India's Digital Health Journey

I (Dr Pankaj Gupta) have been an integral part of India's Digital Health Journey. Here is a summary of my work over the last 15 years. Someday probably I will write a book with all the stories and anecdotes. I am not a public health person, I came in through the back-door but can't believe I have stuck to it.

I started my digital health journey in India's public health arena in 2011. The work I had done for Max Healthcare's complete digital health transformation caught the eye of Government of India in Aug 2010 when I was featured on the cover page of the eHealth magazine. Later Max healthcare became the only Hospital chain in India to be integrated seamlessly across all 12 hospitals hosted on the Dell private cloud and it achieved HIMSS stage 6 accreditation.

Somehow I got talking to Dr Sundararaman T ED @ NHSRC. He invited me to start writing the Public Health IT study report together with NHSRC. This report looked at various public health IT systems built by various vertical programs and found out that every system was built at different points in time in different technologies without any interoperability. There is no way you can analyze the data across vertical programs even if you wanted to triangulate. My favorite example is a low birth weight baby born to a woman who had tuberculosis in the past; then there is no way to trace it back because infants data, birth data, pregnancy data, and TB data are in different systems that don't talk to each other.

In the public health IT study report, I borrowed a lot from my experiences of having done digital health standards consulting work in USA, Canada and couple of other countries. The public health IT study report gave the recommendation that India's ministry of health and ministry of IT needs to get together and write the Healthcare-IT or eHealth standards. So that the various vertical programs can talk to each other and the data can be auto triangulated on near-real-time basis without human interventions. The then planning commission took note of it and included the recommendation in the 12th plan. The institutional memory of this public health IT study report was lost. It turned out to be a beautiful book sitting on the shelf with no users.

Somewhere in 2013 the Government of India setup 2 committees - EHR Standards committee and MDDS for Health Standards committee. I had the fortune of leading the taskforce that wrote the MDDS for Health and I was a consultant to the EHR Standards committee. The MDDS for Health draft standards were published in 2013-2014. It turned out to be a beautiful book sitting on the shelf with no users.

Meanwhile in 2015, MoHFW gave me a project to create India's first Health Facility Registry with a unique national ID number [NIN_HFI]. My team pulled out 250k health facility data from MCTS and HMIS systems to come up with a curated list of 112k health facilities. It again turned out to be a beautiful book sitting on the shelf with no users. Meanwhile the institutional memory was lost.

It took 5 years for the MDDS for Health to be notified by STQC Ministry of IT in Aug 2018. In the meanwhile EHR Standards were also notified by Ministry of Health. EHR standards gave the what and the why of digital health and MDDS for health gave the how part of Digital Health. This was recognized as a digital necessity for starting the Ayushman Bharat in Sep 2018. Also in 2018 it was decided to write the Digital Health blueprint to serve as the Reference Architecture.

In Nov 2018 I was called to discuss an international donors funded project called Digital for Universal Health Coverage in India. Starting Jan 2019, I led transformative initiatives thru the digital health division of a public health NPO, a division I created for advancing digital solutions for Universal Health Coverage (UHC).

Key achievements from a $3M Digital for UHC Grant were - inputs to the writing of NDHB Digital Health Standards, that defined crucial digital health standards for the National Digital Health Blueprint (NDHB). Building the (#ABDM) Digital Health Authority Consensus; i.e. Orchestrated the campaign for consensus-building among public-private-academic sectors for the #ABDM Authority. Digital Health Adoption Framework; Crafted a framework to strengthen digital health adoption, setting the stage for the National Digital Health NDHE Ecosystem.

Thought Leadership: Co-authored Chapter 5 of "Health Systems for New India: Wiring the Indian Health Sector" with Niti Aayog. Advocated for policy changes and recommended Interoperability eObjects. The Chapter 5 of the book gave the 6-pillar strategy spanning Governance, Health Data Standards, Delivery Information Systems, Insurance Platforms, Health Information Exchanges, and IT Infrastructure. That formed the basis for establishing a Strategy Council for guided health system transformation. Led the Program Management Unit, overseeing grant, project, and operations management. Conducted stakeholder consultations for informed policy decisions.

We were hit by the Pandemic in 2020 and everything shifted to work from home. Government fast-tracked the creation of the National Digital Health Mission and Hon' PM announced it on 15th Aug 2020 from the Red Fort. Later it was upgraded to PM' Ayushman Bharat Digital Mission ABDM in Sep 2021. So I cant take all of the credit for this work - because Covid did the magic.

Healthcare is a State subject, whereas IT is a Central subject. Therefore a well considered recommendation was to institutionalize the digital health authority as a mission mode project under Digital India, and house it in the National Health Authority.

Market Access Program was started by NHA to help build the Digital Health Ecosystem. I led the Social Entrepreneurship Accelerator (SEA) associated with the MAP, fostering partnerships within the healthcare innovation ecosystem.

Health Insurance claims engine was envisaged as a innovative solution for digital health adoption. From my past experience, I can vouch for it - Globally Health Insurance and Financial Levers has been the drivers of Digital Health adoption. Therefore I contributed to Health Claims Exchange (HCX) specifications, enabling eClaims automation in NHA/ABPMJAY and InsurTech.

Founded Digital Health Academy, nurturing institutions for HealthTech and Epidemiology capacity building. Established Opensource Software Community, creating a Digital Health Centre of Excellence (CoE). Coordinated opensource partnerships with international organizations, universities and education institutes. This is because I knew that the biggest stumbling block for Digital Health implementation will be the lack of digital health HR capacity in the system. This is because in the Indian education system - after class X the biology and mathematics streams separate and never meet again. Whereas we need exactly that biology plus mathematics combination in the same brain for digital health implementation and roll-out across the states.

The opensource HMIS MVP design created could not be converted into a working software because the donors didn't consent for the money to be used for software development. Arun Kumbhat, Dr Ramachandran Balaji and me didn't give up even after the grant came to an end; we started LIBRA SOCIAL RESEARCH FOUNDATION a section-8 company and rewrote the HMIS MVP specifications. LetsDoc stepped forward to convert the specifications into low level design and then write up the software code. LetsDoc stood to their promise and released the HMIS MVP into opensource. Thus was born the OpenHDIS project and the community. LetsDoc and IIT Jodhpur are the first member organizations to join the OpenHDIS community.

Digital Health Standards done! Digital Health Policy done! Digital Health Authority done! My next chapter will be Digital Health Implementation...