Digitizing Healthcare in India

The COVID pandemic accelerated digital adoption by the general public and businesses across various industries. One such industry that underwent rapid transformation was?healthcare. Given the constraints enforced by the pandemic, the public embraced digital platforms in order to meet their healthcare needs. On the other side, the government announced a national mission to digitize health records.

While these were all steps towards digitizing some of the moving parts of the Indian healthcare ecosystem, the broader vision was first outlined in The India Stack vision. The fundamental premise of the India Stack revolves around creating a comprehensive?digital identity, payment and data-management system.?

Subsequently, industry-specific frameworks were built to achieve the India Stack vision. Suppose we had to map out the industries around the stack. In that case, OCEN aims to address lending, ONDC is targeted towards e-commerce, and?The National Health Stack?aims to revolutionize the healthcare industry.?

Introduction of the National Health Stack

The initial groundwork began in 2021 with the National Digital Health Mission (NDHM) launch. The goal was to provide every individual with a “health ID”; think of it as a health account that contains all your medical documents – everything from prescriptions to diagnostics.

Before we dive deep into understanding the architecture and functioning of the stack, let us take a step back and understand the larger vision at play here.

The primary base for any framework under the India stack is built on the tech stack of Aadhar, wherein a digital identity is provided to every citizen. Along similar lines, the building blocks of the health stack include a unique health identifier, DigiDoctor, registry of healthcare facilities, consent manager, and electronic and personal health records standards.?

These building blocks are built keeping in mind the three layers of the India Stack, i.e. Digital identity, interoperability and payments and data empowerment.

Now, if we had to envision the interaction between the stakeholders within the health ecosystem once the entire infrastructure goes live, it would look something like this:

NDHM Building Blocks

Registries form the first step of the NDHM architecture. Think of it as a data collection exercise and creating a standardised database of all the key participants in the industry. Once the database is created, the next step would be to enable seamless data exchange between the participants.?

NDHM has marked some registries as ‘core registries’. These core registries will be developed, owned and managed by the Government of India. Currently, these core registries include Health ID (digital identity and database of the patient), Healthcare Professionals Registry (Master data of information on healthcare professionals) and Health Facility Registry (Unique identifier for each healthcare facility in the country)

This is what the exchange of data between the participants looks like. Stakeholders in the ecosystem may use the NDHM APIs to access, share and verify health records, healthcare professionals and healthcare facilities.

NDHM Architecture

The architecture, at its core, aims to solve for interoperability and seamless exchange of health data and services. NDHM has built the entire stack on four foundational layers in line with its underlying objective.

JAM & Digital Public Goods:?The JAM trinity, accompanied by other applications such as UPI, Digilocker etc., form the foundational layer of not only digital health services but any other digital platform. NDHM aims to leverage the cross-domain capabilities offered by these goods to enable the key functionalities. For example, the Creation of Health ID by using the verification facility offered by Aadhar, data storage and exchange via Digi locker, and transfer of government subsidies through the Jan Dhan accounts. The objective is to build such integrations in a modular and scalable manner.

Health Data Exchange Layer:?As the name suggests, the next layer is designed to facilitate data interoperability. The objective of this layer is to standardize the data and streamline the flow of data exchange across participants. If we had to dissect this layer, it would consist of three critical elements:

• Digital registries (would act as the master database).
• Health information exchange (it would consist of the architecture required for data exchange, such as consent manager, document standards etc.).
• Health claims standards (a standardized procedure for claims management).?

The plan is to connect various touch points end-to-end in the patient journey.

Unified Health Interface:?If the previous layer ensures data exchange, this layer is built to enable interaction between various participants within the ecosystem. The end goal is to ensure that services ranging from discovering healthcare providers to ordering medicines for home delivery are all enabled end-to-end under an open network. The high-level UHI architecture looks something like this:

?The above image represents the end objective of what the framework intends to achieve. The first image that we shared in this article highlighted how the framework would work from the patient perspective. Now, let us see what the back-end architecture and workflow would look like with an example of an interoperable UHI protocol for teleconsultation.

This workflow highlights the vision of the NDHM behind?"Digitizing Healthcare in India". This use case would naturally extend to various other segments within the industry, such as e-pharmacies, emergency services, personalized healthcare etc.

User Applications:?This is the end-user layer of the ecosystem. It comprises the applications and platforms built by plugging into the network. Just like UPI, it led to the emergence of many innovative use cases built across the fintech landscape. We expect new-age tech-led healthcare solutions to emerge out of this framework.

The HealthStack envisioned by the NDHM has set out an ambitious plan to revolutionize the sector. However, of late, we have observed some criticisms floating around the implementation and execution of the framework when we compare it against the successful UPI implementation in the fintech ecosystem. This is an unfair comparison for various reasons. We need to understand that the implementation of UPI required integration between a much lesser number of participants when compared to the number of participants within the health ecosystem. Also, the backdrop under which UPI gained significant momentum was demonetization. In a way, the macro-environment speeded up UPI's progress and made it a household name. On the other hand, not only does the health stack require a large number of varied participants onboard, but it also needs to go through the tedious exercise of data collection and standardization across the ecosystem. Hence, while the implementation of the framework would have its own set of challenges, the framework acts like a hotbed for market innovation.

Emerging themes to watch out for:

While way too many opportunities and use cases will develop as various layers of architecture gets built on gradually, here are a few of the themes/sectors that we are excited about:

Technology service providers:?Digitization of the entire value chain would require sophisticated tech infrastructure for various participants that can solve for various points within the chain that currently are unorganized and run manually. There lies an opportunity to either develop a focused tech infrastructure for a particular vertical such as digitizing and data storage platform for health documents (a digital health locker), or create vertically integrated end-to-end tech rails for the entire value chain.

Insurance Claims Management:?The under-penetration of health insurance in India has been discussed in the last few years. Efforts are being made by traditional players and new-age start-ups that have emerged in recent years to address the said issue. This would naturally lead to an increase in insurance penetration and, parallelly, an increase in the number of claims raised. This is also why NHDM has created a separate block for health claims standards under the health data exchange layer. Hence, new concepts and use cases under claim management can be explored by leveraging the tech capabilities offered by the framework.

HIMS / LIMS:?With the progress witnessed within the consumer side, the service providers shall also be required to keep pace with the industry's developments. This shall create demand within the health facilities, such as hospitals, clinics, diagnostic chains etc., to upgrade their tech infrastructure to serve the end-patient effectively. A vertically integrated SaaS platform built in line with the planned ecosystem development would be key in transforming the growth of healthcare service providers.

Personalized Health Management & Alternative Care:?The new-age telemedicine platforms have focused more on providing digital solutions to traditional health problems. Personalized health management services addressing issues such as mental health, female health and wellness, emergency care services etc., have largely remained untapped. With an improvement in the quality of basic healthcare services, we expect it to transition into increased demand for personalized health services.

Conclusion:?

We at WaterBridge Ventures have always been firm believers in India's Growth Story. We strongly believe that the healthcare industry developments will pave the way for its transition to the next leg of growth.?

Do write to?[email protected]?or reach out on?LinkedIn?or?Twitter?if you are building in the space or would like to brainstorm.