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The ambitious National Digital Health Mission (NDHM) launched by Prime Minister Narendra Modi on Independence Day has a rough road ahead in terms of adoption and implementation.

India a country with already weary health infrastructure and resource shortages, covid-19 pandemic is further exhausting its healthcare system. The NDHM comprises six key building blocks or digital systems namely, HealthID, DigiDoctor, Health Facility Registry, Personal Health Records, e-Pharmacy and Telemedicine.

The complete technology-based initiative having a potential to be a game changer, are expected to face hurdles in rural India with low internet penetration and little digital health resources. However, India has majorly pushed telemedicine services during covid-19 pandemic, the country has been facing major problems in running the services in rural India for long. Telemedicine involves the use of telecom and information technology to provide healthcare from a distance which is impeded in rural India due to absence of infrastructure, Internet connectivity and lack of sufficient medical personnel.

“Digital literacy and accessibility of digital records is a particular concern in rural areas. Digital literacy is another challenge and government will need to train and equip healthcare workers in digital technology,” said Vikram Thaploo, CEO, Apollo telehealth.

According to a senior health ministry official, for effective telemedicine services, the minimum Internet speed required for consultation with a patient through a computer is 2 Mbps, which is not available in most of the villages. With 159 Internet service providers in India, broadband penetration in the country is less than 2%, according to the government.

When it comes to Electronic Health Records (EHR), a 2018 report prepared by the ministry of electronics and information technology (MeitY) titled Adoption of EHR: A Roadmap for India revealed the shortage of basic requirements to implement the system.

The report highlighted that government hospitals and dispensaries have very little information and communications technology (ICT) infrastructure. Only some major public hospitals have computers and connectivity. Given the large number of public healthcare facilities in India, the report indicated a large investment in hardware and software is required.

“Electronic Medical Records are the foundation for NDHM and implementation based on international classification of diseases (ICD) is a challenge in itself. Especially with the size diversity along with disparity in quality and availability of health services; makes this extremely difficult to implement,” said Dr Vispi Jokhi, CEO, Masina Hospital. Mumbai.

National Health Authority (NHA), the apex Central Government agency responsible for the implementation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), will design, build, roll-out and implement the NDHM. As apparent in Ayushman Bharat scheme that several hospitals opted out due to lack of consensus over costs. Costs for implementing digital health data can also be some of the barriers and challenges.

“Most of the private charitable hospitals from the health care industry, have not accepted ABPMJAY empanelment because the rates are unrealistic and don’t reflect on actual costs incurred,” Jokhi said.

With a sharp increase in cases of data breaches and privacy violations across the world including India, the national register has raised concerns about unauthorized access of health records. “Data security and privacy are the main concern with NDHM. India is yet to have a data protection law and initiatives like Aadhar have earlier also generated significant data security concerns. An integrated system of electronic health records needs to be preceded by a data protection law and a series of stringent measures to eliminate risk of data theft,” said Thaploo.

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