If patients wish to change a healthcare provider, they have to carry pieces of paper. NDHM envisions changing that by digitally storing their health records.
Prime Minister Narendra Modi announced the launch of a National Digital Health Mission (NDHM) in his Independence Day speech, to address serious concerns about the lack of patient records and data in the Indian health system.
Led by the National Health Authority (NHA), the NDHM is set to be India’s major step towards achieving a citizen-centric healthcare system. Unique health IDs that store digital health records of individuals will be created.
However, legal and enforcement issues about data privacy need to be tackled at the same time as regulations and digital systems for patient records are being created.
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The need for digital health records
The health records situation 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 (CAG) of India. For instance, the CAG performance audit report for UP hospitals (2019) highlights that hospitals fail to keep records of basic parameters such as date and time of consultation and diagnosis.
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 to patients.
For example, mortality from Covid-19 is significantly increased by comorbidities, or the presence of other underlying conditions like hypertension or diabetes. However, with poor or non-existent health records, doctors cannot prioritise patients based on their Covid-19 test results.
A fragmented private healthcare market consisting of single-doctor clinics, nursing homes, non-profits and corporate hospitals have varying adoption rates of digitisation. Corporate hospitals like Max, Apollo, Fortis, etc. have voluntarily adopted electronic health records standards notified by the Indian government. However, it is not possible for a patient to digitally transfer their health records from one type of hospital or a healthcare provider to another.
Non-portability of records unfairly locks in a patient with the first hospital she visited, or her most frequently visited hospital. If she wishes to change a healthcare provider for cost or quality reasons, she cannot access her health records. She has to carry pieces of paper — prescriptions and test reports — from one doctor to the next in plastic bags.
Centralised digital health records were first sought to be adopted in 2018 for the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) under the NHA. However, the government of India expanded the scope of digitisation of health records to a national level. Consequently, the National Digital Health Blueprint (NDHB) was released for public consultation in October 2019.
Source: The Print
