DHIndia Association: A conductor of the Next Generation Digital Health Symphony from India

‘Digital’ is trending everywhere and healthcare is no exception. The role of digital technologies in healthcare also known as Digital Health is wide and fuzzy.  It is being pitched as a panacea for the shortcomings in healthcare delivery and is being positioned as a solution

to fill the gaps ranging across from infrastructure shortage (access) to resource scarcity (availability). The National Health Policy-2017 gave a major push to digital health in India as it laid stress on the use of digital tools for improving healthcare efficiency and health outcomes [1]. The Ayushman Bharat scheme envisioned to provide Universal Health Coverage (UHC) to fifty million Indians may have to rely heavily on digital health in order to be successful and may turn out to be the pivotal cog in the wheel for the success of the program [2]. 

As the national government intends to build and maintain a centralised health record system for all citizens, the NITI Aayog released a proposal document on National Health Stack (NHS) in July 2018 and followed it up with the draft implementation framework for the NHS – National Digital Health Blueprint (NDHB) in July 2019 [3].  Big data analytics, Artificial Intelligence, Machine Learning will all be key components fuelling the larger design [4]. Digital health is essentially the coming of age of the adoption of information technologies in medicine and health. It possesses a unique potential to encompass the entire health care gamut of illness and wellness and can go beyond into the spheres of biomedicine and biotechnology to enable precision care [5].  The influence of digital health are not limited to healthcare delivery alone, it relies heavily on health informatics and courts innovations, knowledge discovery and transformation of traditional healthcare practice [6].

Today, workshops and conferences on digital health have become commonplace in India, there is one happening every other week. A rather remarkable fact about these gatherings are that  they are well attended, experts come and speak, delegates come and listen and then, they all meet again at the next conference! So the obvious question arises, do these talks translate into anything on the ground, if yes what if no, why? Not much is known.

After two plus decades of introduction of medical informatics in India, it becomes imperative to review the question ‘Are the Indian doctors ready?’ [7].  We all know for sure there will be no definite answer but as the trends disclose the users are prepping up today as the newer generation is all wired up to the internet and even the seniors have got hooked to at least instant messaging. The use of internet for searching and sharing information has been certainly and steadily rising amongst the care giving community [8].Thus  it will be safe to assume that the age of informatics has finally arrived!

We have heard at innumerable discussions that digital health can work wonders, it can help heal the sick healthcare system, whether it is in governance, management or in patient care. Theoretically it maybe true; but practically do we see those miracles happen? We don’t. The reasons may be multi-factorial but the primary reason is that there are too many cooks who are spoiling the broth. There is no digital cooperation, no single point of truth, no unified voice, no consensus amongst experts on things that matter [9]. There are as many opinions as there are experts. This brings us to a dire need – one chef to play the master cook.

Since the time ISRO introduced telemedicine in India in 2001 [10], if we search for successful implementation of IT systems in healthcare,  if we are able to count a handful, we can consider ourselves lucky. Isn’t it intriguing to note that successful pilots have only led to unsuccessful rollouts? What are the lessons learnt? Can they be avoided in the future? With advancements in technology gone are the days when bandwidth was a problem, network connectivity was poor, storage was expensive and infrastructure was scarce, today there is improvement in all these areas of digital technology but that improvement has not proportionately impacted healthcare practice. Ill-conceived notions of telemedicine practice, contrived ideas, ambiguity in legal interpretation and absent regulations have all added to the complexity [11].

If we review the public and private digital projects in healthcare from a point of business or economics or clinical care we will all agree that a lot is happening but there is a lot more that needs to be done. In the personal space, digital health tools are continuously evolving to allow individuals to manage their own health, share their health data with providers in a safe and secure manner and to contribute to the population health landscape [12]. Standards and interoperability is the key to the success of digital health and as of date that remains a major hurdle to cross. There is an urgent need to build capacity in digital health and to foster inter-disciplinary collaboration for its advancement. The need for intellectual forums and mentoring platforms was never greater than it is now. The tight coupling of industry and academia, which is absolutely essential for research to happen, is absolutely lacking. Policy, standards and regulations related to digital health is found wanting [m]. The scientific engagement of intellectuals for addressing the strategic healthcare goal is missing. 

There is a need for a univocal entity that will be accepted as a true representative of healthcare professionals and at the same time also is representative of the IT industry. The imminent need today is for an alliance of all healthcare IT professionals and professional groups working as advocates of digital health in India to have a unified voice to be heard by the powers that be. It is in this space we position DHIndia Association, as a conductor of the next generation digital health symphony from India.

References

1. Ministry of Health and Family Welfare, Government of India, National Health Policy; 2017. [Last accessed on 2019 Oct 18].  Available from:  https://www.nhp.gov.in//NHPfiles/national_health_policy_2017.pdf 

2.  Wadhwa, M. (2019). ICT Interventions for Improved Health Service Quality and Delivery in India: A Literature Review.

3. Carol, Y., & Cheung, Y. (2019). Data without borders. Lancet, 393, 1331-84.

4. Press Information Bureau, Government of India, NITI Aayog. Comments Invited for Creation of National Health Stack. [Last accessed on 2019 Oct 18].  Available from:  https://pib.gov.in/newsite/PrintRelease.aspx?relid=180450

5. Lupton, D. (2014). Health promotion in the digital era: a critical commentary. Health promotion international, 30(1), 174-183.

6. Mesko, Bertalan et al. “Digital health is a cultural transformation of traditional healthcare.” mHealth vol. 3 38. 14 Sep. 2017, 

7. Sarbadhikari, S. N. (1995). Medical informatics–are the doctors ready? Journal of the Indian Medical Association, 93(5), 165.

8. Deodurg, P. M., Nandini, T., Srikanth, D., & Kumar, P. (2013). Internet usage among doctors in South India. Journal of Scientific and Innovative Research, 2(3), 658-664

9. Report. United Nations Panel on Digital Cooperation (2019). The age of digital interdependence.

10. Bhaskaranarayana, A. & Satyamurthy, L.S. & Remilla, Murthy. (2009). Indian Space Research Organization and Telemedicine in India. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 15. 586-91. 

11. Chandwani, R. K., & Dwivedi, Y. K. (2015). Telemedicine in India: current state, challenges and opportunities. Transforming Government: People, Process and Policy, 9(4), 393-400.

12. Nedungadi, P., Jayakumar, A., & Raman, R. (2018). Personalized health monitoring system for managing well-being in rural areas. Journal of medical systems, 42(1), 22.

13. Srivastava, S. K. (2016). Adoption of electronic health records: a roadmap for India. Healthcare informatics research, 22(4), 261-269. 

14. Official website DHIndia Association, http://www.dhindia.org [Last accessed on 2019 Oct 18]. 


Author Profile:

Dr. Prajeesh RB, Board Member - DHIndia Association
Works at a Leading Indian Technology Company