Mind the gaps in India’s health care digital push

 While the digitisation of health­care data could help, what many Indians face are unaddressed issues in the health sector 

dalone specialists or tertiary hos­ pitals or diagnostic facilities and then they go back to their original practitioner or health centre. They carry back with them hard copies of the reports or soft copies on their smartphones. Most practi­ tioners, especially specialists with­ out data entry staff , often extract only the relevant notes and return the hard copies. All larger health facilities generate and store com­ puterised patient data also for planning treatment, procurement of medicines and consumables. 
Most patients avail medical ser­ vices from doctors or health­care centres in their own State. But when they seek advanced care in other States or migrate to another State have they not been deprived of medical care? Was it then for want of past records or for want of a national network? Or, for want of a national policy on the issue? Ironically, many tertiary hospitals and medical colleges care little for diagnostic reports from peripheral centres or even the prescriptions of previous doctors. So what hap­ pens to all the cards created under the Rashtriya Swasthya Bima Yoja­ na and the Ayushman Bharat Prad­ han Mantri Jan Arogya Yojana? Currently, for pan­India portabili­ ty or for determining insurance cover, these cards were good enough without the need for the entire medical history at any cen­ tralised platform. 
Without pretending that all is hunky dory now, one can still ask this: “Is there a serious problem with the way patient­related infor­ mation is managed today?” Health is under the State­list subject. So did any State government ask for a national­level digitisation plan to help it in its tasks? Has there been a problem of not getting real­time State­wise aggregated data to the government of India? Have any as­ sociations of doctors or civil socie­ ty organisations asked for digitisa­ tion? Let us not brush aside the bene­ fi ts from a plan of virtually Aad­ haar­like proportions to digitise all 
patient’s fi le is accurate. Even en­ tries made for Aadhaar Cards or Voter ID cards have not been error free. With all medical history re­ corded as ‘truth’ in the new soft­ ware, insurance companies would be looking for multiple ways to re­ duce their obligations leading to many disputes. 

Extensive costs, dilemmas On the face of it, from the side of health­care institutions, the NDHM is merely ensuring custo­ misation of a new software and changes in current practices of da­ ta maintenance. However, it would become inevitable for all institu­ tions in the government as well as private sector to upgrade their hardware too apart from consider­ able costs in customisation and transfer of existing data. In the go­ vernment sector there are many existing practices and systems for compilation of data as in the Inte­ grated Disease Surveillance Pro­ gramme and the Health Manage­ ment Information System ( IDSP­HMIS) apart from all learning acquired over the years by staff  in those systems and practices. Some larger hospitals have already gone for robust and sophisticated soft­ ware systems such as enterprise resource planning and would be in a dilemma as to whether they need to scrap them or run parallel software provided by the NDHM. Has anyone in the NDHM or the Ministry of Health attempted to es­ timate the costs of this massive transition to a new system? Public health professionals estimate the cost in thousands of crores for all government and private HIPs to upgrade their hardware and con­ nectivity systems, training of pre­ sent staff , the entry of data afresh apart from other indirect costs. 
Among independent practition­ ers in allopathic and the Indian systems of medicine who run small dispensaries especially in ru­ ral areas, there is no practice of even storing patient data on com­ puters. It is largely based on mu­ tual trust and personal memory. 
For most of them, it is not a feasi­ ble option to enter data in compu­ ters on their own or engage data entry operators merely to comply with the digitisation protocols. 
Data leakage How long would the system pro­ tect its data of many millions get­ ting stored in the decentralised system holding transferable data? Informed consent may mean noth­ ing to a patient or relatives even in normal times let alone in a time of medical emergency. Even highly educated and rational people agree to part with their contacts, photographs and other data to avail nominal or momentary bene­ fi ts off ered by some smart mobile apps. Informed consent is too much of a luxury for the vulnera­ ble and a poor defence against da­ ta leakage. 

Public health practitioners at the grass­root level would conti­ nue to wonder if digitisation is the immediate problem facing the health sector or the best way to go about addressing data gaps. In their eyes, what millions face in the country are unreliable health­ care facilities in both the govern­ ment and private sectors, diffi cul­ ties in getting timely care, availa­ bility of beds and hygienically maintained hospital premises, availability of doctors physically or on line, and the continuous ne­ glect of preventive and communi­ ty health initiatives. If they oppose a new plan, it could either be be­ cause of its doubtful benefi ts to pa­ tients or because of worries re­ garding data leakage. They may be blamed for trying to delay the in­ evitable; the inexorable march to digitisation. Perhaps they need to discover that data is the only cure, for all our ills. 

P. Joy Oommen is a retired civil servant who served as Chief Secretary to the Government of Chhattisgarh. Dr. K.R. Antony is a paediatrician and a public health professional who served UNICEF and the State Health Resource Centre, Chhattisgarh 
P. Joy Oommen & K.R. Antony