Newly launched Ayushman Bharat Digital Mission

1. National Digital
Health Mission: An
overview
Dr. Kumarjit Dutta
MD PGT 2019-2022
Burdwan Medical College

2. Contents
• Global Perspective
• Prospect of Digital Healthcare in India
• Conceptualization of NDHM
• Vision & Objectives of NDHM
• Proposed Benefits & Impacts of NDHM
• ABDM(NDHM) Ecosystem & its Stakeholders
• Architecture of NDHM
• Strategy for implementation
• Data security and Privacy
• Strength, Weakness, Opportunity & Threat
• References
2

3. Global Perspective
May 2005 : 58th World
Health Assembly (WHA)
through its resolution on
eHealth urged Member States
to consider drawing up a long-
term strategic plan for
developing and implementing
eHealth services
May 2013: 66th World
Health Assembly adopted
resolution on eHealth
standardization and
interoperability, which urged
Member States to consider
developing policies and
legislative mechanisms linked
to an overall national eHealth
strategy
3

4. Global Perspective 4
May 2018: 71st World
Health Assembly adopted
resolution on digital health, in
which it requested the
Director-General “to develop,
in close consultation with
Member States and with inputs
from relevant stakeholders, a
global strategy on digital
health, identifying priority
areas including where WHO
should focus its efforts”.
March 2019: The strategy
was developed through a
consultative process that
included discussions in online
public forums, technical
consultations, meetings of the
WHO regional committees and
the Executive Board at its
146th session.

5. 5
May 2020: 73rd World
Health Assembly endorsed
The global strategy on digital
health 2020–2025
Global Perspective

6. Global leaders of digital health care system
 South Korea
About 50% of South Korea’s digitized hospitals already use a paperless and comprehensive health
care system called BESTCare 2.0. It introduced an unparalleled combination of advanced features
and value to the global Electronic medical records (EMR) market.
 USA
The Office of the National Coordinator for Health Information Technology, USA reported that, in
2008, only 9% of hospitals and 17% of physicians utilized an electronic health record (EHR). By
2015, this had increased to 96% of hospital and 78% of physician offices.
 England
NHS Digital is the trading name of the Health and Social Care Information Centre, which is the
national provider of information, data and IT systems for commissioners, analysts and clinicians in
health and social care in England, particularly those involved with the National Health Service of
England.
6

7. Prospect of
Digital
Healthcare
in India
India’s potential
India made remarkable progress in the Information &
Communication Technology (ICT) space over the past two
decades.
The positive impact of IT revolution on the public sector
governance architecture led to some transformational
initiatives like
• UID‐Aadhaar for almost all the residents
• IT enabled platform for GST,
• IT systems integration in banking sector and
• IT‐enabled public service delivery.
Current situation
While India has pockets of IT excellence within the public sector,
the application of IT enabled systems has not yet been uniformly
adopted across the entire governance system.
The IT initiatives in the health sector in particular, have been
fragmented and compartmentalized hindering the realization of
the full potential of ICT.
7

8. Conceptualization
of NDHM
February 2018: In General Budget 2018–19, as part
of Ayushman Bharat Yojana, Pradhan Mantri Rashtriya
Swasthya Suraksha Mission (PM-RSSM) was
announced. This is a flagship programme covering
approx. 50 crore beneficiaries providing coverage upto
5 lakh rupees per family per year for Secondary and
Tertiary Care hospitalization.
15th March 2017: The Union Cabinet approved the
National Health Policy 2017 (NHP 2017) which
envisaged creation of a digital health technology
ecosystem aiming at developing an integrated health
information system.
8

9. Vision
July 2019: A Committee constituted by the Ministry of Health and Family Welfare
produced the National Digital Health Blueprint (NDHB), laying out the building blocks
and an action plan to implement digital health comprehensively and holistically. NDHB
recognizes the need to establish a specialized organization, called National Digital
Health Mission (NDHM) that can drive the implementation of the Blueprint, and
promote and facilitate the evolution of National Digital Health Ecosystem (NDHE) that
supports Universal, information and infrastructure services, duly leveraging open,
interoperable, standards‐based digital systems, and ensuring the security, confidentiality
and privacy of health‐related personal information.
June 2018: NITI Aayog introduced National Health Stack (NHS)- a digital backbone for
India’s health system.
9
Conceptualization of NDHM

10. 7th august, 2020: NDHM released strategic document.
The COVID-19 pandemic has highlighted the importance of digital tools. In parallel,
digital health has ensured that patients can access care during the pandemic through
remote and virtual services; and countries have put in place temporary payment policies
and other provisions to support such telehealth services.
Conceptualization of NDHM 10

11. At present, this programme is renamed as
Ayushman Bharat Digital mission (ABDM)
September 27, 2021: Prime Minister Narendra Modi launched the Pradhan Mantri
Digital Health Mission (PM-DHM) via video conferencing. Currently, PM-DHM is being
implemented in pilot phase in six Union Territories.
Conceptualization of NDHM 11

12. Vision
“To create a National Digital
Health Eco‐system that
supports Universal Health
Coverage in an efficient,
accessible, inclusive,
affordable, timely and safe
manner, through provision of
a wide‐range of data,
information and
infrastructure services, duly
leveraging open,
interoperable,
standards‐based digital
systems, and ensuring the
security, confidentiality and
privacy of health‐related
personal information.”
12

13. Objectives
1. To establish state-of-the-art digital health systems,
• to manage the core digital health data, and
• To create the infrastructure required for its seamless exchange.
2. To establish registries at appropriate level to create single source of truth in respect of
clinical establishments
healthcare professionals
health workers
drugs and pharmacies.
3. To enforce adoption of open standards by all stakeholders
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14. Objectives
4. To create a system of personal health records, based on international standards, easily accessible to
individuals, healthcare professionals and services providers, based on individual’s informed consent.
5. To promote development of enterprise-class health application systems with a special focus on
achieving the Sustainable Development Goals for health.
6. To adopt the best principles of cooperative federalism while working with the States and Union
Territories for the realization of the vision.
7. To ensure that the healthcare institutions and professionals in the private sector participate actively
with public health authorities in the building of the NDHM, through a combination of prescription and
promotion.
8. To ensure national portability in the provision of health services.
14

15. Objectives
9. To promote the use of clinical decision support (CDS) systems by health professionals
and practitioners.
10. To promote a better management of the health sector leveraging health data
analytics and medical research.
11. To support effective steps being taken for ensuring quality of healthcare.
12. To strengthen existing health information systems, by ensuring their conformity with
the defined standards and integration with the proposed NDHM.
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16. Proposed
Benefits
16

17. 17
1.Digital health records:
Provision of access & sharing
medical records with health
care providers 
Prescription, Diagnostic
reports, Discharge summaries
2.Continuum of care:
Integrated ecosystem 
better access to patient’s
medical history more
appropriate and effective
health interventions
3.Ease of doing
business:
digitize the claims process,
faster reimbursement
4.Easy access to
healthcare:
Both public and private
health services,
tele-consultation,
e-pharmacy
5.Evidence based
planning and policies:
Better access to data by
policy makers & programme
managers  informed
decision making by the
Government.
6.Innovation in digital
health services:
researchers will greatly
benefit from the availability
of such aggregated
information.
Proposed Benefits

18. Impacts of NDHM
Empower
individuals
with accurate
information to
enable informed
decision-making
Increase
accountability
of healthcare
providers
Enhance ease of
service
provision
by the health
care providers
Ensure
transparency
in pricing of
services
Enable
monitoring &
appropriate
decision-making
geography &
demography-
based
Strengthen
implementation
of health
programmes and
policies.
Facilitate a
comprehensive
feedback loop
researchers
policymakers
providers
18

19. ABDM(NDHM)
Ecosystem & its
Stakeholders
19

20. Building
Blocks of
NDHM
Health ID
Healthcare Professionals Registry (HPR)
Health Facility Registry (HFR)
Personal Health Record-System (PHR) 20

21. 21
Health ID
Building Blocks of NDHM
It is important to standardize the process of
identification of an individual across
healthcare providers. The Health ID will be
used for the purposes of uniquely
identifying persons, authenticating them,
and threading their health records (only
with the informed consent of the patient)
across multiple systems and stakeholders.
UHID contains demographic details like
• name,
• father's/mother’s/spouse’s name,
• date of birth/age,
• gender,
• mobile number,
• authentication route,
• email address,
• location,
• Family ID, and
• photograph

22. The design of UHID may leverage
existing multiple identifiers
including Aadhaar, PAN card,
Ration Card, Electors Photo
Identity Card (EPIC) etc.
Building Blocks of NDHM 22

23. It is a comprehensive repository of all
healthcare professionals involved in
delivery of healthcare services across
both modern and traditional systems
of medicine. Enrolling in the
Healthcare Professionals Registry will
enable them to get connected to
India’s digital health ecosystem.
Building Blocks of NDHM 23
Healthcare Professionals Registry (HPR)

24. It is a comprehensive repository of
health facilities of the nation across
different systems of medicine. It
includes both public and private
health facilities including hospitals,
clinics, diagnostic laboratories and
imaging centers, pharmacies, etc.
Enrolling in the Health Facility Registry
will enable them to get connected to
India's digital health ecosystem.
Building Blocks of NDHM 24
Health Facility Registry (HFR)

25. A PHR is an electronic record of health-related
information on an individual that conforms to
nationally recognized interoperability standards and
that can be drawn from multiple sources while being
managed, shared, and controlled by the individual.
The most salient feature of the PHR is that the
information it contains is under the control of the
individual. Key features of the ABDM Health Records
(PHR) mobile application are Creation of Health ID,
Discovery of Health Information, Linking of health
records with a given Health ID, Viewing Health
Records (all health data, lab reports, treatment
details, discharge summaries across one or multiple
health facilities) and Management of consents
Building Blocks of NDHM 25
Personal Health
Record-System (PHR)

26. Architecture of NDHM
The National Digital Blueprint (NDHB) provides an approach to establish a Federated
Architecture, defined in terms of its Building Blocks.
Federated Architecture (FA)
Federated architecture (FA) is a pattern in enterprise architecture that allows
interoperability and information sharing between semi‐autonomous de‐centrally
organized entities, information technology systems and applications.
Rationale behind proposing Federated Architecture
1. Essential for enhancing the security and privacy of the personal and sensitive
information of the citizens while ensuring interoperability and technological flexibility
and independence.
2. Such an architectural pattern is also ideally suited to the conditions prevalent in a
federal set up like India and includes both public and private health facilities and
institutions. 26

27. Federated
Architecture
(FA)
27

28. Salient features of the architecture
• The federated architecture is indicative. It can be modified, enhanced and evolved
with time.
• The architecture is laid out at 3 Levels – National, State/UT/ Regional and Facility
Levels.
• Each level has the systems designed in 4 Layers, each layer consisting of a set of
building blocks of a particular type, namely, Infrastructure, Data, Technology and
Application building blocks.
• The building blocks at each layer and across the 4 layers and 3 levels are loosely
coupled on a ‘Need‐to‐Connect’ basis, using standardized API’s.
• To ensure data consistency, interoperability and national portability, only the
minimum required number of building blocks are designed, developed, held and
managed centrally.
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29. Architectural
Building Blocks:
2-dimensional
representation
29

30. Concept of
end user
experience
through
NDHM
Architecture
30

31. Strategy for implementation
31
The Mission will follow the
approach of
‘Think Big, Start Small,
Scale Fast’.
This will enable a
fast paced and agile
implementation
and provide learnings
continually.
The implementation of NDHM
will occur in
3 phases.
Phase 1
comprises a pilot in 6 Union
Territories which is being
implemented now.
Phase 2
will be taking forward the
pilot in additional States and
expand the service bouquet.
Phase 3
will target nation-wide roll-
out, operationalizing and
converging with all health
schemes across India along
with promotion, on-boarding,
and acceptance of NDHM
across the country.

32. Proposed way forward for NDHM in phases 32

33. Pilot Launch:
The NDHM has
been rolled out on
pilot mode in six
Union territories,
namely, Chandigarh,
Lakshadweep,
Ladakh, Puducherry,
Dadra and Nagar
Haveli and Daman
and Diu and
Andaman and
Nicobar Islands
33

34. Predicted Budget for NDHM by NHA
Digital ICT Systems – Rs. 66 Crores
• Health Cloud – 12 Crores
• Storage – 5 Crores
• Bandwidth – 28 Crores
• SOC and NOC – 15 Crores
• Miscellaneous – 6 Crores
Application Development - Rs. 20 Crores
Management Salaries - Rs. 15 Crores
Software Licenses and associated IT Cost - Rs. 12 Crores
Office Space - Rs. 6 Crores
Change Management - Rs. 15 Crores
Miscellaneous Rs. 10 Crores
Total -
Rs.
144
Crores
34

35. Data security and Privacy
35
The security architecture will
be based on the principle of
“Zero Trust
Architecture”
to ensure the protection of
systems, information (data),
resources and services from
accidental and deliberate
threats to confidentiality,
integrity, and availability.
NDHM will establish
1.formal information
security governance
structure,
2.information security
strategies,
3.Information Security
Policy
which will address all related
aspects.
All events on the Health‐Cloud
and the Health Network will
be under
24x7 security
surveillance
ensuring every data byte is
highly secure. This will be
achieved through a
Security Operations Centre
(SOC).

36. Strengths
36
Successful implementation of NDHM will ensure
Health and Well-being for All
Health and Well-being at All ages
Universal Health Coverage
Citizen-centric Services
Quality of Care
Accountability for Performance
Efficiency and Effectiveness in delivery of services
Creation of a holistic and comprehensive health eco-system.

37. Weakness
For nationwide smooth functioning of the programme
maintaining a huge digital cloud space, high speed internet
connectivity with optimum bandwidth at every point will be
resource intensive.
There will always be cyber-security threat despite the measures
taken.
As the participation of different stakeholder is on voluntary
basis, successful implementation will be challenging without a
robust system of collaboration.
37

38. Opportunity
Formation of a databank accessible for quick retrieval for various purposes.
Programme evaluation and gap analysis will be easier.
This will promote platform for performing operational research and translational
research.
Conceptualization of NDHM 38

39. Threat
Conceptualization of NDHM 39
As complete
implementation of NDHM
will enforce the migration
of data source from physical
form to digital form, any
break in the system like
hacking, virus attack, weak
internet connectivity or
software corruption may
put the whole system on
jeopardy.

40. References
1. National Digital Health Mission Strategy Overview [Internet]. National Health
Authority; 2020 [cited 25 November 2021]. Available from:
https://abdm.gov.in/publication/strategy-documents
2. National Digital Health Blueprint [Internet]. New Delhi: Ministry of Health & Family
Welfare, Government of India; 2019 [cited 25 November 2021]. Available from:
https://abdm.gov.in/publication/strategy-documents
3. World Health Organization. Draft global strategy on digital health 2020–2025 (Geneva:
World Health Organization, 2020). World Health Organization and International
Telecommunication Union, Be he@ lthy, be mobile (Geneva: International
Telecommunication Union, 2014).
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