As the Narendra Modi government gears up to digitise healthcare under the flagship Ayushman Bharat Digital Mission (ABDM), making future doctors familiar with the concept of ‘digital health’ is its top agenda.
The National Health Authority — the apex body responsible for implementing Prime Minister Narendra Modi’s flagship ABDM — is designing a curriculum on ‘digital health’ for MBBS students.
As the ABDM, launched on September 27, 2021, aims to enable patients’ interaction with doctors while allowing them to receive digital lab reports, prescriptions, and diagnoses on a single platform, one of the biggest challenges it faces in the rollout is encouraging doctors to use digital platforms.
For instance, doctors presently are comfortable writing prescriptions on paper instead of filling out details on the software or creating e-prescriptions.
“It is not easy to induce behavioural changes. The NHA has been working on bringing apps that can convert speech to text into our systems. However, eventually, doctors need to learn digitally enabled software," Dr Basant Garg, additional CEO at NHA, told News18.com in an exclusive interview.
“Hence, we at NHA are developing a curriculum for ‘digital health’ for MBBS students. Once completed, we will follow the protocol for curriculum approval," he said, adding that NHA is also studying global examples of how it can encourage doctors to use digital technology on a daily basis.
The ABDM aims to create longitudinal health records for individuals across various healthcare providers and improve clinical decision-making by healthcare providers.
A 2005-batch IAS officer from Punjab cadre, Garg said the NHA has been engaged in dialogues with top private hospitals across India to bring them on board. Presently, more than 90% of hospitals enrolled under the scheme are public hospitals.
“We have been trying to understand their concerns about the adoption of ABDM… The response from the private sector has been very encouraging so far."
“All private hospitals already have a software, called HMIS, for keeping patients’ records. As the HMIS becomes ABDM-enabled, patients will get the benefit of interoperability."
Bringing Patients & Healthcare Together
The NHA is working on building both demand and supply for the digital linking of medical records, Garg explained.
According to Garg, who is also the mission director of ABDM, “the objective (of ABDM) is to increase efficiency, save time, eliminate wasteful expenditure, and process claims much faster along with providing convenience and satisfaction to patients and their families."
For instance, to make patients familiar with digital health, the mission has rolled out the ‘scan and share’ feature which is presently used by nearly 500 hospitals across India.
Here people can scan a QR code at OPDs of all big and small hospitals and clinics instead of standing in a queue and waiting for their turn to register.
“This has already brought efficiency to the system where people are saving time," he claimed.
“Right now, our priority is to build Digital Public Goods (DPGs)," he said while adding that “generating ABHA is our first priority".
“Right now, we have generated 37 crore ABHAs. The gains will be increasingly visible to the people once we hit a critical mass for ABHA creation."
ABHA (Ayushman Bharat Health Account) is an account to which your digital health records are or will be linked. By using this number, one can access their entire medical history, including lab tests, reports, and prescriptions available in one place.
“Similarly, we have to achieve certain targets in the Healthcare Professional Registry and Health Facility Registry. Once digital public goods are in place, we can start delivering digital health services and then the system will start giving the experience of digital health."
Healthcare Professional Registry verifies and registers doctors and other medical professionals on the platform whereas, under Health Facility Registry, hospitals and clinics are verified and registered.
OPD to Discharge: Simplifying Journey of Patients
Garg says he has already seen people making behavioural changes at doctors’ clinics or hospitals by using QR codes for taking OPD tokens.
He shared an instance when he visited Mumbai’s Dharavi, India’s largest slum.
“We visited a small single-doctor clinic in the slums. This doctor was sitting in a 6×6 clinic but still, he generated his own QR code from our website and put it outside his clinic for patients to generate tokens. We never reached out to him or gave him a demonstration but he started using it by choice, finding it relevant."
“We were surprised that while we are busy bringing big hospitals on board, there are small clinics that are finding it relevant and are becoming part of this digital journey."
“In hospitals, for instance, to book diagnostic tests, one has to stand in a queue to make payment and then go to the lab to get the tests done. So, we are bringing QR codes where you can make payments without standing in a queue," he added.
The NHA is also developing the technology for making hospital discharges faster. “Today, it takes an entire day to get discharge done but our idea is to make it much faster," he said.
Overall, Garg said that the mission is trying to simplify the journey of the patient.
“Right from the registration at the OPD counter to making payments at diagnostics, pharmacy to hospital discharge, the NHA is trying to bring solutions."
Boosting Medical Record Linkages
Intending to increase the adoption of ABDM, supply-side digital public goods need to be created which begins with compliance towards the digital systems in hospitals, he added.
“Presently, there are several public hospitals that are already ABDM-compliant, but they are not creating ABHA and linking health records."
The NHA is taking proactive steps by engaging with public hospitals to ensure the adoption of ABDM, and hence, improving health record linkages.
To boost the record linkages, NHA is now partnering with all public hospitals and government health programs such as Reproductive Child Health (RCH), the national NCD program, e-Sanjeevani, and several state government software among others.
“Under RCH, one patient interaction creates at least 12 health records. In fact, it could be more," Garg claimed. “This would enable the creation of digital health records of children right from their birth, including immunisation."
No Increased Data Privacy Concerns with ABDM
While several questions were raised over the data privacy concerns, Garg clarified that with the digital mission, there is no increased security issue or vulnerability.
“ABDM is federated health architecture where the data is stored where it is generated."
This implies, he said, that the data will remain where it is, right now. “There is no central server where we collate the data. We are only teaching systems to talk to each other."
“For instance, if today your medical records are lying with AIIMS and one with a private hospital, the data will continue to stay there. We are not bringing anything on government or centralised servers."
With the help of ABDM, he clarified, the two systems will be able to talk to each other, resulting in an interoperable ecosystem.
Claiming that the scheme is running in a transparent manner showing its progress on a real-time basis, Garg said that the NHA ensures that everything is done transparently and all data related to ABDM is available on the public dashboard.
“Anyone can go on the live ABDM dashboard where data of all important initiatives such as digital health incentives, scan and share or ABHA – everything is publicly available."
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