Thread by @sumanthraman

Why a #NationalHealthID is neither needed nor desirable. Thread...
#AyushmanBharatDigitalMission
1. Indians are already drowning in ID's. Aadhar is already a unique ID.Why do we need another one just for health?Why not use Aadhar? #DigitalHealthMission @mansukhmandviya

2. It is well known that vast majority of people seek medical help within their State or neighbouring State.Someone who is from a village in say, UP,is most unlikely to seek medical assistance outside the State or beyond nearest metro city.Why is a National ID required for this?

3.Less than 5% of Indian healthcare system has Electronic Medical records(EMR). Less than 1% may be actually using it as a point of care system. Digitization of medical records in most hospitals, even corporate ones is limited to typing discharge summaries & storing lab reports

There is no uniformity of data capture and no standard nomenclature used,though such standards are available
4.Govt is yet to mandate use of EMR.There is no legal need for hospitals to digitize patient data. So most hospitals maintain manual case sheets #AyushmanBharat #EMR

5.Implementing EMR systems will face massive resistance as doctors do not see it as a core part of their work. Countries that started decades before India still have issues with effective implementation. In most countries it took at least a decade and that too only after laws

making it mandatory and their Govt offering huge incentives in many cases to roll out EMR nationwide. And all this in countries richer and smaller than India.
6. Data Privacy and confidentially are almost non existent in India. So Patients who are educated will not be happy to

have their most confidential health information on a National database.Potentially the data could be sold to just about anyone &there are zilch safeguards available in India
The right way to go about this wd be
1.Pass a law making EMR systems mandatory within say a 5 yr period

Provide incentives for Hospitals & doctors to change over. After 5 years start to disincentivize &levy fines to ensure compliance
2. Define the updated National EMR standards providing uniform standards to be followed across India. The last set of standards published were only

recommendatory as EMR itself is only optional.
3.Use the Aadhar ID instead of National Health ID Today almost everyone has one &many carry it with them
4.Pass a Data Privacy law with stringent safeguards and punishments for breach
5.There is no need at all for a Central database

Instead let each State have its own database. Some States already have a rudimentary database
6.Define a set of anyonymized data that each State will provide to central database on a near real time basis for analysis &forecasting(Relevant fields are already defined under HIPAA)

7.If a patient seeks treatment outside the State a request is made through the system to the home State for access to the patient record. Accordingly access is given and revoked as needed
8.Take State Governments on board at every stage. Health comes under the States

and without their full cooperation and support this project will be a non starter.
9. Ideally this must be an opt in system and not an opt out one. But at the very least people must have the option to opt out of the system if they choose to.

As one who has worked on some of the largest healthcare IT implementations in India and abroad I believe that this would be the way to go. Even then this is a most challenging project. But in its present form it is likely to be little more than one more PR exercise @MoHFW_INDIA

@SonaliVaid please see this thread