News Excerpt
The Union Government has launched the National Digital Health Mission(NDHM). It will come under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana.

•    The origin of the NDHM goes back to the National Health Policy, 2017, which proposed a new National Digital Health Authority.
•    In July 2019, the National Digital Health Blueprint was released by a committee headed by former UIDAI.
•    According to the blueprint, the objective of the digital mission is to achieve a citizen-centric, universal health coverage that provides quality healthcare, with better accessibility and inclusivity by leveraging the power of the digital technologies.
•    The National Digital Health Blueprint recommended the setting up of the NDHM, a governmental organisation with complete functional autonomy on the lines of UIDAI and Goods and Services Network.

Digital Health Records
    The health records in India is as fragmented as its healthcare market.
    Public and private hospitals often have varying technological capacity. The government has been trying to get hospitals to voluntarily adopt digital health records by notifying standards and recommendations under existing legal frameworks, such as the Clinical Establishment Act, 2010, with limited gains.
    The issue of inadequate record-keeping in public hospitals has been documented in the reports of the Comptroller and Auditor General.
    A typical government hospital is unable to keep a uniform record for services received by the patient during their treatment.
    The lack of health information leads to inconvenience, duplication of diagnostic and consultation services, delays in treatment, and increase in expenditure.
    Loss of records and delays can even lead to misdiagnosis and other harms.

National Digital Health Mission
    Under the mission, every Indian will get a new Aadhar-like health ID that will store the individual's medical records, doctor visits, diseases, the line of treatment and drugs taken.
    It will map every citizen's health with a unique ID.It will also be integrated with the facility of telemedicine, e-pharmacy, and national health registry.
    From a doctor’s appointment to hospitalisation, it will be essential.
    It will leverage upon digital systems to provide high-quality healthcare for all.
    It will integrate various digital health services to create an ecosystem which can assimilate existing health information systems.

Health ID
    The health ID will be in the form of a mobile application. Patients can create a health ID, allowing them to share their data between hospitals and doctors digitally.
    They can choose for how long or what specific documents they would like to share with whom. If individuals are looking to benefit from government schemes, then they will be required to connect their ID to their Aadhaar.
    One copy of a patient’s records is stored in their doctor’s files and one is stored in their own individual locker (which can be owned by a company or by the government).
    Other than the registry of doctors, professionals, and institutions, this allows for decentralised storing.

Why this mission could be a game changer?
Once rolled out nationwide, the programme has the potential to be a game changer. But much depends on implementation, and the laws surrounding it.
     The health scheme will provide choice to individuals to access both public and private health services, according to the strategy plan, and ensure transparency in the pricing of services.
     It has created access to patient records without owning their records. That means there is no repository and related costs associated with it. It will provide a platform to contribute to the treatment and speed up the control management of non-communicable diseases such as diabetes and hypertension.
     With telemedicine also being brought within the ambit, the programme ensures that doctors will be able to provide direct access to remote areas across the country.
     In case of diseases such as diabetes and hypertension, it will become easy to monitor the health of the patient and provide remedial measures instead of responding to it at a critical stage, which can be an expensive affair. That means the scheme has a huge role in disease management.

Problems (Data protection and role of NHA)
India has been debating on the requirements under its Draft Personal Data Protection Bill for the past two years. Under the bill, data relating to health, finance, genetics etc. is considered ‘sensitive personal data’ as its disclosure can cause serious harm to individuals and institutions.
     The imminent adoption of NDHM in the absence of a data protection law has led for the policymakers to plan for two policies — security of health systems and privacy of personal health records.
     These policies will adopt globally accepted norms such as privacy by design, risk management and fiduciary principles framework for building the upcoming digital health records ecosystem.
     As a government regulator for NDHM, it would be responsible for regulating the healthcare market while ensuring consumer protection.

Way forward
It would need to adhere to principles of transparency and accountability while functioning as the de-facto regulator for digital health records in India. Its experience in working with the healthcare ecosystem for the AB-PMJAY scheme can guide the agency in formulating future steps for NDHM. For instance, the NHA has been forthcoming in initiating public disclosure of data, hospital accreditation protocol and fraud reports for the AB-PMJAY scheme.Looking ahead, issues related to the protection of fundamental rights, such as the right to privacy of individuals, as well as the need for the government to assess and analyse India’s disease burden, will have to guide the legal and regulatory framework.

AYUSH, DGHS, Article 41, 42, 47, National Health Policy, 2017, National Health Portal