthcare professionals make the implementation of any health mission difficult in remote areas. Taking such factors into account, NDHM works on four core modules – HealthID, DigiDoctor, Health Facility Registry, and Telemedicine. It is expected to aid all stakeholders to move from a conventional to a digitized healthcare system while ensuring a preventive healthcare delivery model.
Presently, the government has rolled out NDHM on a pilot basis in 6 UTs – Puducherry, Chandigarh, Dadra and Nagar Haveli, Ladakh, Andaman & Nicobar Islands, Daman and Diu, and Lakshadweep. Considering the selected UTs face constant connectivity and other challenges, the government’s awareness-building campaigns are going to build adequate digital literacy in rural areas.
NDHM is intended to move India towards a digital healthcare society. By leveraging new-age technologies, the mission improves the quality of healthcare delivery by enabling the doctors and hospitals to access the patient’s medical history and increasing the availability and accessibility of consultation through telemedicine. If implemented in a structured manner, NDHM can create a robust digital healthcare system for effective resource planning as well as disease management. The unprecedented scale of NDHM makes it a prerequisite for obtaining universal health coverage in the country. The proper implementation of the mission can not only bring healthcare to people’s homes but also help in empowering them to make better decisions for their health. Additionally, boosting the concept of e-pharmacies and telemedicine through NDHM is going to fuel the sector’s overall growth. read more at https://www.biovoicenews.com/ndhm-a-game-changer-in-ensuring-universal-health-coverage-in-the-country/
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The Indian government had recognised the potential of digital technologies in improving the healthcare landscape in the country early on. The launch of the National Digital Health Mission (NDHM) and National Digital Health Blueprint (NDHB) underscore the value that the government attaches to the digitisation of healthcare. Digital transformation had been on the agenda of healthcare providers for years—yet, despite huge progress across the industry, full rethinking of healthcare for the digital age often remained an elusive long-term goal. It is here that Covid-19 provided a tailwind to the need for reinforcing the role of digital technologies in improving India’s healthcare. One of the most significant trends that we have observed is that care is moving towards patients in tier-2 and tier-3 cities. Earlier patients from these cities would come to tier-I cities for treatment; with COVID-19 that was not possible. What is happening now is that tier-2 and tier-3 cities are building capacity to treat patients with diagnosis being done by experts in tier-1 cities. Much of this is happening through the internet and often manifests itself in the form of e-consultations, tele medicine and other such forms of intervention. And this really is the concept of connected care where eICUs, NICUs (neonatal ICUs) and Remote Operating Centres (ROCs) can be monitored by experts who aren’t really in the same geographic location. India currently has more than 11.5 lakh doctors, more than 25,000 government hospitals and more than 7 lakh beds in these hospitals. These sizeable assets, which are being improved upon, can be extended and more optimally utilised by using digital approaches to healthcare. Today, you could easily have an entire chain of NICUs in a tier-2 city having its young patients being monitored by top-notch intensivists from a metro. A solution driven approach, where products and services are bundled together, delivered through new mediums can drastically alter the healthcare landscape for the better in the coming days! read more at https://www.financialexpress.com/opinion/healthcare-in-india-digitisation-is-the-way-forward/2210873/
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The ministry in reply to a parliamentary question said that the total number of Health IDs issued under the NDHM pilot is over 1.1 million. The Ministry of Health and Family Welfare (MoHFW) in reply to a parliamentary question revealed that the total number of Unique Health IDs created so far under the ongoing pilot project of the National Digital Health Mission (NDHM) is over 1.1 million. The question was asked by Congress MP Pradyut Bordoloi in the Lok Sabha and answered on July 23. Minister of State for the MoHFW Dr. Bharati Pravin Pawar in her reply also said that the total budget that was earmarked for creating Unique Health IDs for the year 2020-21 under the NDHM pilot was Rs 30 crore. Why it matters? The National Digital Health Mission, started as a pilot project in August 2020, was instituted to create a digital health architecture using health IDs, unique identifiers and registries for doctors and health facilities, personal health records, telemedicine, and e-pharmacies, among other components. Since then, it has also been expanded nationwide after the health ministry earlier this year allowed the creation of Health IDs through voluntary authentication of identity through Aadhaar to beneficiaries of “various health IT applications.” Privacy experts had, upon the NDHM’s launch, raised concerns about the digitisation of health records, saying that the proposed ‘womb to tomb’ health identity raised the possibility of surveillance. Pawar said that 11,68,226 Health IDs had been issued under the pilot that is currently taking place in six Union Territories. - Andaman & Nicobar Islands (2,14,297)
- Lakshadweep (51,745)
- Ladakh (76,968)
- Dadra & Nagar Haveli and Daman & Diu (1,39,449)
- Puducherry (4,91,903)
- Chandigarh (1,93,864)
What is a Unique Health ID? A Unique Health ID is a unique identifier that is linked to a person’s health records, their Aadhaar card, and phone number. According to an NHA consultation paper, this would create a longitudinal Personal Health Record (PHR) for the individual, i.e., a medical record across multiple patient encounters in different health facilities. read more at https://www.medianama.com/2021/07/223-parliament-ndhm-health-id/
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With the resurgent wave of the pandemic reaffirming our belief in the benefits and positive externalities of a robust health infrastructure.The existing health care policy framework is multi-dimensional and … Read More...
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New guidelines leave several questions unanswered, including those regarding data safety and involvement of technology providers.
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The National Digital Health Mission (NDHM) has been busy signing up doctors into the Digi-Doctor portal in 6 union territories and is being met with a mixed response. The Digi-Doctor Portal will act as a registry for the doctors and provide services to them and their patients. The services will be provided on the backbone of digital data portability initially related to patient demographic information and clinical data but later to expand to claims, prescriptions, and more. Before we do list the benefits of the NDHM framework for doctors it would be good to list the reasons the doctors may not want to sign-up as per a few snippets floating online. Three stand-out reasons put forth are: - Doctors in general, will not be comfortable sharing their treatments and protocols with others, either for reasons of knowledge protection but more importantly due to opening themselves to malpractice suits.
- Some doctors who indulge in the same may feel their referral system under duress as NDHM ensures Diagnostic reporting is done a minimum number of times due to data being shared easily under consent.
- Lastly, there is some talk of having a standardized price list (already attempted under the Clinical Establishment Act) having to be shared as part of the NDHM sign-up, which may affect what the doctors charge for their services. While this standardization attempt is still speculation in terms of how it will be attempted or what it entails, this particular point will affect all doctors and hospitals irrespective of them being signed up or not and hence becomes moot.
Here is a summary of the benefits for the doctors. The details are available at the original source Benefits of signing up with NDHM for doctors Some of the Administrative benefits are: - License Renewal:
- A barrier for quacks:
- CME Credit tracking:
- Faster Insurance approvals:
The Patient and Work-related benefits are: - Access to Patient History:
- Tele-Consultations:
- Access to Global Standards:
- Access to Government Programs and Studies:
The Business-related benefits are: - Online Presence:
- Access to Additional services:
- Storage of records:
- Patient insurance claims:
There is apprehension amongst the Doctor community as there is with any Government registration process on whether it will infringe on their rights or bring in regulation that is detrimental to their wellbeing or livelihoods. The NHA for its part has started outreach programs at least in union territories so far to allay these fears. Their framework and plans so far speak of the good intentions of the ministry of health and family welfare (MOHFW). The question remains, will all these benefits outweigh the few niggling doubts in the minds of our current day superheroes. Read the post written by my good friend and among the best EMR Experts in world, Aditya Patkar at https://technology4doctors.blogspot.com/2021/05/benefits-of-signing-up-with-ndhm-for.html
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Technology in the Indian healthcare sector has always been at a nascent stage but its rate of advancement and adoption is making the sector leapfrog into a highly digitized system. Imagine a scenario where the patients’ health records are accessible to healthcare facilitators in just a few clicks. It is possible and has been already happening in the industry through digital healthcare systems. However, the biggest challenge presented in enabling a digitized healthcare system is the population of India scattered in urban and rural areas. To overcome this problem a shared digital infrastructure leveraging both public and private enterprises is the need of the hour to provide innovative solutions
To fulfill the vision of promoting holistic wellness, accessibility, and affordability, the Indian government has launched the National Digital Health Mission (NDHM) that bridges the existing gap amongst different stakeholders of the Healthcare ecosystem through digital highways. The mission aims to develop the backbone necessary to support the integrated digital health infrastructure of the country.
Technology is highly pervasive and in a country like India, it plays a crucial role in realizing the goal of universal health coverage. The NDHM leverages new-age technology and has designed NDHM Sandbox that allows all products to be tested in compliance with NDHM standards. It is a framework that provides open access to all healthcare stakeholders to build/expand the product line in the healthcare industry while empowering the core building blocks of the mission. It includes health ID for every citizen, DigiDoctor (a unique identifier to every doctor of every stream of medicine), Health Facility Registry (a unique and standardized identifier to hospitals, clinics, pharmacies, and labs) that are projected to ensure an efficient and connected healthcare experience.
India was longing for a more planned approach in the healthcare system integrated with new technologies and digitized structure. NDHM’s plan comprises actions that address the challenges in the conventional healthcare scenario. By simplifying the processes and improving accessibility, NDHM can play an integral role in the vision of providing universal health coverage across the country.
read more at https://www.biovoicenews.com/ndhm-paving-the-way-for-a-digitized-and-connected-healthcare-system/
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Global healthcare is rapidly changing with the infusion of technology. COVID-19 has significantly accelerated virtual health adoption; virtual visits rose from 19% in the beginning of 2020 to 28% in April 2020. Additionally, consumers are now more comfortable sharing personal data through digital health channels. The future of healthcare will be heavily dependent on the convergence of multiple technologies that will suit the varying requirements of different (healthcare) stakeholders - HSPs, HCPs, patients etc.
For instance, here is a visualization of India’s National Digital Health Blueprint (NDHB) that includes key features like a unified architecture, avenues for privacy and consent control, national portability, electronic health records, appropriate principles and guidelines, and health analytics. Our observation is India’s National Digital Health Mission (NDHM) is leveraging the guiding principles that we have described in this blog. In their creation of a digital infrastructure for the country’s progressive health ecosystem, NDHM is implementing several digital forward initiatives:
Identification - Individuals can use a health ID and a digital health locker will store and enable access to a patient’s medical history in a safe and secured manner.
Citizen in control - NDHM is implementing the principles of Data Empowerment and Protection Architecture (DEPA) through the consent manager, privacy operations center and anonymizer.
Omnichannel service delivery - Digital technologies allow for patient information to be accessible to both the patient and health care provider through a channel of choice - health portals or apps, call centers or even social media platforms.
Interoperability - Interoperability allows for all players in the ecosystem to share and consume information. This strengthens the healthcare value chain, by giving the patient a comprehensive health and wellness solution.
We believe digital healthcare will not only fix existing hurdles in the healthcare system but will also call for the (much needed) reengineering of key areas like data security and privacy. Advancements in regulatory compliance, robust fallback systems when tech can’t deliver will accelerate adoption within low-tech populations.
And we believe, not unlike with digital payments, if initial apprehensions are addressed in a timely manner - adoption of digital tech will not just improve but become inevitable for the healthcare space. read the whole post at https://www.thoughtworks.com/insights/blog/building-digital-first-healthcare-ecosystem
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NDHM holds significant promise on transforming India’s healthcare system, especially for the country’s most underserved.. Most of the discussion around India’s public health infrastructure in the past year has been centred on fighting Covid-19. But amidst this big challenge, India has taken an important step towards better delivery of healthcare by committing itself to building its digital highways through the National Digital Health Mission (NDHM). If NDHM works, the familiar scenes of hospital waiting rooms with patients carrying binders of their medical records for the doctor’s reference could soon be history. NDHM’s digital infrastructure is envisioned to enable patients to move seamlessly from one healthcare provider to another. It hopes to create and link distributed databases of patient health to ease access for doctors and hospitals while providing add-on services. Consider a migrant worker from Bihar with a chronic ailment, working as a daily wage labourer in Delhi—he is unlikely to have preserved and carried any of his past medical reports from his hometown. NDHM would allow him to get treatment at a facility in Delhi without going through long registration processes and re-tests, and if eligible, in a cashless manner under the PM-JAY scheme. In time, as the ecosystem develops, he would also be able to avail additional services built on top of the NDHM platform, such as telemedicine, additional insurance products, and even AI-powered diagnostics. more at https://www.financialexpress.com/opinion/reimagining-indias-healthcare/2210213/
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