India Digital Health Net
The India Digital Health Net (IDHN) is a Harvard-wide research and policy collaborative focused on the development of a patient-centric, provider-friendly, API-enabled health exchange ecosystem.
Our key partners in India include government agencies, healthcare enterprises, clinical providers, and researchers from across the country. We are committed to prototyping and developing a federated API-enabled exchange ecosystem. The proposed model will avoid expensive proprietary health information silos and monolithic homogeneous electronic medical records (EMRs) with centralized repositories, both of which are riddled with concerns for security, timely data transfer, usability, and high physician burnout.
India’s 1.3 billion people seek healthcare through a maze of public and private providers – the majority of these interactions are captured on hand-written paper records, or not at all. In January 2018, the Government of India announced what is potentially the world’s largest health insurance scheme, offering coverage for up to ₹500,000 (USD 7600) to approximately 500 million people.
The need to monitor and evaluate services and payments for this vast insurance scheme will provide the impetus needed to jumpstart the health ecosystem. This greenfield also allows India to envision a bold new architecture for digital health data that avoids the shackles of redundancy and inaccessibility faced by health information exchange in the United States.
The First 12 Months
For the proposed API-enabled, UPI-like technological spine to meet its game-changing potential, we implemented the following steps to scale:
- Prototype an EHR-lite that is tested at a range of institutions
- Prototype a Personal Health Record that exchanges data across multiple entities, including the NCD Screening and Management Tool, and the National Health Stack
- City-wide PHR demonstration in a major Indian city (2019 first quarter)
- Training, development, and testing across healthcare entities; chiefly, clinics, hospitals, laboratories, chemists (pharmacies), and public health agencies
Our team of scientists from India and Harvard are developing scalable prototypes for health data exchange that will build on the core principles outlined in our roadmap and on the National Health Stack: Strategy and Approach Document released by the NITI Aayog. These include:
- A federated architecture underpinned by Personal Health Records
- Prioritization of patient and population needs over billing and compliance
- Substitutability that allows for a play-and-plug model of highly customizable applications that can address varying context-specific needs, that also respond to market incentives for better user interfaces
- Data-minimization that allows the creation of a “EHR-lite”
- Technological solutions to ensure adherence to data and privacy regulations in India. Such privacy-by-design will be further supported by automated, consented, and audited data flows
API-Enabled Roadmap for Digital Health
In a roadmap published in the Journal of Internet Medical Research in 2018, we proposed a federated, patient-centric, and application programming interface (API)–enabled health information ecosystem that enables the exchange of health information in conformity with India’s evolving data protection and privacy laws.
Our proposed model has been adopted and implemented by policymakers in India — first by the NITI Aayog in its approach paper for the National Health Stack, and then by the Ministry of Health and Family Welfare in its National Digital Health Blueprint.
In comments submitted to the Ministry of Health and Family Welfare in 2019 on its proposed National Digital Health Mission (NDHM), we recommended the adoption of Regulatory Sandboxes. These are controlled testing environments within which existing regulations may be temporarily relaxed to allow experimentation for novel technologies. They provide the enabling conditions that administrators need in order to test new solutions in subsets of populations in a responsible, controlled, and monitored real-world environment, before mandating change at scale.
In August 2020, the National Health Authority announced the “NDHM Sandbox,” allowing integration and validation of third-party software by partnering with NDHM APIs.