India has faced numerous challenges in the healthcare landscape, including limited rural access, uneven facility distribution, high out-of-pocket costs, reliance on paper-based records, insufficient insurance coverage, poor healthcare quality, and privacy concerns. However, on August 15, 2020, Prime Minister Narendra Modi unveiled a transformative initiative called the Ayushman Bharat Digital Mission (ABDM).
The ABDM aims to establish a Unique Health Identifier (UHID) system, which assigns a unique number to individuals or entities and links it to their electronic health records (EHR). This mission aligns with the National Digital Health Mission: Health Data Management Policy (NDHM-HDMP), released by the Government of India in December 2020. Although existing technology laws in India do not explicitly address telehealth, the Digital Information Security in Healthcare Act of 2018 (DISHA) defines “digital health data” as electronic health-related information. Additionally, the Telemedicine Practice Guidelines (TPG), introduced by the Indian government in March 2020, aim to regulate telemedicine practices. These guidelines adhere to the WHO’s definition of telemedicine as the delivery of healthcare services using information and communication technologies when distance is a significant factor.
The “Scan and Share” initiative, launched within the ABDM framework, has seen remarkable success within just nine months of its introduction. On average, 70,000 tokens are generated daily, signifying the rapid adoption of this program. Approximately 2,000 healthcare facilities across India have embraced the initiative, marking a significant milestone on August 29, 2023, when a staggering 1 lakh tokens were generated in a single day.
To encourage the creation of electronic health records, facilities have been motivated by the introduction of incentive schemes. In July and August 2023, an additional 248 facilities joined the program, bringing the total to 1,304, including both healthcare facilities and digital solution companies. Notably, financial incentives of 1.75 crores were disbursed in May 2023, with 1 crore allocated to hospitals and 74 lakhs to digital solution companies. In June 2023, 2.60 crores were provided as incentives, with 1.9 crores going to facilities and 65 lakhs to digital solution companies.
The “ABHA” healthcare initiative has created and linked 44,95,76,161 health records, establishing a robust health data infrastructure. This integration connects 30,40,59,663 registered healthcare professionals and 2,24,469 health facilities, promoting efficient healthcare services. Moreover, 2,18,397 health facilities are part of this network. Achievement of the ABHA is bolstered by its 116 successful integrations, enhancing healthcare coordination and accessibility for patients, professionals, and facilities. This comprehensive health ecosystem is a testament to the commitment of ABHA to advancing healthcare through data integration and interconnectivity. India has 0.8 doctors per 1,000 patients, falling short of the recommendation of WHO as 1 doctor behind per 1,000 patients. The ABDM comprises 35 building blocks, aligning with data protection laws. Healthcare goals involve improving life expectancy, reducing infant mortality, and enhancing HIV care, and public health expenditure aims to reach 2.5% of GDP by 2025.
Globally, several policies and guidelines exist on digital health. The Global Strategy of the WHO on Digital Health 2020–2025 aims to enhance healthcare systems through technology. The Global Initiative of the WHO and G20 on Digital Health (GIDH) aligns with this strategy, fostering collaboration and global standards. These international strategies and initiatives share similar goals with the ABDM.
In the United States, the HITECH Act and HIPAA ensure healthcare data security and encourage technology adoption. In the United Kingdom, the NHS focuses on digital transformation, enhancing patient care through modernized records and data exchange. In Canada provincial eHealth initiatives aim to establish electronic health records, improving healthcare efficiency. The NEHR system in Singapore digitally manages healthcare data, improving patient care and outcomes. The GDPR, applicable across the European Union, safeguards health data privacy, while individual EU countries have their distinct regulations and digital health initiatives to complement it.
In conclusion, the ABDM represents a significant step toward transforming healthcare in the country. It addresses critical challenges, promotes digital health, and aligns with global efforts to enhance healthcare through technology. While each country has its unique approach, they all share the common goal of leveraging digital solutions to improve healthcare access, quality, and efficiency.