The National Health Authority is planning to allow companies to provide Artificial Intelligence and Machine Learning technologies to healthcare providers through the Ayushman Bharat Digital Mission (ABDM) as a Software as a Service (SaaS) solution, NHA CEO R.S. Sharma said on February 26. He was speaking at the post-budget webinar on the ABDM, organised by the Ministry of Health and Family Welfare (MoHFW), where various stakeholders in the health sector posed questions to Sharma and other senior government officials.
In response to one such question, Sharma added that AI and ML solutions could allow doctors to get a diagnosis on an anonymised patient record and would allow the (AI/ML) models to learn while simultaneously benefitting stakeholders.
This isn’t the first time that the use of AI and ML in the ABDM is being discussed — the consultation paper on the Unified Health Interface (a teleconsultation platform of the ABDM) had mentioned the future inclusion of health bots to give health advice to patients. The involvement of AI in healthcare is significant as it is a critical area of life. Besides this, the webinar served as an avenue for various stakeholders to share their concerns regarding the ABDM with the government.
Here are some of the key stakeholder issues that shed light on the ABDM’s challenges ahead:
Incentivising participation in the ABDM
“How can we also start thinking of some sort of an incentivisation that will grow this as a platform? This can be organic or inorganic incentivisation as is the case in UPI. To make this a UPI moment in healthcare I definitely feel there has to be a layer of incentivisation on two sides – one on the payor (patient) and the (healthcare) provider.” — Vikalp Sahni, founder of health locker app Eka.Care
Incentivisation for enrollment and adoption of the ABDM has come up during various consultation meetings, submissions, as well as public statements made by the NHA itself and thus, appears to be key to its success.
NHA’s possible approach:
- QR codes for hospital admission: At another webinar, NHA director Kiran Gopal Vaska commented on the authority’s consumer-facing efforts in this matter. “So what we are coming up with is we are working with all these PHR apps like PayTM and Aarogya Setu where we are saying that the hospital can simply put a QR-code for that counter, you scan the QR code with the application and then your data is already registered in their system so you don’t have to stand in the queue. So there’s a difference between someone who has an ABHA and someone who doesn’t have an ABHA number [earlier called Unique Health ID] who has to go through the regular route,” he said.
- Policy incentives for smaller clinics: Apart from adoption by patients, adoption of ABDM by smaller health clinics, especially in remote areas, has been an area of concern. In their submissions on the Health Data Retention Policy of the ABDM, health tech start-up Practo, industry body FICCI, and digital rights group IFF all suggested that the government provide financial aid and relaxations from policy provisions to help them adopt the ABDM.
- Cabinet clearance for funds could help digitisation: Sources involved in the ABDM told MediaNama that the recent cabinet approval of funds for the mission would also help in supporting such digitisation efforts by smaller government clinics.
Along similar lines of affordable digital infrastructure, Sharma at the post-budget webinar said that the government was going to release digital public goods such as a Health Information Management System which can be used by smaller clinics free of cost.
Resistance to digitisation of doctor prescriptions
“80% hospitals are now doing everything online and they are trying to do everything online but only one thing everybody is not able to do is the consultation prescription of doctors. They are quite resistant to use computers for the prescriptions so I think that the government has to provide some easy software where we can make our doctors ready to do that.”— Dr Upasana Arora, Director of Yashoda Super Specialty Hospitals
The digitisation of prescriptions, doctors’ notes in hospital wards has been a significant area of concern under the ABDM, as is apparent from public consultations and webinars. In August last year, at a consultation meeting on the Healthcare Professionals and Health Facility Registries, NHA’s Additional CEO Praveen Gedam had identified that getting doctors to record observations and notes from hospital ward visits was a challenge.
NHA’s possible approach:
- Class of ‘Health Information Management Professionals’: At an earlier consultation meeting on the registries and the Unified Health Interface, Gedam said that the NHA would consider the creation of a class of ‘‘Health Information Management Professionals’ for data entry in certain cases, such as in-patient departments where typically doctors take rounds and take notes on patients.
- ‘Data entry should not become additional activity’: In another webinar with government medical colleges, Gedam said that while the NHA recognises the difficulty in digitising such records, it would not want that data entry to become an additional activity. “You don’t see data entry operators in banks or on railway booking counter,” he added.
- Software solutions also being considered: Sources involved in the ABDM have told MediaNama that apart from data entry operators, software solutions for transcribing, converting speech-to-text are also being considered.
The digitisation of consultations and prescriptions is important, considering that over-burdened doctors in the USA have had to outsource transcribing their consultations to operators in India. Uptake and adoption of the ABDM by doctors are extremely crucial as a similar health digitisation project in the UK failed after not being well-received by healthcare workers, despite spending millions of pounds on it.
Interestingly, the Health Data Retention Policy released by the NHA specifically excludes daily monitoring records of in-patient department (IPD) patients from the scope of the policy.
Retrospective digitisation of health records
“While ABDM will be hugely helpful for future data, how do we connect the dots to people’s past records?…When we think about how to bring in past data it will again be equally important to ensure the quality of data.” — Ameera Shah, Director at Metropolis Labs
NHA’s possible approach:
- Scan existing paper records: Digitisation of existing health records has not been something that has been extensively discussed during webinars or consultations, except for a few suggestions like scanning existing paper records.
- The private sector offers ‘scan-at-home’ service: Meanwhile, there could already be a solution in the private sector with certain health locker and aggregator apps providing ‘scan-at-home’ services for digitising, meta-tagging, and storing existing physical health records on health locker applications.
The role of states and the private sector in the ABDM
“Health being a state subject creates great opportunities but also difficulties in terms of rolling out something nationally – how do we look at it differently as we are rolling out something like ABDM? Can health be a concurrent subject? Are there areas where the national health system can play a bigger role? How do we make sure that public-private partnerships are actually happening in the right direction? While there are increase in public-private partnerships the spirit of it would be true collaboration not just the government sort of putting together tenders which the private industry works for, but truly thinking – how can we create a blueprint for the future?” — Ameera Shah, Director at Metropolis Labs
NHA’s possible approach:
- No movement yet on State vs Centre issue: This issue of states’ participation and its claim over health as a state subject has not been raised frequently in relation to the ABDM. However, there has been a push by state governments to launch their own digital health programmes, MediaNama has learned. These programmes can later be integrated with the nation-wide ABDM. States like Bihar, Uttarakhand, Telangana, and Delhi have already begun their respective initiatives.
- PM Modi, NHA leadership continuously urging private participation: Inaugurating the webinar, Prime Minister Narendra Modi urged the private sector to help figure out the scope of the ABDM. The NHA as well has repeatedly stressed on Private-Public Partnerships in building the ABDM with an open, API-based structure encouraging private players to build solutions on top of it. Already 27 health locker apps, health aggregators, information management systems, and other third-party entities have been integrated with the ABDM and can now provide services under it.
Other points raised by stakeholders
A few other issues were raised during the webinar such as:
- Support for more local languages, and not only English or a few other official languages, on the mission.
- Integration of the mission with mechanisms to track the adverse effects of drugs, checked or monitored by labs and drug regulators.
- Encouragement to take up standards (for electronic health records) like ICD-11, along with existing use of SNOMED-CT. (Both ICD-11 and SNOMED-CT are internationally known standards for electronically recording health terms)
- Leveraging the ABDM to reduce existing bottlenecks in bureaucratic requirements related to hospitals
The way forward for the Ayushman Bharat Digital Mission
Besides the Unified Health Interface, Healthcare Professionals and Health Facility Registries, there are a few other components of the ABDM which are yet to be rolled out by the NHA such as:
- Consultation Paper on the Drug Registry: At a webinar in November, Gedam had said that a consultation paper on the registry would be released by December. However, in response to MediaNama’s question about the same, Vaska said that the registry has had to go through multiple iterations and would be released ‘soon’. A registry of all drugs in the country was proposed as one of the key building blocks of the ABDM in its strategy document released last year.
- Unified Health Interface: The UHI, was opened up for public consultation in July last year and went live in January 2022. Decisions made on the inputs received from the consultation has not been released yet.
- Health Data Retention Policy: The NHA has yet to reveal the final form of the Health Data and Retention Policy which was opened to public consultation in November last year. The paper lays down retention periods for different types of health data and other obligations related to the handling of such data.
The ABDM is still at a nascent stage with not much data being generated through it and many government hospitals waiting on the recent cabinet approval of funds to begin digitisation, sources claimed. Although, this could not be independently verified by MediaNama.
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