National Digital Health Blueprint: A Blueprint To Transform Healthcare

Universal Healthcare (UHC) is a key commitment for India by 2030, as it affects the achievement of all other goals for sustainable development (SDGs). Even though India’s business growth has been slowed down by the pandemic, India is perceived as one of the fastest-growing economies. India needs to introduce and implement initiatives that ensure a healthy workforce, improve the public healthcare framework, and, most importantly, integrate public and private healthcare resources to stimulate growth and development.

The National Digital Health Blueprint (NDHB) was published in the public domain by the Ministry of Health and Family Welfare in July 2019, inviting comments from various stakeholders, including the general public. The purpose of this blueprint is to establish and manage core digital health data and to provide the adequate infrastructure necessary for its continuous exchange.

Understanding the need to introduce the National Digital Health Blueprint

This National Digital Health Blueprint is an extension of the 2017 National Health Policy (NHP 2017), which was formulated to provide all Indian citizens with universal healthcare based on digital technologies to achieve greater efficiency and efficiency.

The National Health Stack (NHS), which is a digital arrangement aimed at developing a clearer and stronger health insurance system, was introduced in 2018 by the NITI Aayog.

In essence, multiple mechanisms are covered by the NHS, including an electronic national health registry that would function as a single health database for the nation. Another mechanism involves a platform for coverage and claims to function as the building blocks for robust health protection schemes, allowing the states to horizontally and vertically expand schemes such as Ayushman Bharat, and further enabling a robust fraud detection system.

Also, the NHS aims to provide a Federated Personal Health Records (PHR) system to provide the citizens with access to their health data, and further facilitating the accessibility of the health data for medical research, which is crucial for evolving the understanding of human health. The NHS also aims to provide citizens with access to their health data through the Federated Personal Health Records (PHR) system and to further facilitate the accessibility of health data for medical research, which is crucial for improving the understanding of human health.

The NHS also requires the implementation of additional horizontal structures with a specific digital health ID, health data language, and supply chain management through health programs, to ensure that different facets of the NHS are completely linked and avoid the accumulation of disconnected silos.

The NDHB is a constructive document that has been introduced for the application of the NHS, keeping in mind the above initiatives. The underlying concept is to make a national digital health ecosystem capable of supporting universal health coverage in a professional, open, comprehensive, fair, timely, and secure manner by offering comprehensive data, information, and infrastructure collection services.

Features of the National Digital Health Blueprint 

The NDHB recognizes the need to set up a new agency called the National Digital Health Mission (NDHM) to help and simplify the creation of a national digital health ecosystem that can promote the implementation of the blueprint.

A coherent architecture, a collection of architectural components, a five-layer system of institutional architectural blocks, a Specific Health ID (UHID), control of privacy and consent, national portability, electronic health records, suitable principles and guidelines, and health analytics are the main features of this blueprint.

For its execution, the Blueprint sets out five horizontal and two vertical blocks of construction. Although the document lists National Health Standards as Vertical Layer-1, the implementation of STGs, which will be the basis for incorporating providers’ patient data, is not comprehensive.

Personal Health Records are included in the Horizontal Layer-2, suggesting a federated structure of multiple players operating on an interoperable standard for health data sharing. The Blueprint also recognizes the significance of protection and seamless interoperability requirements for all building blocks and prescribes the use of EHR standards.

The objectives of NDHB include:-

  • Establishing and maintaining the core digital health data and the infrastructure needed to share it seamlessly
  • Promoting the adoption of open standards by all stakeholders in the National Digital Health Ecosystem to build multiple digital health systems from wellness to disease control across the sector
  • Creation of an international standards-based EHR framework that is easily accessible to people and service providers based on citizen consent
  • Establishing pathways of data ownership such that the patient is the owner of his/her EHR, and on behalf of the patient, health facilities and government bodies retain the data under trust. The collection and final use of the data shall take place through a process of consent. However, if it properly meets the standards so described, the anonymized data may be used for research purposes. The health facility is responsible for maintaining data protection, security, and confidentiality
  • Following the best principles of cooperative federalism while working with the states and union territories for the realization of the vision
  • Promoting medical research and health data analytics
  • Boosting the efficacy and quality of governance at all levels
  • Ensuring quality of healthcare
  • Leveraging the already existing knowledge systems in the health sector

Expected Outcomes

  • All people should be able to have secure access to their EHRs
  • Leveraging existing health record results of citizens, and not repeatedly undertaking medical testing unless warranted
  • In a single application (EHR), people should be able to aggregate health data from multiple agencies/departments/service providers where data is generated
  • NDHM can provide residents with quality care through primary, secondary, and tertiary care and public and private service providers
  • To facilitate the outreach of voice-based services, a framework for Unified Communication Centre will be established
  • NDHM will support the national portability of healthcare services
  • Privacy of personal and health data and consent-based access to EHRs will be the inviolable quality that all programs and stakeholders will compile.
  • NDHM will correspond to health-related SDGs
  • NDHM will allow evidence-based interventions in the field of public health
  • Most importantly, NDHM’s analytical capabilities will help data-driven decision-making and policy analysis

The government should consider working with the private sector to develop public infrastructure that can be open-sourced and potentially used at scale by both public and private entities to speed up the implementation of NDHB. Many of the NDHB’s core building blocks, such as the consent manager, health portal, etc, can be easily developed by the private sector and deployed as a public good by the government. This strategy would assist the government to move forward with overdrive in the execution of the NDHB vision.

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Prediction For Post-Pandemic Merger & Acquisition Boom In Healthcare Consolidation

Many small businesses are struggling to thrive in times of chaos and this pandemic has launched Merger & Acquisition (M&A) through many sectors, one of which is healthcare. Small businesses may initially attempt to preserve their independence sometimes, but they ultimately see that maybe the best thing for their patients is to become part of a larger whole.

Over the last decade, providers have been consolidating as businesses embrace economies of scale and vertically and horizontally grow. Post-Covid-19, larger healthcare groups, and investors are expected to increase their acquisitions of smaller hospitals, physicians’ practices, and alternative care locations.

A recent industry insider study by Bain & Company said that strained finances and a sharp drop in volumes of procedures have forced organizations hard hit by the pandemic to entertain acquisition offers.

The key highlights of the report were:-

  • 50% of hospital administrators said their institutions are highly likely to make one or more acquisitions in the next 2 years
  • Almost 70% of physicians in independent practices were agreeable to the thought of acquisition
  • Physicians advocated acquisition by organizations that offered financial security and yet provided autonomy for them

The results were consistent across surgical specialties (74%), primary care practitioners (69%), and other office-based procedures (67%). Surgeons and office-based doctors were both prepared to consider an acquisition.

According to Bain research, 30 percent of physicians who owned practices in 2019 reported that they will sell their practice in the next two years. Today, physicians support the acquisition of organizations that offer greater financial stability but also provide autonomy for physicians, namely by other physician practices.

Large healthcare organizations, including hospital associations, expect further acquisitions and mergers to be made. 50% of hospital managers said that their institutions are very likely to make one or more acquisitions to achieve greater growth in the next two years. Alternative treatment locations, including ambulatory surgery centers, emergency care facilities, and pharmacy in-store clinics, were on the priority list of administrators considering M&A.

Independent physician practices were the next most common target, followed by standalone hospitals. Home health companies that offer medical services in the home have continued to gain market share over the last few years, fuelled by lower prices and patient comfort, and investors have taken advantage of this development.

They are expected to invest in digital technologies as healthcare providers consolidate. As digital natives such as Amazon and Google join the fray, the move is increasingly relevant. Leading providers are developing digital capabilities that improve care delivery and reinforce patient engagement, such as applications to connect directly with patients.

Consolidation is expected to pick up in MedTech, too. Medtech companies with category leadership roles will be in the best place to succeed in the subsequent flight to quality as provider networks merge suppliers. Despite the slowdown, well-capitalized, larger MedTech firms will be able to invest to gain market share through organic and inorganic growth as demand returns.

What does this mean for health systems that are considering M&A?

To reinvent themselves, innovate care delivery, and thrive in the future, health systems should understand how they can utilize the instruments of M&A-acquisitions, mergers, integration, and divestments. To position their company for the future, executives should take the following approach:

  • Determine an optimal asset portfolio: The portfolio should fit with the long-term plan and patterns of the company. This will mean that organizations will need a wider portfolio of non-inpatient care services-the best combination of clinics, ambulatory, virtual health, and other care delivery environments that will ensure their community’s equity, prevention, and well-being.
  • Develop a buy, build, partner analysis to fill in gaps: In their current asset portfolio, companies can recognize holes and develop a strategy to build, acquire, or combine. This will allow creative ways to gain new skills or enter new markets or geographies. Partnerships with technology providers, disruptors, and those in the community will all help create new models and capabilities for the delivery of treatment or non-healthcare services that a company could not have achieved alone. Divestitures can be an essential instrument, too.
  • Maximize and integrate the organization’s current assets: Current assets in technology, community, branding, leadership, and clinical delivery should be in alignment. To ensure alignment, legacy acquisitions or newly constructed properties should be reassessed. Divestitures, shuttering, and repurposing properties can also be considered

With rapid consolidation anticipated in almost every industry and to manage one’s destiny, health systems should immediately begin strategic planning to position themselves for potential success.

The pandemic may have had an unforeseen effect. However, progress is expected to be a constant in the health care industry even as we set out on the road to recovery. The delivery of treatment is shifting. Business models at hospitals are evolving. The theory of scale is shifting. Leaders should be prudent on how they get there.

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Digital Health Adoption Challenges

During the COVID-19 pandemic, the inclusion of telehealth services shone a spotlight on the use of emerging technology in healthcare. Telehealth systems have linked patients and physicians remotely, but the rise of telehealth has overshadowed a wider trend that has already been underway for some time: the use of digital health to transform treatment. There should be no doubt about the pandemic’s disruptive effect and the rush to digitize that it has ignited. But as with all rushes, there will be winners and losers, successes, and errors.

COVID-19 has moved digital health forward, but there exist areas that still face challenges

At the HIMSS & Health 2.0 European Conference, experts discussed the impact of digital technologies on the COVID-19 responses in Europe and some existing challenges in pushing digital health further. Some challenges were noted by Dr. Pravene Nath, MD, Global Head, Digital Health Strategy, Personalized Health Care, Roche, US, especially in the areas of access and administration, operations, and personalization.

  • Telehealth has been common in terms of access and administration over a short period, but it is still very uneven in terms of addressing all communities and the real smooth experience required to minimize uncertainty at a time when there is a limited supply
  • In operations, he said that demand forecasting, supply chain management, capacity management, and technology are important and ready for that. If these technological tools can be distributed to healthcare providers, they can make tactical decisions with real data in real-time
  • Finally, Dr. Nath noted that there is still some way to go in digitally activated, condition-focused (personalized) care, such as remote patient monitoring when combined with a care delivery model that enables moving beyondthe encounter

Hospitals are behind the digital health adoption curve

According to new research from Unisys Corporation, close to two-thirds of healthcare providers rate themselves as being behind the curve on their digital health implementation initiatives. HIMSS surveyed 220 health IT decision-makers/influencers in U.S. hospitals and health systems on behalf of Unisys and asked them to rate their company based on how they utilize digital and mobile technology to enhance patient service, lower the cost of delivering treatment and increase the performance of clinicians/staff. Then they were ranked as ahead of the curve (early adopters/early majority) or behind the curve (late majority/laggards).

Survey results found that 64%rated themselves as being behind the curve, including 20% who were rated as laggards. Notably, when it came to new technology adoption and deployment, only 11% of organizations were rated as early adopters.

Four obstacles to digital health adoption in hospital & health systems

Behind the curve, respondents cited digital health adoption challenges when asked about the obstacles to advancing digital health initiatives:

  1. Resistance of the clinician in introducing new solutions (51%)
  2. Difficulties with combining legacy systems with modern digital/mobile technologies (50%)
  3. Availability of experienced IT personnel (48%)
  4. Cybersecurity hazard identification/remedialization (45%)

Some potential challenges associated with the rapid, mass adoption of digital healthcare technology are:-

  1. The limitations of remote care

Another revealing statistic to come out of the pandemic is that there was reported to be a 42% drop in Attendances and Emergency (A&E) attendances in May 2020 as compared to May 2019 (according to NHS performance summary report Apr-May 2020). There are likely a multitude of reasons for this, including less trauma because of, for example, significantly reduced vehicle use and less contact sports being played, as well as less (non-COVID) illness and disease circulating in the community because of reduced societal contacts. However, there is undoubtedly a cohort of people who will have been too frightened to attend A&E and who may be finding other ways of getting treated without going to hospital, for example via video consultations with their GP.

  1. Digital Exclusion

Also, those that are most likely to encounter chronic health conditions such as diabetes, cardiopulmonary disease, hypertension, obesity, as well as poor mental health are the same groups who are least likely to interact with digital healthcare. For such groups, the rush to digital may well worsen health inequality and increased isolation as a visit to the GP becomes more difficult, if not impossible.

  1. Commercialising Data

Although patients may be prepared to support the use and promotion of anonymized health data for the good of a larger community, the use of data, which is lacking in accountability and intended to advance corporate interests and shareholder returns, may be less accommodating for them. The potential for their data to be exploited by insurance providers or in cases where it could result in other types of data-driven discrimination is another Red Line issue for patients.

  1. Data driven discrimination

Some may presume that grubby human bias would inherently be more impartial and less likely to tarnish the algorithms and machine learning that underpin many digital health solutions. That however may not be the case. Broadly speaking, algorithms are nothing more than encoded procedures or instructions, but it is knowledge that is the basis of all and information can discriminate just as much as individuals because, for instance, it is incomplete, poorly chosen, unrepresentative, obsolete, or just plain wrong and algorithms can also perpetuate prejudices.

  1. Legal liability

What happens when a decision is made or alerted by AI that causes patient damage, is a pertinent problem for digital health. In the end, where does liability for unintended harm lie? Should those who supply or curate the data sets on which the AI depends be held responsible or those who construct and code the AI; those who validate it; those who run it; or those clinicians whose decisions are supported by it?

The way health services are delivered and consumed has been altered through digital health, and COVID-19 has accentuated some of the benefits and possibilities of innovation in this sector.Yet these new healthcare delivery media present new problems, risks, and threats that cut to the very root of who we are as individuals and communities, and itwould be wise not to lose sight of some of the constraints of digital care, and the need to take everyone along on this journey.

References:-

  1. https://www.healtheuropa.eu/rapid-mass-adoption-of-digital-health-technology/103842/
  2. https://www.healthcareitnews.com/news/emea/covid-19-has-pushed-digital-health-forward-challenges-still-persist
  3. https://hitconsultant.net/2019/04/08/digital-health-adoption-barriers-hospitals/
  4. https://www2.stardust-testing.com/en/the-digital-transformation-trends-and-challenges-in-healthcare