by Dr. Shravan Subramaniam
The pandemic turned a new leaf in the history of healthcare for a country like India. Digital Health took on a whole new meaning and we saw patients taking the digital healthcare turn. Per capita data usage in India is 12 gigabytes per person per month. India has 1.18 billion phone connections, 700 million internet connections and 600 million smartphone connections. There is no doubt how Covid-19 has accelerated the momentum for digital health, for the medium to become non-negotiable, which it already has been in recent times, we will need more than policies. We need measures that strengthen policies in progress.
The government’s initiative with the National Digital Health Mission (now known as Ayushman Bharat Digital Mission, ABDM) clearly redefines the role of digital, creating a coherent digital path for the future. But the next phase of this journey will be determined by the actions we take today.
Delving deeper into tech-infra solutions
Today, we have access to technology that allows us to share our records digitally. With an Ayushman Bharat Health Account (ABHA) number, patients can now interact with participating healthcare providers and receive their digital lab reports, prescriptions and diagnoses – accessed by verified healthcare professionals. As we build the dream of Digital India, the roadmap will be defined by technical and financial incentives to small and large providers – on the pillars of accessibility, affordability and reliability.
The guiding principles of the National Digital Health Ecosystem are based on open APIs and interoperability, federated architecture, frameworks, compliance assessment, voluntary participation, user inclusion, seamless portability and more. ABDM is an ambitious project in the healthcare sector that seeks to break down silos.
Integration of healthcare records
India is seeing some very successful digital initiatives such as ABDM’s emphasis on interoperability, and a single source of truth – these will make healthcare services more accessible. The Unified Health Interface (UHI) will give the sector a much needed boost and ensure ease of access and interoperability among service providers. Focusing on developing a health data exchange layer (ABDM architecture), we are focusing on developing a common public digital good in the context of digital registries. These are changes that will change the healthcare story in a country where we have seen a lack of standardization in data storage systems make it impossible to aggregate data from multiple sources—resulting in duplication, redundancy and delay.
Skills for change
Although technology is the central thread of India’s digital mission, we cannot ignore the role of skills in this journey. For instance, even with about 110 million patients Chronic kidney disease (CKD) patients, about half require timely intervention by a nephrologist (kidney specialist doctor) to slow the progression of their disease. If the disease is not controlled early, the chances of developing CKD in the final stages are high.
At this point, the patient will need dialysis, which is an extremely expensive and painful lifelong kidney replacement therapy. Now, we not only need hospitals and doctors to adopt and use ABDM-linked solutions, we also need more experts. Shortage—There are a total of 2,600 nephrologists in India, most of whom are concentrated in top cities. How can we bridge this gap?
Mainstreaming AYUSH is a great step forward by the government. According to the Rural Health Statistical Report for 2020 released by the Union Health Ministry, 8,709 AYUSH doctors were appointed at 25,140 rural primary health centers and 541 at 5,481 community health centres. Now, with just over 13 lakh allopathic doctors and nearly 8 lakh AYUSH practitioners, we are looking at preventive care and promotional health, bridge courses for primary care and public health, and continuing medical education. AYUSH doctors can fill the gap in healthcare availability in the interior. Primary, secondary and tertiary care linkages can be further enhanced through digital tools, telemedicine and remote monitoring.
Having said this, we need to know that there has been insufficient research and development on the ingredients of medicines prescribed by some strands of AYUSH.
On top of significant change in healthcare, we must look to solutions that are driven by collaboration between industry, academia and government. The objective is to create a new system based on the pillars of digital transformation. From partners and hospitals finding solutions to partner and finding common ground for tech that helps us eliminate duplication and redundancy as much as possible, the new era of digital health demands much more than policies, and we must deliver.
Dr. Shravan Subramaniam, President, NetHealth and Managing Director, Wipro GE Healthcare
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