Much recently, the Prime Minister had launched the Digital Health ID project (DHID), generating debate on issues related to the use of technology in a broken health system.

Explained: Digital Health ID

Good intents of the DHID

• The key objective of DHID is to improve the quality, access and affordability of health services by making the service delivery “quicker, less expensive and more robust”.
• The ambition is undoubtedly high. Given that health systems are highly complex, the DHID would hardly be able to address some of the issues plaguing it.

Why need DHID?

(a) Record maintenance

• The use of technology for record maintenance is not just inevitable but necessary. Its time has certainly come.
• A decade ago, the process to shift towards electronic medical records was initiated in the private sector.
• It met with limited success, despite the strong positives.
• With DHID, the burden of storing and carrying health records for every visit to the doctor is minimised.

(b) Better tracking of medical history

• The doctor has instant access to the patient’s case history –the treatment undertaken, where and with what outcomes — enabling more accurate diagnosis and treatment.
• As the DHID enables portability across geography and healthcare providers, it also helps reduce re-testing or repeating problems every time a patient consults a new doctor.
• That’s a huge gain, impacting the quality of care and enhancing patient satisfaction and confidence.

(c) Better Diagnosis

• DHID can have a transformative impact in promoting ecosystems that function as paperless facilities.
• Paperless hospitals can promote early diagnosis before the patient reaches the doctor after spending long hours in queue.
• The doctor can already go through the patient’s record and the pharmacist can make the drugs available by the time the patient reached its counter.

(d) Promoting medical research

• Digitisation of medical records is another important positive, given the problems related to space and retrieving huge databases.
• Well organised repositories that enable easy access to records can stimulate much-needed research on medical devices and drugs.
• This storehouse of patient data can be valuable for clinical and operational research.

Given our population, would this be an idealistic expectation?

• We need to conduct pilot studies to assess the use of technology for streamlining patient flows and medical records and thereby increase efficiencies across different typologies of hospitals and facilities.
• While technology helps smoothen processes and enhance patient experience, there is a cost attached.
• Investments have to be made upfront and results should not be expected overnight.

Issues with DHID

(a) A costly affair

• In the immediate short run, DHID will increase administrative costs by about 20 per cent, due to the capital investment in data infrastructure.
• Over the long run, the additional cost to healthcare is expected to be about 2 per cent.
• Any scaling up of this reform would require extensive fiscal subsidies and more importantly providing techno-logistical support to both government and private hospitals.

(b) Privacy concerns

• Most important is the issue of privacy, the high possibility of hacking and breach of confidentiality.
• The possibility of privacy being violated increases with the centralisation of all information.
• Though it is said that the patient is the owner of the information, how many of us deny access, as a matter of routine, when we download apps or programmes that seek access to all our records?
• How far is this “consent” practical for an illiterate, vulnerable patient desperate to get well?
• So, taking refuge behind a technical statement that access is contingent on patient consent is unconvincing.

Ground situation in India

• Inherently unaffordable healthcare: The costs in the Indian context can be high and that should lead to a careful assessment of the project.
• Digital divide: Such a scenario is not inconceivable and in the case of health, may cause immense hardship to the most marginalised sections of our population.
• Infrastructure gap: A large majority of facilities do not have the required physical infrastructure — electricity, accommodation, trained personnel.
• Usual nature of technical glitches: Cards getting corrupted, servers being down, computers crashing or hanging, and power outages are common in India.
• Conformity over data synchronization: The inability to synchronise biometric data with ID cards has resulted in large-scale exclusions of the poor from welfare projects.
• Accuracy of records: Besides, the efficacy of the DHID hinges on the assumption that every visit and every drug consumed by the patient is faithfully and accurately recorded.
• Increased workload on Medical Professionals: Moreover, while electronic mapping of providers may enable patients to spot a less busy doctor near their location, it is simplistic to assume that the patient will go there.

Plugging the existing gaps

• Patient preference for a doctor is dependent upon perception and trust. Likewise, teleconsultations need a huge backend infrastructure and organisation.
• Teleconsulting has certainly helped patients access medical advice for managing minor ailments, getting prescriptions on the phone and even getting drugs delivered home.
• But in handling chronic diseases that necessitate continuity of care, teleconsultations have been problematic and cannot be substituted for actual physical examination.
• Continuity of care is central to good outcomes in inpatient management of chronic diseases.
• The one serious shortcoming of using teleconsultation for such management is the high attrition rate of doctors within the context of an overall shortage of doctors.
• Technology can be of little use in the absence of doctors and basic infrastructure.

Way forward

• What is needed is building very robust firewalls and trust.
• Seeing the frequency with which Aadhaar cards have been breached, it is not unreasonable to be concerned with this issue and the implications it has at the family and societal levels.
• For this reason, instead of a big bang approach, it is better to go slow and steady.
• That’s the only way to ensure that a good policy does not die along the way due to poor implementation.

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