The Indian healthcare industry is on the cusp of a digital transformation. The end goal of this transformation, which is led by the government, is to provide universal, affordable, equitable and quality care to all citizens,leveraging digital technologies.Given the demographics of the country and the complexity of the healthcare system, this will be a challenging journey. All the stakeholders in the ecosystem (individuals, providers, payers and government) will need to collaborate closely to make this happen.
Over the next decade, there is a potential to unlock an incremental economic value of over USD 200 billion for the health sector from this transformation. To get a share of this pie there is an urgent need for all the stakeholders to start preparing themselves, by charting out a digital strategy to support, and mutually benefit, from this unfolding transformation.
The government has taken several steps in shaping national policy, to support this digital health journey. This includes the, National Health Policy (NHP) (2017), National Health Stack (NHS) (2018), National Digital Health Blueprint (NDHB) (2019), and the National Digital Health Mission (NDHM) launched in August 2020 with an aim to create an “Open digital health ecosystem” (ODE).
These initiatives taken by the government are with an intent to establish an “open digital health ecosystem”. This ecosystem will be supported by a shared digital infrastructure, that can be leveraged by both public and private stakeholders,to build and deploy new innovative health solutions. The proposed digital infrastructure will comprise of several elements including a health information exchange, infrastructure for seamless exchange of data, adoption of open standards and a national health information network to be deployed by 2025.
The key building blocks of this digital infrastructure will include, standardized health registries, a unique patient health identity, health data dictionary, federated digital health records, interoperability standards, and automatic claim settlement engines.
One of the key building blocks of this shared digital infrastructure is the digital health record which will be a EHR or a PHR. This will hold all the health information relating to a patient in a computer readable form.
For all interactions between a patient and a provider e.g., diagnosis, treatment etc. it should be possible to seamlessly update/access the relevant EHR/PHR data. This should be possible from anywhere, anytime, and by anyone, with the consent of the patient. This will require EHR’s/PHR’s to be interoperable and conform to open standards (FHIR, HL7etc.).
The current state of digitization of patient records in the country across public and private healthcare providers is very low. Most of the patient records and reports are paper based documentation (refer table below) with the exception of some well-known large private hospitals, and tertiary level government hospitals like AIIMS etc. Given this current state of digitization,it is impossible to seamlessly exchange digital patient information between the various stakeholders.
For a seamless information flow to happen across the digital health ecosystem, all the stakeholders in the ecosystem would need to rethink their digital strategy. This new strategy should include:
- “Rewiring”internal systems to be able to create/access/process digital patient data
- Leveraging HIPAA compliant platforms and hybrid cloud infrastructure
- Building redundancy and upgrading the capacity of the external internet broadband link
- Ensuring system conformance to interoperability standards
- Having data privacy and confidentiality controls in place
- Imparting the required training to the staff to operate productively
This will involve significant investments, which the private health providers may be reluctant to make. Over 75% of outpatients and 65% of the inpatients are served by the private providers in the country. It is imperative that they make these investments and are onboard this digital transformation for it to be successful. There is a need for increased government healthcare spend, new public private partnerships and suitable incentives to the private health sector.
The private health providers need to view these investments strategically. There is a need to realize that a reluctance on their part to embrace digital, could challenge their very existence in the future. It is important to understand that being part of the new digital healthcare ecosystem will benefit them with:
- Improved productivity and customer service
- Better quality of life of clinicians and administrative staff
- Providing high quality care with improved patient outcomes
- New business opportunities and delivery models like Telehealth
- Increased demand and patient loyalty
Individuals (patients) need to realize that there will be a cost that will be incurred for using an EHR/PHR. However, the benefits would far outweigh the cost. Having control of one’s longitudinal health data from all providers, health devices and applications in a single PHR repository would help the individual:
- Control the access and the usage of the data by others
- Move between care providers seamlessly without loss of data
- Get quality care with improved clinical outcomes
- Choice to make available anonymized data for population health, disease prevention and other research initiatives by the government
- Monetize the anonymized data by making it available to private entities for initiatives like clinical research, drug discovery, building artificial intelligence based tools etc.
The success of this government led transformation, is crucial for the future economic growth of the country. In the past, the telecom and financial sector shave been revolutionized by similar digital transformations. Learning from the experiences of other countries like Israel, UK, Russia, Brazil, South Korea and France can help in getting this “first time right”. The private healthcare sector has an important role to play in the success of this transformation. There are significant investments required from the government as well as by the private players in the health sector to make this happen. However, the benefits will far outweigh these investments.
The digital health infrastructure when ready, will help streamline the health system, and will benefit all the stakeholders including individuals, government, payers, private health providers, healthcare technology companies and startups.This will help the government achieve the goal of universal healthcare, and provide every citizen of India,the choice of access to personalized quality care.
(Srinivas Prasad is Founder and CEO of Neusights and the views expressed in this article are his own)