Open Forum
New Delhi, 13 October 2021
Digital Health
HUGE IDEA, WEAK LINKS
By Dr Oishee
Mukherjee
Prime Minister Modi launched the Ayushman
Bharat Digital Mission (ABDM) last month, which is envisaged as a complete
digital health ecosystem with a health ID for every citizen, digitised personal
health records, as well as registry of doctors and health facilities across the
country. Though Modi said the digital mission will play a big role in
eliminating problems in providing medical treatment to the poor and the middle
class, the question remains how much of the country is digitised and what
percentage of the population is likely to benefit.
The ABDM launched on 27 September aims to develop
the backbone necessary to support the integrated digital health infrastructure
of the country. It is expected to bridge the existing gap amongst different
stakeholders of Healthcare ecosystem through digital highways. The Mission it
is said will connect the digital health
solutions of hospitals across the country with each other; it will not only
make the processes of hospitals simplified but also increase ease of living.
The Digital Ecosystem will also enable a host of other facilities like Digital
Consultation, Consent of patients in letting medical practitioners access their
records, etc. With the implementation of this scheme, old medical records
cannot get lost as every record will be stored digitally.
Simply put, people will be provided with the digital
ID, which will contain health records of the person and enable
inter-operationability within the digital health system. Any public hospital,
community health centre or health and wellness centre across the country or any
healthcare provider included in the health infrastructure registry, will be
able to support an individual in obtaining a health ID. Patients can also
obtain a health ID by self-registration from a mobile or web registration.
However, the reality is that 90 percent of
hospitals in developing countries, including India, do not have Electronic
Medical Records (EMR). Obviously, EMR will help document real-time events
happening around a patient, inside the hospital with seamless movement of data
between patients, technicians and doctors on a mobile platform. Doctors are
under tremendous pressure due to the fear of possible human error, which can
adversely affect a patient’s life.
More than anything else, well-designed
intuitive EMR built with inputs from the doctor community is expected to open
the door for Indian digital health start-ups to dominate the global digital
health industry. Data analytics will build clinical decision support systems on
EMRs, which will suggest alternative diagnosis based on the patient’s condition
virtually like offering second options from senior doctors. Quackery it is
believed will be abolished since only registered doctors will be allowed to
prescribe medication on digital prescription pads.
The Unified Health Interface (UHI) by the
Mission should help India leapfrog into a new realm of digital health services.
Today UPI is used to pay anyone, but now it is envisaged that through this app
one can connect with any doctor, book an appointment, make payment, share
health records and get the prescription added to health records. The Mission
announced it will set the digital standards for health claims processing.
Meanwhile, with health insurance moving from covering just in-patient incidents
to comprehensive outpatient care, India possibly requires a new health claims
exchange that can bring greater transparency and new auto adjudication
technology.
But though all this appears quite impressive,
the most important question that arises is to identify the priority and take
necessary action in this regard. No doubt this step would bring healthcare to
the doorstep of the upper and middle classes, but what will happen to the poor
and economically weaker sections for whom digitisation has no meaning. One may
mention here that various surveys reveal that online education has not helped
the rural masses as they do not have basic internet connection.
In such a situation, the priority is
obviously to create more rural health centres and block level hospitals and
ensure that an adequate number of doctors and nurses are posted. This means
that resources for the health sector has to be significantly increased. Also
the private sector should be persuaded to set up not nursing homes but
charitable hospitals in backward blocks and sub-divisions of the country.
While the Constitution doesn’t explicitly
recognise health as a fundamental right, our judiciary and a large majority of
people see healthcare as a right and doctors as performing the hallowed duty of
saving lives. But 70 per cent of patient care in our country today is handled
by private hospitals, which have a reputation of having and making profit as
their main motive. The problem is not with privatisation per se, but how
healthcare has become a seller’s market in India.
It is thus not surprising that private
hospitals are increasingly being questioned by our courts. On July 27, the
Supreme Court issued notices to the Centre and all State governments on a PIL
that alleged that private hospitals were fleecing patients. Again on July 19,
the apex court, while hearing a case about fire safety in hospitals in Gujarat
stated: “These hospitals have become like a huge real estate industry instead
of serving the cause of humanity in the face of human tragedy”. The underlying
message is clear – healthcare’s sole motive cannot be profit. Besides, at least
10 different State governments across the country have capped Covid-19
treatment rates at private hospitals, often after being prompted by high
courts.
It is indeed a shame that we spend 1.3
percent of our GDP on healthcare. India’s population grew by more than 13%
between 2011 and 2020 but governments, both state and Centre, spent less than 1
percent of healthcare during that period. The Human Development Report 2020
stated India has just five beds per 10,000 people, ranking 155th
among 167 countries in bed availability. Even Bangladesh has eight beds
per 10,000 people.
Thus, while modernisation and digitisation of
the system is, no doubt necessary, to meet global standards and attract people
from neighbouring countries to avail facilities here, the focus has to be on
upgrading the health care system in rural India. The dichotomy in health care
between metros and big towns and backward districts cannot continue. To start
with, the so-called aspirational districts may be singled out for revamping the
rural health centres and upgrading facilities at the block levels with
equipment, doctors and support staff and with the Mission in mind internet
connectivity.
One should not forget the fact that the
country lives in villages and the huge population there has a right to get the
same facility as their urban counterparts. Voices are being raised to make
health a fundamental right and the government cannot ignore this any longer.
Education has already got the status of a fundamental right and health should
also be given this Constitutional status.
The government must remember that it’s not
enough to launch missions, but do its homework well so that it turns out to be
success. Time will tell, whether this National Digital Health Eco-system will,
despite practical difficulties, achieve its target, or close to it i.e. to support
Universal Health Coverage in an efficient, accessible, inclusive, affordable,
timely, and safe manner. ---INFA
(Copyright,
India News & Feature Alliance)
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