In India, as in most growing economies, coverage leads and innovation follows. And as we noticed in our earlier article, healthcare coverage has not precisely been the robust level of India’s authorities regardless of excessive profile schemes comparable to Ayushman Bharat. Even the place the policymakers have proven the gumption to forge forward-thinking coverage, there was some hesitation. And now the Dissecting India’s Healthtech Playbook turns to the one coverage choice that can have the most important influence on healthtech.
The Nationwide Well being Stack, which is a set of important APIs, not too long ago went dwell for testing. When carried out in the fitting method, it can make telemedicine and different healthtech potentialities a actuality with security, interoperability, safety and reliability being the first pillars. If that sounds acquainted, it’s as a result of India has already reaped the advantages of one thing like this prior to now.
We’ve got seen it in how India Stack — Aadhaar, UPI, Digilocker, digital banking and now account aggregator — have remodeled fintech, digital funds, commerce in India. Envisioning an analogous cohesive future for healthcare, dozens organisations and corporations — Nationwide Most cancers Grid, Swasth Alliance, LiveHealth, DRiefcase and others — have begun testing the newly constructed Nationwide Well being Stack APIs prior to now few weeks. However there’s nonetheless an extended technique to go earlier than there’s full-fledged innovation constructed on the well being stack.
“It will take a few months before all the APIs get authenticated and certified by an empanelled ecosystem of certification agencies,” iSPIRT Basis’s core volunteer Siddharth Shetty, who has carefully labored on the Nationwide Well being Stack challenge, informed Inc42.
The federal government has accredited telemedicine tips and that will work as oxygen for the Nationwide Well being Stack ecosystem. Among the many insurance policies catching up with the instances are the age-old pending privateness and knowledge safety payments, the framework for the Nationwide eHealth Authority which is meant to manage distant healthcare in India.
And as common, there’s loads of urge for food from startups and the non-public sector in adopting the newest know-how to faucet the chance. However the query is whether or not they need to be allowed to only but? Though there exists the need to vary issues, Indian healthcare is just not data-ready for the tech revolution. Talking to Inc42, Justice BN Srikrishna, chairman of Monetary Sector Legislative Reforms Fee and the person behind Private Information Safety Invoice, indicated that India will not be prepared. Not but at the least.
“The Personal Data Protection Bill has not been passed through the parliament. There is no law that currently governs it except the fact the Supreme Court of India has recognised Right to Privacy as our fundamental right. In the case of new developments, we have to check if it compromises any fundamental rights or does it comply with the three core directive principles with regards to the fundamental rights.”
With consent managers answerable for linking the sufferers’ private well being information from one entity to a different, there’s positively higher emphasis on knowledge security and safety within the digital healthcare ecosystem. So can the Indian authorities and the healthcare ministry win the belief of individuals amid lack of privateness legal guidelines, a Information Safety Authority and a Nationwide eHealth Authority? And with no oversight in place, ought to India even be accelerating its healthtech efforts?
From India Stack To The Nationwide Well being Stack
The event of the final brick of India Stack layers — Information Empowerment and Safety Structure (DEPA) accomplished earlier this yr. Consent managers together with API bridges have unleashed an enormous potential not solely in BFSI but in addition in different sectors like healthcare.
On the core of those developments has been the iSPIRT Basis, a pro-bono companion within the growth of India Stack APIs. The volunteers who labored for the Aadhaar growth — the presenceless layer, as they name it — a decade again have since then efficiently labored on a slew of different open API tasks forming different layers — paperless layers (Aadhaar-enabled eKYC,eSign and DigiLocker), cashless layers (UPI, AePS and many others) and consent layer (DEPA) of India Stack.
These layers or APIs haven’t solely made transactions seamless anytime, anyplace but in addition have diminished the price of transactions by manifold — for suppliers and customers. The much-acclaimed JAM (acronymized from Jan Dhan Yojana checking account, Aadhaar and cellular quantity) mannequin has opened up big scope for BFSI gamers and fintech startups.
Your complete structure has unleashed an enormous potential of its replicability in different sectors as effectively. As an example, a transaction might be of any sort — funds, knowledge and therefore these constructing blocks comparable to consent layer, presenceless layer, paperless layer and cashless layer would equally be helpful in constructing digital healthcare structure too.
What Does Nationwide Well being Stack imply For Indian Healthcare?
Like account aggregators coined by the RBI within the case of banking and finance, iSPIRT has coined a brand new time period for consent managers within the well being stack referred to as Well being Information Consent Supervisor (HDCM). The consent administration structure based mostly on DEPA is once more complying with the Digital Consent Framework printed by the Ministry of Electronics and Info Know-how, claimed Shetty.
This together with different requirements which iSPIRT not too long ago printed set the pretext of the consented sharing of well being data between well being data suppliers (HIPs) – like hospitals, pathology labs, and clinics – and well being data customers (HIUs) like pharmacies, medical consultants, docs and so forth.
Within the standard healthcare system, a affected person has to bodily go to the Hospitals/clinics and labs after which carry PHR print copies in all places he/she goes for consultancy/treatment. The consent administration is often irreversible and in case a affected person loses any doc and overlook to hold, it takes an enormous time and effort to recuperate the identical significantly if the affected person goes to a brand new hospital/lab. The onus of sustaining the file stays on sufferers.
Within the newest Nationwide Well being Stack structure, in accordance with iSPIRT, “a user is able to generate a longitudinal view of their health data across providers. The interoperability and security of the PHR architecture allow users to securely discover, share, and manage their health data in a safe, convenient, and universally acceptable manner. For instance, a user could use an HDCM to discover their account at one hospital or diagnostic lab, and then select certain electronic reports to share with a doctor from another hospital or clinic. The flow of data would be safe, and the user would have granular control over who can access their data and for how long.”
Just like DigiLocker, the idea of a Well being Locker has additionally been launched which permits people to retailer copies of their private well being information and share with the well being data customers.
Can Nationwide Well being Stack Meet The Wants Of Ayushman Bharat?
Proper after saying Ayushman Bharat, the biggest healthcare insurance coverage programme which goals to learn over 50 Cr poor Indians, in 2018, the Indian authorities had tasked its public coverage suppose tank NITI Aayog to provide you with an in depth define on Nationwide Well being Stack with the intention to meet the wants of Ayushman Bharat public insurance coverage implementation.
As introduced within the Finances 2018-19, Ayushman Bharat supposed to arrange 1.5 Lakh well being and wellness centres for complete main healthcare and a flagship scheme Pradhan Mantri-Rashtriya Swasthya Suraksha Mission (PM-RSSM) which is able to cowl over 10 Cr poor and susceptible households offering protection as much as INR 5 Lakh per household per yr for secondary and tertiary care hospitalisation.
It’s price noting that over 300 hospitals have been later served show-cause notices and de-empanelled, and penalties of over INR three Cr have been levied on them for submitting cast claims beneath the Ayushman Bharat Well being Insurance coverage Scheme.
The NITI Aayog in July, 2018 had submitted its draft on Nationwide Well being Stack. The important thing elements as outlined within the draft have been:
- Nationwide Well being Digital Registries to create a single supply of fact for and handle grasp well being knowledge of the nation
- A protection and claims platform as constructing blocks to assist massive well being safety schemes, allow horizontal and vertical growth and sturdy fraud detection
- A Federated Private Well being Information (PHR) Framework to unravel twin challenges of entry to their very own well being knowledge by sufferers and availability of well being knowledge for medical analysis, essential for advancing our understanding of human well being
- A Nationwide Well being Analytics Platform to carry a holistic view combining data on a number of well being initiatives and feed into good coverage making, as an illustration, via improved predictive analytics
- Different horizontal elements together with distinctive digital well being ID, well being knowledge dictionaries and provide chain administration for medicine, fee gateways and extra
iSPIRT Basis has been stated to be engaged on the ideation since 2016. Explaining the thought behind Nationwide Well being Stack, Nita Tyagi one of many core volunteers at iSPIRT, stated, “I belong to Uttarakhand. In the rural, semi-places like Uttarakhand, it’s mostly doctors’ clinics that a patient visits in the case of an emergency. Now, even if the patient has his health insured, and the doctor is willing to treat the patient, insurers don’t extend the cover due to the fear factor of forged claims. This is where the National Health Stack comes in by making the entire process transparent, efficient.”
With the assistance of consent managers, insurers thus can look at the affected person’s previous information and their claims or claims made by hospitals on their behalf. “As was in the case of the KYC process, earlier the claim-verification process conducted by insurance companies used to cost at INR 600-INR 1,000 per claim. The National Health Stack would reduce the same to a few bucks.This is significant for insurance companies,” added Tyagi.
Nevertheless, assembly Ayushman Bharat’s necessities has its personal challenges. Ayushman Bharat is designed to fulfill the well being necessities of transient staff comparable to home assist, washermen, ragpickers, sweepers and even unemployed and homeless individuals who could not have regular revenue.
Telemedicine advantages would take a long time to succeed in out to them since a really small variety of these Ayushman Bharat beneficiaries are believed to have smartphones. In such instances, even when the well being data suppliers digitise their well being knowledge, getting consent from them by way of mobiles will not be possible as has been conceptualised by NITI Aayog.
iSPIRT cofounder Sharad Sharma, nevertheless, claimed, “Once implemented, the National Health Stack will significantly bring down the costs of health protection, converge disparate systems to ensure a cashless and seamlessly integrated experience for the poorest beneficiaries, and promote wellness across the population.”
The Making Of IndEA And Nationwide Digital Well being Blueprint
Nationwide Well being Stack proposed by NITI Aayog is merely the draft discussing the know-how, technique and adoption of the APIs pertaining to well being stack. Nevertheless, on the governance stage, the federal government wished it to see how it could match with the India Enterprise Structure (IndEA) an e-governance commonplace with a set of reusable constructing blocks which may very well be slot in all of the precedence sectors. Additionally, there must be extra readability on the regulatory aspect of the well being stack.
In consequence, the Ministry of Well being and Household Welfare, in July 2018, constituted a committee beneath the chairmanship of former UIDAI chairman and MeitY secretary J Satyanarayana to create a framework and implementation plan for Nationwide Well being Stack. The J Satyanarayana Committee submitted the Nationwide Digital Well being Blueprint 2019 in July 2019 and the identical has now been accredited by the standing finance committee of the federal government.
Talking to Inc42, Dr Pallab Saha, chief architect, The Open Group, who has contributed in IndEA framework in addition to within the NDHB, stated, “The version of IndEA which was released and notified back in October 2018 actually talks about a holistic approach to e-governance solutions. Certain priority areas were identified such as agriculture and healthcare as part of the architecture to make the services more affordable, accessible.”
That’s how NDHB was conceptualised too. The Nationwide Well being Stack might be thought-about as a precursor to the Nationwide Digital Well being Blueprint 2019, stated Dr Saha. The NHS appears to cowl a lot of the know-how infrastructure whereas the Indian enterprise structure is a typical platform to be utilised for digital well being, digital agriculture or digital training platform and plenty of different issues that must be captured.
“The 24 building blocks and one more, which will be added in order to meet the agritech demands, are very similar to Lego blocks which are reusable and the same set of blocks could be used to make different stuff. That’s the concept with NDHB,” – Dr Pallab Saha
The Unanswered Questions: Information Privateness
Whereas work goes full-steam in creating the info and tech framework for healthcare, plainly the federal government hasn’t totally learnt from the Aadhaar fiasco the place over 49Okay Aadhaar centres have been blacklisted for alleged digital theft, knowledge leaks and innumerable different instances the place Aadhaar knowledge was allegedly hacked via varied different authorities web sites and portals. Only in the near past, Cyble, a 3rd get together intelligence platform has acquired 100 Gb of information belonging to Indian customers together with their Aadhaar playing cards from the darkish net for simply $4,800.
The non-public well being knowledge is far more delicate in nature. The Nationwide Digital Well being Blueprint seeks to create a single repository of medical information of all residents. But, as soon as once more because the NHS is only a few months away from being opened to the market, there is no such thing as a enough regulation to make sure knowledge privateness. There is no such thing as a stringent authority to manage nationwide digital well being entry and consent. The Nationwide Digital Well being Mission, as proposed by the NDHB, is but to see the sunshine of the day. The proposed knowledge privateness drafts, the Digital lnformation Safety in Healthcare, Act (DISHA) and the Private Information Safety Invoice are nonetheless pending approval at varied phases.
Whereas DISHA is extra more likely to be dropped in its present format as a result of onerous line method in the direction of knowledge safety, the private knowledge safety invoice as soon as cleared by the joint parliamentary committee will likely be moved additional, stated a authorities official from ministry of Electronics and Info Know-how on the situation of anonymity.
In such a state of affairs, is the Nationwide Well being Stack additionally set to draw controversy as occurred in Aadhaar?
So far as knowledge privateness is anxious, the PDP Invoice as soon as enacted would carry extra readability over the matter. Whereas there’s already a stage of conscientiousness and readability, the federal government should resolve all such points in time so that folks shouldn’t have any doubts of their thoughts,” stated Prashant Tandon, cofounder of 1MG, which expanded from on-line pharmacy to telemedicine in the course of the lockdown. 1mg has additionally been part of the NHS challenge, it has additionally contributed to the federal government’s Aarogya Setu contract tracing app and telemedicine portal Aarogya Setu Mitr.
In a great state of affairs, it’s at all times good to have every little thing in place as a result of one begins constructing any system or any software program, however in a practical state of affairs, that’s by no means the case, stated Dr Saha. The regulation at all times catches up with know-how because the latter strikes first and sooner. “Be it privacy or else, was there a law about mobile phones before it came into existence? The gaps between technology and policy making would always be there and the law would eventually catch up. Unlike innovations, the making of a law needs to take many factors into consideration and that takes time. If we really want to become a country which is knowledge-driven, which is innovation-driven, we cannot wait for the law before implementing technology.”
In such instances, the federal government ought to widen the idea of sandbox frameworks throughout the sectors which is able to whereas encouraging the event of rising applied sciences, may even enable the lawmakers to check the identical and put together or amend the legal guidelines. In India, it is going to be, nevertheless, an excessive amount of to ask, given the previous monitor file.
Arguing that the NHS presents privateness by design, Shetty stated, “Every data flow has to be consented to and that’s the foundational principle. The user has been put at the centre of the data flow and it’s them who choose what aspects of data they want to share for what purpose. The second key part is the certification. The entities that are facilitating access to data will have to be certified first, as a part of the certification process. So, there will be a strong ecosystem of data governance certification in place, followed by the regular data audit,as prescribed by the Srikrishna Committee.”
Compared to the west, the Indian startup ecosystem may be very nascent. Ankit Chaudhari, CEO & founder, Aiisma, primarily a well being knowledge market providing symptom mapping options, says that there’s not a lot consciousness or sensitisation concerning the essentiality of information privateness amongst Indian startup ecosystem. “We have been talking about this mainly because of Facebooks, Amazons and Googles. The Indian startup ecosystem is not really talking about. This basically implies that either we’re not even worried about it or we don’t see an opportunity huge enough in this particular space”
The Unanswered Questions: Regulatory Authority
Your complete well being stack structure is closely dependent upon consent managers. Within the case of fintech house, consent managers or account aggregators are accredited, licensed and controlled by the Reserve Financial institution of India. Nevertheless, within the case of the NHS which is already dwell for testing, there is no such thing as a readability over which authority goes to approve, license and regulate these consent managers.
To this, iSPIRT’s Sharma responded,
“We are hopeful that the government will soon come up with a regulatory mechanism for the oversight of various processes under the healthtech spectrum. The development of healthtech will need multiple institutions to work in tandem without compromising the integrity of individual systems.”
The J Satyanarayana Committee in its blueprint has really useful the making of Nationwide Digital Well being Mission as a brand new organisation and an apex governing physique to oversee all the implementation. The apex physique, the committee stated, would have the authority to make regulatory insurance policies too. Not like NPCI, the physique construction could be much like UIDAI, a completely authorities enterprise.
In June 2020, Preeti Sudan, well being ministry secretary, said that the work on the NDHM has already underway. “We have forwarded a proposal to the finance ministry. We are also working on the sanctioning of posts. This will be a population registry that will have a long-term positive impact on the healthcare ecosystem in India. We are working as per the vision of the finance minister to create a digital health ecosystem.”
Again in 2015 an idea word on the necessity of a Nationwide eHealth Authority was printed. The idea word had then recommended, “It is also strongly recommended that NeHA be created at the earliest, as it will give a fillip to all the current and envisaged programs of the government in respect of IT in Health and accelerated adoption of EHR in an orderly manner. It will also help avoid problems arising out of uncoordinated induction of IT systems in hospitals and public health systems which will become inevitable with the passage of time in the absence of a suitable authority to guide and enforce orderly evolution.”
Nevertheless, this was by no means finalised. And, the query is that can the NHS go dwell with none watchdog or authority monitoring the developments? To which, Shetty stated that it could be the NHA that will be taking a look at functioning at first. The authority has additionally been a part of this growth.
The Information Safety Authority too stays non-existent till the PDP invoice will get enacted.
Vested Pursuits And Uneven Taking part in Area
Proper from Aadhaar challenge to UPI, many amongst those that have been concerned within the making have been accused of vested pursuits. As an example, UPI’s early adoption as a part of the testing train was prolonged to quite a few gamers together with Phonepe and YES Financial institution however there was no mechanism to ask different gamers.
In consequence, by the point different gamers like Citrus began constructing their UPI options, Phonepe and YES Financial institution have been already forward within the race. Thus, individuals related to the challenge growth have been allegedly the direct beneficiaries of the challenge.
In Nationwide Well being Stack too, it’s being alleged by a number of the healthtech startups that over a dozen corporations and organisations are already engaged on the challenge and by the point the APIs get licensed and are open for market adoption, these corporations would have already got market-ready merchandise. Among the many corporations and organisations which are related to the NHS challenge are 1mg, Practo, mfine, Nationwide Most cancers Grid, LiveHealth, DRiefcase and many others. Per week earlier than the launch, an alliance referred to as Swasth Alliance of 100 non-public and non-profit corporations together with 1mg, Acko, Carefit, Dozee and so forth was launched which is now working together with iSPIRT on constructing an Open Well being Companies Community.
Whereas LiveHealth, a laboratory data administration system (LIMS) supplier has been engaged on the API bridges, DRiefcase has constructed the Well being Locker facility, a platform much like DigiLocker for longitudinal well being information.
With the Well being Stack, is iSPIRT serving to create an unequal alternative out there? iSPIRT Cofounder Sharma claimed there have been a number of open homes hosted on-line the place anybody may take part and construct their very own teams, consortium and even SROs. Until now, 5 open homes on NHS have been hosted on-line, the place all points of how iSPIRT is concerned within the Nationwide Well being Stack growth course of have been mentioned. A number of teachers, founders, media individuals, college students amongst others take part in these open homes. iSPIRT has additionally launched de-facto requirements for PHR obtainable for everybody and anybody to make the most of. These requirements can be found on-line on our web site.
With India Stack, UPI modified the way in which funds used to occur in India. On a yearly foundation, the cardboard market in India fell by 10% in 2019, compared to 2018. Among the many playing cards market too, RuPay held the lion’s share with 58% of market share among the many new playing cards issued in 2019. In September 2019, UPI surpassed playing cards as probably the most most well-liked mode of fee and continues to take action.
With Nationwide Well being Stack too, a number of the constructing blocks are set to create a complete new market alternatives for tech startups.
Based on Datalabs by Inc42, the general Indian healthcare market is predicted to develop to $638 Bn by 2025, boosted by the elevated adoption of digital applied sciences in healthcare. Preventive healthcare and medical tourism too are set to hit $169 Bn and $54 Bn respectively by 2025.
As soon as the Nationwide Well being Stack is in place, it will unleash a slew of recent market alternatives for tech startups comparable to consent managers, API bridges, gamifier gamers, market, aggregators, for quite a few associated companies, constructing interfaces, software program options, apps for well being data customers and suppliers in addition to sufferers.
Relying on the brand new markets with care intermediaries, democratisation of biomarkers and so forth, iSPIRT’s Shetty stated the influence that it would create would maintain India in good stead for the long run and would even assist immensely in preventing pandemics comparable to Covid-19. But it surely’s no straightforward job, as in contrast to banking and monetary companies, no Indian can afford to be underserved in terms of healthcare. So attaining the stability of privateness, knowledge safety and potential of innovation is paramount for the Nationwide Well being Stack. It can’t be achieved shortly or rushed in any method.
“Health is something that affects everyone at every level, hence in terms of the market size, it is the entire population of India. That is the market size that we are trying to address.” – Dr Saha
The important thing function of Nationwide Well being Stack is that it’s 100% citizen-centric. iSPIRT’s Sharma added, “The aim and hope is that with the build of the recommended foundational blocks, the frictions in the current health ecosystem — trust and cost — will be addressed which will allow a complete redesign of the flow of people, money, and information, as well as a layered approach to providing comprehensive foundational health functions for all states and programmes in an inclusive and interoperable manner.”