National Digital Health Mission [NDHM]

National Digital Health Mission launched by PM Modi from Red Fort on 15th August 2020. ABPMJAY set the stage in 2018. Now India is taking the next big Digital Health leap in 2020. NDHM will serve as the Digital backbone for Health Insurance and the Provider Healthcare Ecosystem. https://lnkd.in/dsRK3te

I had coined the term national ehealth authority [NeHA] in 2011 while doing the public health IT study report together with national health systems resource center [NHSRC]. I then spoke about NeHA, HIE and NHIN at the WITFOR 2012. I again spoke about NeHA, HIE and NHIN @ the eHealth conference Hyderabad 2012. I then wrote about it in the meta data and data [MDDS] standards for health domain again in 2013. On 30th Dec 2016 MDDS had been notified as part of the EHR v2 2016. Aug 2018 - MDDS for Health had been Notified. Nov 2019 - NDHB carried forward MDDS for Health and recommended the creation of NDHM.

#NDHM vision is to create a national digital health ecosystem that provides access to efficient, accessible, inclusive, affordable, timely and safe healthcare for all citizens.

Clearly India is moving from a payout-of-pocket model to a Universal Healthcare Coverage model. About 60% of India's population will soon be covered as all Govt Health Schemes are folding-in to ABPMJAY and the Missing-Middle is all set to be covered too. Total claims are set to go up by 10-13 times. Digital is the only way to manage the upcoming Tsunami of claims.

World over Health Insurance does not just pay for Secondary and Tertiary care; it is in the interest of Health Insurance to reduce the overall Disease burden. Digital will help us catch the disease earlier at Primary care levels. Will better manage the Referral network. Data driven Clinical Protocols to slow down the disease progression. Evidence based medicine to reduce the disease burden. Some Examples - John Hancock shifts from Life Insurance to Disease management; CVS purchased Aetna; UnitedHealth bought a large Doctors Group. ICICI Prudential Life Insurance covers Critical illnesses. 

Healthcare Wallet will Emerge: Soon a level playing field will enable a Healthcare Marketplace to emerge, to help the Person make better choices on Hospitals, Doctors, Appointments, Pharmacies, Labs and more. Patients will be inundated with plethora of choices and price competition will play out for them just like it happened in Telecom, Airlines and Retail.

Covid19 did not break the Healthcare system, it only exposed a broken system. Today Public Health cant do resource optimization because they don't really know how many Doctors, Nurses, Beds, Hospitals, Assets exist. This is not going to be the last epidemic hitting us. In this Pandemic, and Next time around we will be better prepared with resource optimization tools, predictive analytics and armed with Epidemiological studies to tackle it. 

NDHB Standards Compliance: To comply with NDHB Standards, the Health System has 2 options:

For Legacy systems - apply the eObjects published here with FHIR Extensions and JSON. https://openhealthcode.blogspot.com/2020/04/provider-eobjects-published.html

For new systems - please build the Standards into your information model. https://openhealthcode.blogspot.com/2020/06/hdis-mvp-microservices-published.html Health Delivery Information System MVP Microservices published in #opensource. It is Free. Anyone can use the code under MPL 2.0 #opensourcesoftware license. Our objective is to take the Digital Healthcare Ecosystem to the next level.
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India Leads the Way in Digital Health

 

India is in the midst of what some have dubbed the “world’s biggest healthcare overhaul.” In addition to recently launching one of the world’s largest publicly funded health insurance programs, set to cover some 500 million people living in poverty, the government has also been working diligently to develop a new digital health strategy for the nation.

The work on the strategy began more than five years ago, when the Ministry of Health and Family Welfare and the Ministry of Communication and Technologies developed a new set a metadata and data standards for health – essentially a common set of standards for the collection, creation, and coding of all health data that can be easily transferred across computers and information systems anywhere in the country. The standards were based on global best practices but adapted to better serve the local context. Previous to its work on data standards, the government also developed a system to allow it to issue a National Identification Number to all healthcare facilities in India.

These efforts have now put the government of India in a position to launch a new National Digital Health Blueprint. The blueprint, which is now open for public comments and consultations, validates the six pillar strategy that ACCESS Health has advocated for, namely:

1. A governance methodology and framework to help the digital health blueprint bring balance between patient privacy and scale.
2. Highlight the value and role of standards-based system design, including meta data and data standards for health, the health data dictionary, and registries.
3. A Health Delivery Information System to better manage healthcare provider operations, including software for patients medical records.
4. A Health Insurance Information Platform to provide better underwriting support for government schemes and to manage fraud and risks.
5. Electronic Health Records and a Health Information Exchange to provide citizens access to their health records and allow policy experts to understand disease burdens patterns.
6. Information and communications technology for infrastructure and capacity building to support digital health transformation.

A number of key members now on the ACCESS Health Digital Health team previously worked on the metadata and data standards initiative and on developing the national identification numbers. Their work was carried forward in the national blueprint.

In addition to its impact in India, the work the government has undertaken is likely to become a model for other emerging nations. The blueprint highlights some of the key points that ACCESS Health believes should be a part of any national digital health strategy. These include:

The need for federated governance and technology models to reflect the healthcare system, given that healthcare in India is a state-related subject;

The need to shift focus to more preventive medicine via a focus on strengthening the primary healthcare system and promoting alternative schools of medicine;

The importance of issuing of a personal health identification number that allows consent-based identification and portability of medical records across the continuum of care;

The importance of a mobile-first design approach that recognizes the growing penetration of telecommunication links on the back of low data tariffs;

The need for a data-driven approach to health policy making that recognizes the role of disease registries for accurate capturing of health burden; and

Recognition that there’s a need for keeping citizens healthy and productive to achieve economic growth as sick citizens become a burden on the system.

ACCESS Health Digital team looks forward to supporting the Government of India in its ongoing efforts to develop and implement this critical new strategy to improve health in the country.

https://accessh.org/india-leads-the-way-in-digital-health/

Healthcare IoT - Welcome to The Future

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Listen to Dr Pankaj Gupta speaking @ IoT Grand Slam 2015:
https://www.youtube.com/watch?v=bFSm4Xhr4E0 
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The global IoT healthcare market is expected to grow from $30 billion in 2015 to $150 billion+ by 2020 and IoT-enabled connectivity within hospital labs will increase total global laboratory test throughput by more than 3 billion diagnostic tests over the next 5 years. 

The Internet of Things (IoT) is the network of physical objects or “things” embedded with electronics, software, sensors, and network connectivity, which enables these objects to collect and exchange data. This has huge applications and implications on Healthcare. Are we prepared for the next big game changer? 

Every aspect of healthcare has devices from direct care to supporting care and rehab to community care. With the advent of smart mobile phone that space started getting connected and shrinking into the smart phone. Now the smart phones are eating away into the medical devices space. The networks are getting smarter such that the line between IT infrastructure, Networking and Applications is blurring as we move to the cloud. The Digital Hospital has all of these. Whereas Disease management takes this beyond the enterprise into the homes and lives of the person. Insurance and Pharma are analysing the lifestyle data which is not necessarily disease data. Our lives are rapidly getting digitized! 

On the flip side: Imagine what happens if someone changes the calibration of Lab analyser, Radiology modality, Cath Lab, Dialysis devices, ICU or bedside monitors. Or switches off a pacemaker. Or changes the rate of infusion or gas in the OR. All of this and more can be potentially done remotely in an IoT connected world. Scared already? Welcome to the future.

Look for the latest IoT Slam event @ https://iotslam.com/

New Healthcare Aggregators: SMAC and IoT

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See Dr Pankaj Gupta @ Healthscape IDE 2017 Panel Discussion Video 2: https://youtu.be/7RgY-5lp1qQ. Why are hospitals not moving to cloud computing?

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The old paradigm of business as a linear value chain is now facing extinction. Businesses are now ecologies and not merely producers and sellers ! That requires a change in thinking. Customer Relationship Management (CRM) needs to be a mission at every step of the process. This is hard to overemphasize! The internet is clearly the medium that allows such integration across time and space. It is time to take a more accepting look at Cloud and Social Media technologies. This offers the only universal layer of engagement across stakeholders. The investment in IT hardware as we knew it in the past has been greatly optimized by mobile. It has brought a tactile feel to life and work for all of us. Mobile mirrors the nature of Healthcare in terms of immediacy and continuity so well. Healthcare needs to embrace it wholeheartedly. Healthcare can only profit from it.

There is a huge Vacuum in Indian Healthcare-IT space. Large Healthcare-IT vendors have exited the market. Either they lost interest and exited or got bought out e.g. TrakHealth, iSoft. Also many traditional HIS/EHR are losing market share as the market is moving from client-server to cloud and from Capex to Opex models e.g. Wipro HIS, TCS Med Mantra, HealthFore. Many of these players like Wipro, TCS, CSC are suffering in their primary market [USA] due to shifts in US Govt policy and Automation and hence lack the Executive confidence to invest in product upgrades for the Indian market. On the other hand many incumbent players are not able to shift out to cloud because of their long term negotiated contracts in client-server model e.g Napier, Akhil, Srishti. New cloud based players like Dwise, UBQ, SRIT, ICT, Attune are small in size and yet to reach size and scale. Whereas Practo is trying to solve a problem that doesn't exist! Someone was stupid to assume that Appointments and Scheduling will sell whereas we Doctors want to see long waiting line of patients outside our clinics. Also the patients like to see waiting queues - in Doc sahib ki chalti hai.

Effect of Demonetization -- many hospitals are going to be sold off to PE that can invest in FDI e.g. Fortis is on the chopping block. The new management is going to hit on the bottom-line, optimize processes, re-skill staff and invest in growing the topline. All this is obviously a compelling case for Digital! So the time is now when full conversion of Client-Server Enterprise class to Digital [SMAC, IoT, CRM, AI] will happen. Now Healthcare CIOs have a choice to make - keep eyes closed and risk losing their jobs or tighten the belt and ride the Digital wave. Welcome to the Future!

The Government push towards MDDS/EHR Standards is not helping the old horses. PM Modi has put the focus of his Digital India on Healthcare, Education and Jobs [see http://economictimes.indiatimes.com/topic/Digital-India]. Whereas Healthcare is a State Subject and District Health Officers are wondering how do we benefit from Digital! Hard for many to imagine SMAC is a unifying force across enterprises and IoT breaks the silos. PM Modi's Digital India can be quite a game changer!

The era of hierarchical command and control is over. Now is the time for horizontal networking across Communities of Practice [CoP]. Whatever gets the maximum likes becomes the In Thing. Whatever is the In Thing gets used the maximum. Students are learning more from the online networking than from the formal classroom and professors. Research will reach the point of use as soon as it gets published. Primary care Providers in semi-urban and rural areas will have access to latest therapeutic recommendations. The old Adage that 'Knowledge is the only form of power that is not expendable but grows when shared' has become true.

The movie Avatar has beautifully depicted the concept of Small data ^ = Big Data where small knowledge base of each living being [App] is contributing towards the collective consciousness [Big Data] of Eywa. Now the question is will the future of SMAC/IoT be driven by technology or biotechnology?

Anyways for now - The time has come when you don't need big monolithic HIS software to run hospitals. Now you can do everything with small mobile based Apps for every function. Though I am already seeing many of these Apps in the market but what is lacking is a unified platform on which the Apps should be built such that the data can be seamlessly collated. Also it gives the provider the flexibility to select from a bouquet of Apps.

IoT integration platforms are emerging that will integrate at the App level, Data level and Semantic level. Anyone in the ecosystem can slice, dice, run reports on the collated data.

Successful Cloud models have dug the grave for the Enterprise Hardware. Capex has got converted to Opex. Now you can pay for the software on the cloud like you pay your monthly electricity bill.

SMAC coupled with IoT has a potential to bring the Aggregator Business model to Healthcare. Soon the unorganised and fragmented primary care, secondary care and supporting care market will begin to get Aggregated. I see these Aggregators becoming larger than established capital intensive Enterprise market similar to what happened in the Automobile market. It will be in the interest of Insurance, Pharma and Govt to go all out and support this emerging SMAC/IoT driven Healthcare Market Aggregation.

What happened in the FinTech space will now happen to HealthTech too. Just as the FinTech became a game changer to the Financial sector, a Digital Healthcare Ecosystem is taking shape. So many times bosses mocked new technology and got it wrong! Healthcare Businesses that are still in a denial mode will have huge re-skill challenges and risk shut shop.

References:

Why Healthcare must Re-imagine itself - and how

https://www.linkedin.com/pulse/why-healthcare-must-re-imagine-itself-how-arun-kumbhat

Why All Indian Hospitals IT is in Bad Shape

http://healthcareitstrategy.blogspot.in/2014/04/why-all-indian-hospitals-it-is-in-bad.html

Global HIS/EMR vendor nightmare outside US

http://healthcareitstrategy.blogspot.in/2012/08/global-hisemr-vendor-nightmare-outside.html

Thick client vs Thin client

http://healthcareitstrategy.blogspot.in/2008/08/thick-client-vs-thin-client.html

There is no Market for EMR in India

http://healthcareitstrategy.blogspot.in/2012/10/there-is-no-market-for-emr-in-india.html

Size of Healthcare-IT Market in India

http://healthcareitstrategy.blogspot.in/2012/06/size-of-healthcare-it-market-in-india.html