Ayushman Bharat Digital Mission

Background

The National Health Policy (NHP) 2017 seeks the attainment of the highest possible level of health and wellbeing for all at all ages, through a preventive and promotive health care orientation in all developmental policies, and universal access to good quality health care services without anyone having to face financial hardship as a consequence.

In a follow-up of the NHP’s specific goals for adopting digital technologies, the Ministry of Health and Family Welfare constituted a committee headed by Shri J. Satyanarayana to develop an implementation framework for the National Health Stack. This committee produced the National Digital Health Blueprint (NDHB), laying out the building blocks and an action plan to comprehensively and holistically implement digital health.

Since the implementation is envisioned to be in a mission mode, the initiative is referred to as the Ayushman Bharat Digital Mission (ABDM).

The Ayushman Bharat Digital Mission (ABDM) aims to develop the backbone necessary to support the integrated digital health infrastructure of the country. It will bridge the existing gap amongst different stakeholders of Healthcare ecosystem through digital highways.

Vision

To create a national digital health ecosystem that supports universal health coverage in an efficient, accessible, inclusive, affordable, timely and safe manner, that provides a wide-range of data, information and infrastructure services, duly leveraging open, interoperable, standards-based digital systems, and ensures the security, confidentiality and privacy of health-related personal information.

Objectives

To strengthen the accessibility and equity of health services, including continuum of care with citizen as the owner of data, in a holistic healthcare programme approach leveraging IT & associated technologies and support the existing health systems in a ‘citizen-centric’ approach, the ABDM envisages the following specific objectives:

• To establish state-of-the-art digital health systems, to manage the core digital health data, and the infrastructure required for its seamless exchange;
• To establish registries at appropriate level to create single source of truth in respect of clinical establishments, healthcare professionals, health workers, drugs and pharmacies;
• To enforce adoption of open standards by all national digital health stakeholders;
• To create a system of personal health records, based on international standards, easily accessible to individuals and healthcare professionals and services providers, based on individual’s informed consent;
• To promote development of enterprise-class health application systems with a special focus on achieving the Sustainable Development Goals for health;
• To adopt the best principles of cooperative federalism while working with the States and Union Territories for the realization of the vision;
• To ensure that the healthcare institutions and professionals in the private sector participate actively with public health authorities in the building of the ABDM, through a combination of prescription and promotion;
• To ensure national portability in the provision of health services;
• To promote the use of clinical decision support (CDS) systems by health professionals and practitioners;
• To promote a better management of the health sector leveraging health data analytics and medical research;
• To provide for enhancing the efficiency and effectiveness of governance at all levels;
• To support effective steps being taken for ensuring quality of healthcare; and
• To strengthen existing health information systems, by ensuring their conformity with the defined standards and integration with the proposed ABDM.

Guiding Principles

The ABDM will be designed, developed, deployed, operated and maintained by the Government in accordance with the guiding principles as laid out in NDHB. The ABDM guiding principles are as follows:

Business Principles (Health Domain Principles)

• ABDM will be wellness-centric and wellness-driven - Wellness centres and mobile screening teams will be strengthened through real-time access to personal health records.
• ABDM will educate and empower individuals to avail a wide range of health and wellness services - Mass awareness and education will be promoted through use of appropriate platforms and a portfolio of Health Apps.
• ABDM systems will be designed to be inclusive - Specialized systems will be designed to reach out to the "unconnected", digitally illiterate, remote, hilly, and tribal areas.
• ABDM will ensure security and privacy by design - A National Policy on Security of Health Systems and Privacy of Personal Health Records will be developed, in accordance with the PDP Bill 2019. All the building blocks that require handling personal health records will be designed to comply with such a policy at the outset. (How does ABDM ensure Information Security and Privacy ?)
• ABDM will be designed to measure and display the performance and accountability of all health service providers - Real-time monitoring of performance of all health institutions and professionals against agreed KPIs will be done across service levels of the health sector and published.
• ABDM will have a national footprint and will enable seamless portability across the country through a Health ID – Personal Health Identifier, with supporting blocks, including adoption of Health Information Standards will play a pivotal role in national portability.
• The eco-system of ABDM will be built basing on the principle, "Think big, start small, scale fast" - ABDM will adopt a combination of strategies like taking a minimalistic approach for designing each building block, prioritizing and sequencing of the development/ launch of these blocks, and designing a technology architecture that can rapidly and agilely scale horizontally and vertically.

Technology Principles

• ABDM will be developed by adopting India Enterprise Architecture Framework (IndEA) - The design of the building blocks of ABDM will adopt and conform to IndEA by default. All the design and development efforts will adopt the Agile IndEA Framework notified by MeitY.
• All the building blocks and components of ABDM will conform to open standards, be interoperable and based on Open Source Software products and open source development - The policy on Open Standards and Open Source Software, notified by MeitY, GoI, will be adopted in designing of the building blocks and in all procurements. Interoperability will be inherent to all the building blocks.
• Federated Architecture will be adopted in all aspects of ABDM - Only the identified Core Building Blocks will be developed and maintained centrally. All other building blocks will be designed to be operated in a federated model that factors regional, state-level and institution-level platforms and systems to function independently but in an interoperable manner. As defined in ABDM, the data will be federated and stored close to the point of generation.
• ABDM will be an Open API-based ecosystem - All the building Blocks will be architected adopting the Open API Policy notified by MeitY, GoI and will share data as per standards as defined in NDHB. Security and Privacy will be built into the design and development of the APIs, which should be audited for security and privacy before deployment.
• All major legacy systems will be assessed for conformance to NDHB principles and leveraged to the extent feasible - Compliance of legacy systems to the Blueprint principles and Agile IndEA principles will be assessed through an appropriately designed assessment tool to evaluate the current conformance and effort required to integrate them with ABDM. Only those legacy systems that cross the bar will be allowed to operate within the eco-system. However, the useful data about healthcare providers, labs, patients available in the legacy applications will be leveraged and utilized to the extent possible, leading to savings in time and effort in collecting such information again.
• All the components, building blocks, registries, and artefacts of ABDM will be designed adopting a minimalistic approach - Easy, early, and collective adoption of the Blueprint by majority will be critical to its success. Hence every component of the Blueprint will be designed to be minimalistic.
• All the registries and other master databases of ABDM will be built as Single Source of Truth on different aspects and backed by strong data governance - Rigid validation processes will be applied to all mandatory 'fields', clear ownership and responsibilities will be defined for all core databases and strong, dedicated data governance structures will be established at the State and Central levels.

Building blocks of ABDM

1. Health ID - It is important to standardize the process of identification of an individual across healthcare providers. This is the only way to ensure that the created medical records are issued to the correct individual or accessed by Health Information User through appropriate consent. In order to issue the UHID, the system must collect certain basic details including demographic and location, family/relationship, and contact details. Ability to update contact information easily is the key. The Health ID will be used for the purposes of uniquely identifying persons, authenticating them, and threading their health records (only with the informed consent of the patient) across multiple systems and stakeholders.
2. Healthcare Professionals Registry (HPR) - It is a comprehensive repository of all healthcare professionals involved in delivery of healthcare services across both modern and traditional systems of medicine. Enrolling in the Healthcare Professionals Registry will enable them to get connected to India’s digital health ecosystem.
3. Health Facility Registry (HFR) - It is a comprehensive repository of health facilities of the nation across different systems of medicine. It includes both public and private health facilities including hospitals, clinics, diagnostic laboratories and imaging centers, pharmacies, etc. Enrolling in the Health Facility Registry will enable them to get connected to India's digital health ecosystem.
4. ABHA Mobile App (PHR) - A PHR is an electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual. The most salient feature of the PHR, and the one that distinguishes it from the EMR and EHR, is that the information it contains is under the control of the individual. 
   The functions that are supported by a Personal Health Record-System (PHR) will enable an individual to manage information about his or her healthcare. This includes viewing of a longitudinal record, comprising of all health data, lab reports, treatment details, discharge summaries across one or multiple health facilities.

Key features of the ABHA mobile application are :

• • Creation of ABHA Address
  • Discovery of Health Information
  • Linking of health records/ with a given ABHA Address
  • View Health Records
  • Management of consents

Source : Ayushman Bharat Digital Mission website