Though it could take a few years for it to finally take off, the plan to create a National Health Stack (NHS) based on the principles of the India Stack—cashless, paperless and presence-less with a distinct consent layer—as part of the Ayushman Bharat Yojana is to be welcomed. The NHS envisages a centralised health record for all citizens and, since this will also contain information on all diagnoses made and treatments received from any clinic/hospital across the country, it also provides a wealth of information that can be analysed—with even artificial intelligence tools—to get meaningful insights. As in the case of payments/banking today, the health records will be digitised and stored in a central place in the cloud—say, a DigiLocker—and accessed remotely by both patients as well as doctors/hospitals/insurance firms, after user consent is provided.
Having a unique digital health ID is critical for this and, given that most people have Aadhaar numbers, that shouldn’t be too difficult. So if, for instance, a patient has had two appendix operations over a period of time, and each treatment/payment gets tagged on to the patient’s unique ID, this will get thrown up immediately by a good fraud management system. The current level of fraud-management systems will just check if there has been an operation or not; what is envisaged under the NHS takes this to another level since it is essentially scanning records over the lifetime of an individual. Similarly, such a system will also help provide meaningful solutions for community medicine, based on the characteristics of each region/district as opposed to the one-size-fits-all solutions that are used today.
Putting together such a database is both expensive as well as time-consuming, at most times. What makes it easier under Ayushman Bharat is that, with the government planning a massive universal healthcare solution—1.5 lakh health and wellness centres offering preventive and primary care are, for instance, to be built under this—creating NHS is easier. Also, since the plan is to provide cashless hospital treatment upto around Rs 5 lakh per year to 10 crore families, a very large level of digitalisation is assured—all hospitals/clinics will be sending digital data to insurance companies anyway, so it is a matter of tagging this to the unique health records of individuals. Similarly, once the contours of the NHS are finalised and a basic architecture is put in place, entrepreneurs will come up with their own apps/solutions that are interoperable. Some could involve the use of more sophisticated artificial intelligence solutions, others could look at better solutions to digitise X-rays and other scans, and some could even provide tentative medical solutions for hospitals based on a larger patient/treatment database—the possibilities are enormous. Once this is achieved, India’s healthcare may never be the same again.