Introduction

In 2021 the government went on a transformative journey with the launch of Ayushman
Bharat Digital Health Mission. This groundbreaking initiative builds upon the 2018-launched
Ayushman Bharat Yojana, aiming not just at evolution but revolution of the medical sector
by aiming to create a unified digital health ecosystem in India is the aim of ABDM. The goal
of ABDM is to establish a nationwide digital health ecosystem that offers a variety of data,
information, and infrastructure services and supports universal health coverage in a way that
is effective, economical, inclusive, fast, and safe. Additionally, it guarantees the privacy,
security, and confidentiality of personal health information.

History
The National Health Policy (NHP) of 2017 places a strong emphasis on preventative and
promotive healthcare in development strategies with the goal of achieving the best possible
level of health and wellbeing for everybody. Additionally, it seeks to give everyone access to
high-quality healthcare at an affordable price. The NHP's digital goals will be implemented
by a committee headed by Shri J. Satyanarayana, which was formed by the Ministry of
Health of Family Welfare. The group produced a comprehensive implementation strategy for
digital health known as the “National Digital Health Blueprint” (NDHB). The “Ayushman
Bharat Digital Health Mission” is the initiative to deploy this in a mission mode (ABDHM).
Using digital channels to bridge gaps between various healthcare ecosystem players is the
purpose of ABDM, which aims to provide the groundwork needed for integrated digital
healthcare.

In addition to providing a wide range of data,

information, and infrastructure services, the goal of
ABDM's development was to ensure the security,
confidentiality, and privacy of personal health
information by effectively leveraging open,
interoperable, standards-based digital platforms.

ABDM is built as a collection of "digital building

blocks" that may be applied to the large-scale planning, creation, and provision of healthcare
services. The “Ayushman Bharat Health Account (ABHA)” Number, Registries, Health
Information Exchange and Consent Manager (HIE-CM), and Unified Health Interface (UHI)
are some of these fundamental components. The rise in ABDM funding is indicative of a
growing emphasis on digital health.

In all, ABDM is anticipated to establish a pan-Indian ecosystem that connects government

regulators, healthcare providers, and patients.

Key objectives
The key objectives of this policy include:

 Through this initiative, a new phase has been initiated in the expanded focus on
developing healthcare facilities for the masses in India. It will allow medical
practitioners to access a large amount of data through this platform would ease the
process of doctor-patient consultancy. The ease of discovery, teleconsultations that
expand patient reach, improved follow-up and referral process efficiency, and
organized access to patient health records, including prescriptions, are all advantages
for registered healthcare practitioners.
 Additionally, the proposed digital health network may facilitate the administration of
insurance and related services. Because ABDM makes it easier for the network of
licensed healthcare providers to grow, insurers may be able to empanel more
healthcare providers, giving patients additional options.
 Government organizations could be able to link data across programs and coordinate
policy and activity across departments and ministries with the use of a sizable,
integrated database. Finding this information is more difficult at the moment. For
example, information on diseases associated with malnutrition that is kept up to date
through ABDM may be helpful in developing nutrition policy under the “Ministry of
Women and Child Development.”
  The aforementioned goals ill be achieved while preserving the confidentiality,
privacy, and security of personal health data. The Ayushman Bharat Digital Mission
aims to digitize patients' cumbersome medical data and files so that physicians,

clinicians, and other healthcare practitioners can access them with permission or
consent of the patients only.

Way Forward
Post the covid pandemic, there has been a significant surge in digital healthcare services
worldwide characterized by an exponential increase in the number of remote appointments,
greater use of technology for managing the medical records of patients, and the usage of a
variety of apps to make the medical process more efficient.

Ayshman Bharat digital health Mission is one such initiative spearheaded by the Indian
government to handle the medical requirements of the general public in more effective
manner. When analysing the digitalization of the medical field in other countries several
lessons can be gleaned and further implemented in India.

In Denmark a platform called [Link] is used by the citizens to access their medical
records. Including their vaccination reports, and covid results, with medical professionals also
receiving additional training to manage data across the online platforms.
Furthermore, in Sweden, even though remote consultations were accessible prior to Covid,
their use has grown significantly during the crisis, and medical personnel have received
additional training to enable them to be used efficiently.

Even though the pandemic has changed everything, international cooperation and leadership
have been crucial in helping nations all over the world advance in their use of digital
technology to support their healthcare systems. “The World Health Organization's Global
Strategy on Digital Health” recognizes the critical role that digital health technology plays in
promoting sustainable health care systems, and the European Commission's Digital Strategy
highlights the need of building digital skills and standards.

This was deemed necessary in Finland for the creation of Findata, which regulates the use
of health care data for research, as well as the more comprehensive e-government strategy
employed in Estonia. The use of primary care data has recently caused controversy in
England, which has highlighted how crucial it is to increase public confidence, trust, and skill
in this area.

In order to facilitate patients' access to care, Australia was the first nation to design a
population-centric approach for the implementation of “My Health Record (MHR)”, a
national repository of patient electronic health histories. MHR gave patients the freedom to
opt in or out at any moment, whenever they see fit, in order to allay concerns about data
breaches and foster a sense of confidence among the public. This approach teaches India
valuable lessons, as permission, privacy of health data, and security of personal data are
crucial concerns.

While considering the societal conditions of India, digitalization of the healthcare system
poses an evident problem which is lack of access to technology for a large proportion of
the Indian populous. The government can only resolve this issue by providing digital
connectivity to rural areas of the countries. Thus, the government should digitalize medical
field through a combination of the Norwegian countries and Australia, wherein the public
has more digital connectivity whilst simultaneously the government is reassuring the public
regarding the safety of personal data that is being feed to it.

A number of the countries delegate health care to local regions or areas, who have also
created or implemented digital solutions suitable for their local populace. Despite the fact that
this implies that instruments can differ, nations have made efforts to unify them. For instance,
in Denmark, [Link] serves as a gateway through which patients and medical
professionals can access data from various local and regional information sources.

In India it is imperative to decentralize the digitization of the healthcare sector by delegating

more work to the lower tiers of the government. This approach ensures the benefits of this
system permeates all strata of the society and enabling both patients and medical
professionals to access and leverage these resources uniformly.

Navigating the Current Landscape

Pre-pandemic usage of telehealth services, e-
pharmacies, etc., was minimal. Most patients and
healthcare professionals preferred traditional in-
person/offline methods of care delivery; however,
physical lockdowns and restrictions heightened
demand for digital health solutions, highlighting the
necessity of more skill fully integrating state-of-the-
art digital technologies into healthcare services in
areas like telemedicine, surveillance, and remote
clinical management.

Among the noteworthy public digital solutions

developed during the Covid-19 epidemic are Aarogya Setu and the Covid Vaccine
Intelligence Network (CoWIN). CoWIN made it possible to remotely monitor the vaccination
of over 1.78 billion Covid-19 doses and the registration of about a billion individuals as
recipients of vaccinations. The CoWIN digital certificate emerged as a reliable and secure
means of verifying universal vaccination

In partnership with the commercial sector, the “Ministry of Electronics and Information
Technology” created “Aarogya Setu,” another digital tool that directed our country's Covid
management activities. Front-line staff and the general public were provided with real-time
information on current cases and containment zones, which aided in their assessment of the
risk in their communities and facilitated information sharing in emergency situations.

A Boston Consulting Group poll [19] found that around 85% of physicians used
teleconsultation during the shutdown and that 65% of physicians planned to use telemedicine
in the post-Covid future. This shift from in-person doctor visits to telehealth solutions
indicates a rise in patient adoption as well as an increase in the number of digital solutions
available on the market.

The country's healthcare system is something that ABDM hopes to significantly alter. It
is evident that ABDM is being widely adopted by healthcare professionals and citizens
with over “35 crore ABHA accounts, approximately 25 crore linked health records, 1.6
lakh HPR, and nearly 2 lakh HFR produced.”

India is thus developing as a leader with significant growth potential in this field, as seen by
growing involvement as well as public and private investment in digital healthcare.

Roadblock on the highways to scaling up

1. Clash of state and Centre interest

The main obstacle is that, while health is a state issue in India, the Ayushman Bharat Digital
Mission is a national endeavor. The goals and objectives of certain state programs and
projects align with those of ABDM. Take Kerala's eHealth project, for example. This
suggests one of two things. First, state schemes might operate in parallel with ABDM,
necessitating the effective cross-platform data integration.

Even if this is accomplished, there is ample proof from the industrialized world that this kind
of integration or interoperability is a difficult obstacle to overcome. While "information
blocking" by states has been legally outlawed, the NHS in the UK is still struggling with
interoperability, and the US has not achieved full interoperability. Integration has proven to
be difficult in India, even at the level of the Union government. The Union Health Secretary
has advocated for coherence amongst datasets and may endeavor to expand the purview of
ABDM in terms of data gathering.
The alternative scenario is states sticking with their current systems and refusing to
implement ABDM. This may cause issues with ABDM adoption and scaling up. As a result,
state governments may need to be incentivized n by the Union government.

2. Data Digitalization

a system where the average patient visit lasts as little as two minutes, providers will be
unwilling to pay for the time cost of digitizing patient data; even if the patient's history and
records are available digitally, the doctor or care provider may not have the time to go
through them. Adding private suppliers to the system as participants is the next issue. It's
probable that incentives will need to be provided to private sector payers and providers to
encourage their participation in digitization if there isn't much enthusiasm.

3. Infrastructure

A strong and stable technical infrastructure is necessary for the “Ayushman Bharat Digital
Mission” to succeed. To enable the program's implementation, the government will have to
make significant investments in the development of digital infrastructure.

4. Lack of human resource

The competence of a trained workforce to establish and manage the digital infrastructure
required for providing healthcare services is critical to the “Ayushman Bharat Digital
Mission's success”. To create a workforce with the necessary skills, the government must
fund training and capacity-building initiatives.

5. Increasing dipartites and inequalities

When health services are provided digitally within the framework of the Ayushman Bharat
Digital Mission, it instantly serves those who have access to and are accustomed to digital
infrastructure, such as computers, broadband, cellphones, etc. It may disfavor illiterate
persons, women, elderly people, and residents of remote areas. This means that even while
some groups within the population may be more vulnerable, it becomes more difficult for
them to accept these measures. "Intervention-Generated Inequality" is the term used to
describe this phenomena (IGI). Even well-meaning programs can wind up working better for
the privileged than for the general public. When this occurs, actions that are supposed to
improve access and equity actually have the opposite effect. This problem closely resembles
the caste, class, gender, and religious hierarchies that now exist in Indian culture, where
people on the margins lack access to the necessities for a decent, healthy existence.

6. Privacy and security concerns

Privacy is an inherent concern wherever data is collected. Even with Aadhaar, enforcing the
right to privacy in India has proven difficult, and reliable mechanisms are needed to collect
and store sensitive medical data for a sizable population. Safety, privacy, and dignity
concerns have been raised in the wake of the recent ransom ware attack on the “All-India
Institute of Medical Sciences” (AIIMS), located in Delhi.
Interplay of e-governance and digital health care system in India
The concept of e-governance is basically government ‘anytime, anywhere’. The objective is
to offer all government related services and utilities 'on line’. E-Governance is really E-
nabled government, E-ffective government and E-xcellent government. The E-Governance or
'electronic governance' is basically the “application of Information and Communications
Technology to the processes of Government functioning in order to bring at about Simple,
Moral, Accountable, Responsive and Transparent' (SMART) governance.”

E-governance practices, propelled by technological advancements, are revolutionizing the

delivery of healthcare services across India. Service delivery becomes more effective when
administrative procedures like patient registration, appointment scheduling, and claims
processing are streamlined through e-governance. This
effectiveness results in shorter patient wait times and
better access to healthcare, especially in
underprivileged areas. Improved data management and
analysis are made possible by the digitization of
medical records and the deployment of electronic
health information systems. Platforms for e-
governance make it easier for healthcare professionals
to securely share patient data, enabling well-informed
decisions and individualized treatment.

In conclusion, e-governance encourages accountability and transparency in the provision of

healthcare by giving stakeholders access to feedback channels and real-time data. This
encourages accountability among healthcare managers and providers as patients may monitor
the progress of their appointments, access their health information, and offer comments on
the quality of care received.

CONCLUSION

The goal of the ABDM is to establish the framework for the nation's integrated digital health
system. It makes use of open networks and digital highways to close the current divide
between the different players in the healthcare ecosystem. Numerous factors, including the
general technological revolution in India, the right government policies and interventions in
the healthcare sector, the rise of health-tech start-ups, the impetus for digital healthcare
caused by the pandemic, and the general awareness of health and wellness among the
populace, all combine to create a lucrative opportunity in the healthcare sector.

Despite the mission's quick advancement, it still needs the cooperation of more major
companies in health technology, big public and private hospitals, and labs. Additionally,
through motivating important stakeholders and operationalizing realistic use cases that lower
out-of-pocket costs by making it easier for the general public to access high-quality
healthcare services, there is a need to concentrate on widespread publicity, persistent
advocacy, and social acceptability of the mission.

References
 National Health Authority, [Link] (last visited 29th April 2024)
 E-health Kerala Government, [Link] (last visited 29th
April 2024)
 Hutchings R (2021) “What can we learn about digital health care from other
countries?”, Nuffield Trust comment.
 Deekshitha ganesan, Human Rights Implications of the Digital Revolution in Health
Care in India, Vol. 24, Health and Human Rights, pp 15-20,
[Link]
 Kotak Life,
[Link]
digital-mission (last visited 28th April 2024)

Prattay Lodh, G20 and Global Medical Device Policies - Assessing Risks and Opportunitie