ABDM INTEGRATION DEMYSTIFIED by Racloop || AConnect

In our previous blog, we saw the need and scope of healthcare services and the imminent need for it to be digitized in the near future. We understood government initiatives through #ABDM mission by introducing the #ABHA number. The #ABHA number is a 14-digit number that identifies a person as a participant in India's digital #healthcare ecosystem. The #ABHA number will establish a strong and trustworthy identity that will be recognized by #healthcare providers and payers nationwide.

It is clear if the #digitalization of health records needs to be achieved Doctors, Hospitals, Labs & other health service provider plays a vital role, we will talk in other blog around the nation-wide registries for providers, it is crucial that the digital systems these providers use needs to get connected to a central exchange so that information can be shared across and the benefits from the Digital health records can be taken by provider.

In the current blog, we are going to look at the implementation of integrating and process of compliance with the #ABDM (#AyushmanBharatDigitalMission).?

It is an important step while carrying through with the process of integration. This will establish state-of-the-art digital health ecosystems at national level which will eventually manage the core digital health data, and the infrastructure required for its seamless exchange.

However, we delve deep into this uphill task of integration; let us take a note of few essential elements and key terms which will aid us in understanding the process.

?#ABHA Address is an easy to remember username that enables a user to access their health records digitally and share their records with various healthcare providers. An #ABHA address may look like ‘name @abdm’. It is required to sign up on #ABHA Application.

#ABHA number is a 14 digit number that will uniquely identify the participant in India’s digital healthcare ecosystem. #ABHA number will establish a strong and trustable identity that will be accepted by healthcare providers and payers across the country.

A HIP (Health Information Provider) can be a hospital, laboratory, clinic, pharmacy, or other defined health facilities which create medical data pertaining to a citizen/patient

The Health Facility Registry (HFR) is a comprehensive registry of all health facilities in the country across modern and traditional systems of medicine. It includes government, public and private health facilities including hospitals, clinics, diagnostic center, imaging centers and pharmacies, etc.

Health Information User or HIUs are the entities that want to access digital health information from HIPs, in order to provide services to the patient to whom the information belongs. An HIU can be a hospital, clinic, health care technology company, organization working on health analytics, insurers, medical researchers, and government entities. These HIUs will be able to request for health records of a patient, and upon obtaining the patient’s digital consent, view the health records for a limited time period.

To develop a robust infrastructure, it is always advisable to list out details in step by step manner. National Health Authority (NHA) or NHA has listed process of integration in three milestones.

#MILESTONE 1

• ABHA Number Creation And Capture & Verification For Seamless Patient Registration

One of the key things about #ABDM is the creation of #ABHA number.? This milestone will help create #ABHA (identity) with either Aadhaar number,? or mobile number, or patient’s driver's license number.?

This involves the role of Health Information Provider (HIP), since the data will be registered with them. An HIP (Health Information Provider) is any entity that creates medical data about a patient, such as a hospital, laboratory, health care centre, clinic, or pharmacy. By agreeing to participate in this federated health records system, health care providers become Health Information Providers (HIPs) who are willing to share data through the system. HIPs are required to keep a digital copy of each person in their care's inpatient and outpatient records. To become a HIP, the health care facility must register with the #ABDM health care infrastructure registry.

The patient who is required to be registered at the #ABHA portal would be termed as Health Information User or HIU. An HIU (Health Information User) is a person or organisation that wants to access digital health information from HIPs in order to provide services to the patient whose information is registered. An HIU can be hospital, clinic, #healthcare technology company, health analytics organisations, insurers, medical researchers, or government entities. These HIUs will be able to request a patient's health records and, after obtaining the patient's digital consent, view the health records for a limited time.

The general flow of the mobile number registration process is along these lines. The registering entity is required to generate an Aadhaar OTP on the registered mobile number. Then, he or she must validate the Aadhaar OTP received on the registered mobile number. After that, generate a Mobile OTP for verification and then verify the Mobile OTP in an existing transaction. This procedure would assist him in creating a Health ID using pre-verified Aadhaar and Mobile, as well as checking the #ABHA in our system. This API determines whether an #ABHA is reserved/used, including permanently deleted #ABHAs.

The creation of an #ABHA id provides a person with a unique identity, which can then be used to identify and tag his or her health records across health providers. We can call it AADHAAR for the medical services and records.

MILESTONE 2

• Building Health Information Provider (HIP) Services To link Digital Records to central ABDM ecosystem so that it can be accessed via Personal Health Records Apps like ABHA app

The creation of Health Information Provider (HIP) services for connecting a patient's old and new records to their #ABHA ID or #ABHA address is the next milestone. It is a crucial and important step in the development of the #ABDM by National Health Authority (NHA) since only after this step the health care entity can become a Health Information Provider (HIP) as it is the step where it gets certified you are an entity which generate health records for a person. This step entails both discovering a patient’s already existing information and then linking the information to its #ABHA ID or Address and also get future health records from Health Information Provider automatically linked.

Once this is done, HIP can initiate linking of health records, when #ABHA address is available with HIP and get patient's authentication modes relevant to specified purpose. This step also involves confirming authentication of users. This means that the clinical artefacts created will be linked to the #ABHA and will be available for consent-based sharing within the #ABDM eco-system. The generated and linked health records will be viewable by the patient in any of his or her preferred PHR app downloaded on the mobile device.

MILESTONE 3

• Developing Health Information User (HIU) Services To Provide View Of Patient’s Medical History To Authorized Healthcare Workers With Complete Consent

The last milestone is about creating Health Information User (HIU) services to allow authorized healthcare workers to view a patient's medical history with their full consent. After completing this milestone, a healthcare entity/professional can become a Health Information User (HIU). Based solely on patient authentication, this milestone allows for the exchange of health data between healthcare entities or #healthcare professionals, or with a health locker. The Health Locker is Federated Health Records exchange system, which stores patients' information as longitudinal records, and which are electronically searchable and provide flagged abnormal values directly within the patient's health chart. Health Information Users must manage a software system that allows them to securely store and access longitudinal patient data in their care. The longitudinal health records of a patient are kept in a secure location, either on the patient's personal devices or on a user-trusted cloud service. A personal health locker is the name given to such a software system.?

As explained before, a Health Information User is any entity that seeks health records for treatment or diagnosis (HIU).

There is a set of APIs which are provided by the National Health Authority (NHA) to integrate any HMIS with the National Health Authority (NHA) to become National Health Authority (NHA) compliance

Now, let us list out the challenges being faced in the entire integration process. Once the challenges have been identified, it can make the whole process more resilient and robust.

CHALLENGES FACED

ANALYSIS OF EXTENSIBILITY OF EXISTING HEALTH MANAGEMENT INFORMATION SYSTEMS (HMIS)

• The integration of APIs might take time as the flow or sequence of APIs are complex to handle. Implementing #ABHA number for a Health Information Provider (HIP) can be a complex and challenging process. It needs to be designed in such a way that it can effectively manage the enormous amounts of data and information that are handled in the #healthcare sector, while also ensuring the privacy and security of sensitive patient information.
• Integration of Application Programming Interface (API)
• The #healthcare industry deals with complex and sensitive data, and integrating APIs for this data can be a challenging task. Data from different sources may have varying formats and structures, and the software needs to be designed to handle all these different types of data.?
• Analysis of existing HMIs?
• #healthcare providers typically use a range of different Health Management Information (HMI) systems. These systems may be developed by different vendors, and they may have different data structures and formats. We must analyze these existing HMIs to understand their structure and data formats, and then implement #ABHA to work seamlessly with these systems.
• The majority of HMIS are available since long, so they need ways to incorporate the set of API into their systems.
• The availability and scalability of the HMIS will be necessary as we move towards higher usage of the ecosystem, as the HMIS will need to provide the health records for millions of people.?

DOMAIN KNOWLEDGE AROUND ABHA CREATION & HEALTH EXCHANGES

• Domain knowledge is critical for designing effective data collection tools and ensuring that the data collected for #ABHA is RELEVANT, RELIABLE, AND ACCURATE.
• Apparently, Health Information Providers (HIP) lacks a thorough understanding of the #ABHA process. It is crucial to have domain expertise because it can aid in understanding the data collection process and, in turn, the proper preprocessing techniques.
• Knowledge of standards such as FHIR, as well as encryption algorithms, is essential for data sharing.
• Having a deep understanding of the #healthcare domain is essential for building that trust and ensuring that the information provided by #HMIS is relevant and useful.
• #Healthcare is a complex field, and understanding the different systems, workflows, and stakeholders involved is critical for successful #ABHA implementation. Domain knowledge can help ensure that the system is designed and implemented in a way that meets the needs of all stakeholders and fits seamlessly into existing workflows.

COMPLEXITY IN IMPLEMENTATION OF ABHA

• The ABHA process is difficult to comprehend because the flow and implementation of APIs provided by #ABDM by National Health Authority (NHA) is quite COMPLEX AND INTRICATE.
• The implementation of #ABHA process is a complex task that requires proper planning and processes to ensure its success. This is because #HMIS software typically involves the integration of multiple systems, data sources, and stakeholders?
• The first step in implementing of #ABHA is to define the scope and objectives of the process. Once the scope and objectives are defined, the next step is to develop a detailed project plan. This plan should include a timeline for the implementation, #milestones , and key deliverables. It should also include a budget and resource plan to ensure that the project is adequately resourced and funded.
• Call Back must be elaborated so that this complex process can be broken down into simple steps. During the implementation process, it is important to regularly assess progress and address any issues that arise. This involves scheduling regular call-backs with stakeholders to provide updates on the project's progress, discuss any issues that have arisen, and ensure that everyone is aligned and moving in the same direction.
• Testing and training are also essential components of the implementation process. It is important to thoroughly test the system to ensure that it is functioning correctly and meeting the requirements of stakeholders. Training should also be provided to users to ensure that they are comfortable with the system and can use it effectively.

CERTIFICATION REQUIREMENTS

• Certification is essential for Health information providers to become #ABDM compliant.
• All HIPs are required to be certified to become #ABDM compliant.
• Each of the #milestones we discussed has its own set of scenarios that must be certified.
• To get the scenarios cleared by the certification authorities, a team of IT professionals is required.
• Certification ensures that benchmarking and quality standards are maintained, which is crucial for patient safety and care.
• Certification provides a level of assurance to patients and healthcare professionals that the #ABHA is reliable and secure.
• Certification also helps to mitigate the risk of potential data breaches and ensure compliance with privacy regulations.
• However, certification can be a costly affair, involving financial implications for the organisations and Health Information Providers.
• The certification process can also be quite elaborate and complex, and it may take time to complete it.
• Despite these challenges, certification is a crucial component for the implementation of #ABHA process, and it is essential for #healthcare providers to invest in this process to ensure the highest level of patient care and safety.?