National Digital

Health Mission
Unified Health Interface
Consultation Webinar: 4th August 2021
 I. Introduction & Housekeeping
II. Journey to NDHM
III. Consultation Process
IV. Principles of NDHM
V. The Need for Interoperable Digital
Agenda Health Services
VI. Understanding Open Networks
VII. UHI: An Overview
VIII. UHI: Technical Design and Operation
IX. UHI: Governance and Management
X. Next Steps
XI. Q&A
 Housekeeping

1. All participants are muted and will not be allowed to share video for the duration of the Webinar.

2. Following the core content of the Webinar, a Q&A session will be held. All questions are to be submitted
through the Q&A Box - our moderator will ensure that they are answered appropriately

3. Please ensure your questions are concise and targeted towards the points raised in this Webinar or the UHI
Consultation Paper released on Tuesday, 23rd July

4. If there are any technical difficulties joining, please double check your internet connection and rejoin

NDHM intends to develop UHI in a holistic, consultative manner. Please voice your opinions on issues
raised here respectfully.
 The National Digital Health Mission (NDHM) is the outcome of an
Journey to NDHM iterative process involving stakeholders across the health ecosystem

National Digital Health

National Health Policy National Health Stack
Blueprint
2017 2018
2019

The National Health Policy, 2017 Vision for a digital stack for Framework of building the
policy advocated extensive health laid out with key National Digital Health Network
deployment of digital tools for objectives and principles finalized
improving the efficiency and
outcome of the healthcare
system
 NDHM is currently conducting the fourth round of consultations,
Consultation Process Till and will continue to engage with ecosystem stakeholders as the
Date initiative

1st Level of Consultations 3rd Level of Consultations

An initial round of consultation One-on-one consultations with specific stakeholders

was held prior to releasing the including insurance companies, govt. Health
National Digital Health Blueprint programmes, licensing authorities, medical councils,
in 2019 among others, were held after the pilot to gather
feedback on specific building blocks

2020 2021

2019 2020-21
2nd Level of Consultations 4th Level of Consultations (Current)

Before launch of the NDHM pilot Currently ongoing consultations with

in August 2020, a series of ecosystem stakeholders through
consultations were held with consultation papers released for various
varied groups of stakeholders at building blocks
the state and central level
The Need for Interoperable Digital Health Services
● Key Challenges to be addressed
● Proposed Approach
 NDHM proposes to build a new layer in NDHM that is
NDHM STACK designed to enable the interoperability of health services

The NDHM Stack Enabling Digital Service Delivery

● Till date, NDHM has built the foundational infrastructure to

enable the interoperability of health data

● Moving forward, a new layer in the NDHM architecture will

be built to enable the seamless provision and fulfilment of
digital health services

● The NDHM architecture will connect to other digital

ecosystems in India (e.g., UPI) to enable innovation and
new modes of service delivery

This webinar focuses on the design of this layer

- Unified Health Interface (UHI)
 India lacks the standards and infrastructure for health data
Key Challenge
HPR Vision that enable the accelerated adoption of digital health services

COVID 19 highlighted the importance of enabling But structural challenges hinder digital health services in
digital health services India

Ecosystemic Challenges Technical Challenges

Discovery
Reliable and accurate search for ● Non standardized processes for ● Engagement between providers
hospital beds, drugs and O2 digital health services & patients dictated by platform

● Lack of digital records for accurate ● Fragmented health data

delivery of health services via standards and infrastructure
Booking digital means
Easy scheduling appointments
for vaccination or treatment

A decentralized, inclusive and open network may spur

Fulfilment adoption of digital health services which in turn may help in
Teleconsultation with verified addressing critical healthcare ecosystem needs
professionals
 The Health Services Layer will be designed in accordance
Open Networks with the principles of ‘open networks’

An open network is based on open

protocols - shared technical standards
available to every participant in an
ecosystem

Features of Open Networks

Open & Accessible

No Single Owner

Interoperable / Not Platform Centric

An Open Network for Open Networks allow patients and providers to engage in
digital health interactions across platforms and
Health Services applications

Platforms vs. Open Networks

 Consultation Questions

Requested Inputs and Feedback:

1. The Telemedicine Guidelines issued by The Board of Governors of the Medical Council of India (MCI) in
March 2020. Stakeholders are requested to go through them and suggest changes to the policy, if any,
to ensure adoption of telemedicine and e-pharmacy. Please note that NHA will act as a coordinator and
only forward these suggestions to the appropriate/concerned ministry

2. As a stakeholder in the health ecosystem, what benefits and risks do you see if an open network to
digital health services is adopted? Please respond with details.
Unified Health Interface: An Overview
● A Teleconsultation Journey through UHI
● UHI Stakeholders
● UHI Objectives
 A Teleconsultation Journey The Health Services Layer will be designed in accordance
with the principles of ‘open networks’
through UHI
Seeking Teleconsultation via UHI

1 2 3 4

Application (EUA)
Health ID Creation Professional Search Search Results
Login
Patient creates their Health ID via Patient logs in to EUA of their Patient searches for professionals Professionals that meet patient’s
Aadhaar or any other KYC choice using their HID and according to certain criteria e.g., criteria are displayed along with
provides consent to access linked specialty, language spoken availability and price
health records

5 6 7 8

Booking Payment Consent Request Consultation

Patient selects a professional and EUA collects payments for the Patient gets request for consent At the booked slot, the
books a slot with them teleconsultation service and from the professional on their professional calls the patient
booking is confirmed EUA to share medical records

Post-Consultation
Prescriptions / discharge summaries
issued digitally on EUA, and rate
services
 There are 3 key stakeholders in UHI - the Patients, the
UHI Stakeholders Health Service Providers and the Technology Service
Providers

UHI enables bidirectional exchange of service requests

Health Service
Patients and responses
Providers
Health
End User Service
Application UHI Protocols Provider
(EUA) Application
(HSPA)
Access digital
health services Fulfill services, generate
and health data and share health data;
including but not limited
to:
● Doctors
● Hospitals
● Labs
● Clinics
Technology Service Providers ● Pharmacies

Build and provide software compatible with

UHI to Patients and HSPs
Stakeholders
 NDHM aims to create an open ecosystem for verified,
Objectives of UHI seamless digital health transactions

Fair Service
Discovery

Platform Flexibility
Entity Verification
/ Tech Neutrality

Easy Open Goals enabled Service

Protocols by UHI Interoperability

Post Fulfilment Streamlined

Activities Service Fulfilment
Flexible, Secure
Financial
Settlement
Leapfrogging in Digital UHI can transform the processes involved in digital health
Health service delivery; selected examples are outlined below

Process Current State Under UHI

Patients and providers need to use the Patients can use any app of their
Patient-Provider
same application or mode to complete choice to find doctors, book services,
Engagement digital health interactions make payments, and share health data

To find the best price for a service like

UHI allows HSPs to publish prices for
an MRI, patients need to call multiple
their services. Patients can easily
Price Discovery labs- aggregated reliable information is
discover them and book these services
not easily available

Complex cases requiring different

UHI can enable Group Consult to allow
specialties involved the patient
Continuity of Care integrating medical advice and
professionals to easily collaborate to
address a patient’s needs holistically
records and visiting multiple doctors
 Consultation Questions

Requested Inputs and Feedback:

1. Are there any other primary or secondary stakeholders that should be considered while building the
interface? If yes, please outline their role in the UHI ecosystem.

2. Please share your comments on the comprehensiveness of the UHI objectives outlined, and suggest
methods to ensure these objectives are adhered to. Please comment if there are other objectives which
must be included.

3. UHI will support a range of digital health services and is expected to evolve with time. How should the
digital health services be phased in the upcoming versions of UHI?

4. Please review the incentives / disincentives for various stakeholders to participate as covered in chapter
4 of the UHI Consultation Paper

5. For disincentives outlined in the UHI Consultation Paper, please provide possible mitigating measures
that may be taken to minimize the impact of said disincentives.
UHI: Technical Design and Operation
● UHI Architecture
● Components
● The Digital Health Journey Under UHI
 UHI will use several NDHM building blocks to enable the
UHI Architecture interoperable layer for digital health services

Exchange of Requests and Data in UHI

 There are five key components that work together to
Components of UHI enable digital health transactions to occur in UHI

UHI is envisioned as an open protocol that will enable a variety of digital health transactions between patients and health service providers

Components of the UHI Ecosystem

UHI Gateway NDHM Registries Health Information End User Applications Health Service
Exchange Provider Applications

Role Implements the open Accurate identification Enables interoperable Enable patients to Enable providers to
technical protocols that and verification of exchange of health access and avail digital deliver health services
enable UHI participating entities records health services to end users

Owner NDHM (Initially) NDHM Public or Private Market Players

User All ecosystem All ecosystem All ecosystem Patients Health Service
participants participants participants Providers

Instance NDHM UHI Gateway Health Facility Registry NDHM Consent Multiple Public or Private HMIS
Manager Private Applications
(For eg: e-Sanjeevini)
 The Digital Health Journey UHI will address every step in the end to end delivery of
under UHI digital health services

Service Service Financial

Service Discovery Post Fulfillment
Booking Fulfillment Settlement

Role of UHI Gateway

Open protocols enable UHI protocols may support a
The EUA presents HSP is accountable for The gateway tracks
HSPs to declare their rating system that for user
discovery results as per delivering the service details of the transaction
services for patients to and providers; the display of
user’s criteria within the EUAs and confirmation of
discover these ratings may be
parameters financial transfers
When EUA books the customized
The UHI Gateway sends
service, the gateway UHI gateway will only In case of disputes, the
a request to all HSPs UHI will also support
presents the various maintain transaction UHI will be able to
that meet the request grievance redressal, with
payment mechanisms data logs but will not provide details of every
criteria respect to issues on the
available participate in fulfilment transaction
digital network
HSP can evaluate the
A UHI transaction ID is
request and respond The Gateway may suspect
created upon booking
with pricing and other users, TSPs or HSPs if in
the service
details breach of UHI policies
 Consultation Questions

Requested Inputs and Feedback:

1. In the proposed discovery model, EUAs are expected to present all responses returned by the Gateway
to the user and allow the user to choose the HSP. Should any alternate models be allowed? If yes,
provide details.

2. Are there any other areas that must be supported by the Gateway for service fulfilment? If yes, provide
details.

3. Post-fulfilment covers ratings and grievances. Are there any other areas that must be supported by the
Gateway for post service fulfilment? If yes, provide details.

4. The proposed approach for allowing users to share ratings for the HSPs as well as EUAs has been laid
out. Please comment on the same and share any other approach that might be adopted.
 Governance and NDHM has also developed a framework for governing,
Management of UHI managing and driving adoption of the UHI gateway

Development of UHI Protocols Onboarding

The current NDHM sandbox will be expanded and

Design by include a process for accessing the UHI APIs
Consultation Consultation Adoption by
Specification with Experts with Public Ecosystem
Committee

Development and Management of UHI Gateway Pricing

NDHM plans to maintain and operate the first UHI gateway for a certain A usage fee may be charged to cover the
period of time before considering introducing market-developed gateways. development, management & operation of the
gateway. HSPs and EUAs will also be free to set
NDHM will manage two instances of the UHI Gateway: service charges

1 Sandbox: Testing 2 Total Price for End User = HSP price for service + UHI
Production: Live Gateway charges (if any) + EUA service charges
and Integration delivery of services
 Consultation Questions

Requested Inputs and Feedback:

1. What other approaches should be considered for managing and governing the UHI gateway? Please
provide details.

2. Are there any inputs on the pricing of services detailed? Please suggest other alternate pricing models
that must be supported by the Gateway.

3. What should the UHI Gateway charge in the initial few years of operation? How can this model evolve
over time?

4. Please share your views on the duration for which NDHM should manage and govern the UHI gateway,
and if NDHM should open the path to multiple gateways. Please provide details on the benefits and risks
of the options.
 The success of UHI depends on active participation and
Next Steps adoption of the registry by the ecosystem

All participants are requested to:

1. Read the full text of the consultation paper released on July 23th
2. Provide comments on the consultation paper against relevant questions by August 23rd
3. Share your feedback through the form that will be shared with you after this webinar
 Pre-Submitted Q&A

1. EHR System: Will NHA mandate a uniform EHR system (allowing state based modification) for whole Indian health system?

2. Is it economically feasible to have a data controller at each health facility? Or is there an alternative to protect the data security?
Are there any laws to be proposed in the coming future for data security regulation?

3. Against what policies & standards are UHI data protection, data access and data use benchmarked?

4. Will the patient record be accessible only on entry of Health ID or will there also be provision of personal password?

5. How will the Specification Committee and the experts for the expert consultation be selected? The paper only says they will be
from ‘government’, ‘academia’, ‘industry’, and some will be ‘independent’.

6. Health and other related data of every individual in India need to be digitized for the better future, and link them with health
insurance to cover them. How long until this process will happen or when will we witness this change similar to other countries?

7. Are you planning to create a unique health id like upi-id for all citizens of India?

8. How will cybersecurity concerns with third-party apps of private organisations/NGOs joining the UHI gateway be allayed?

9. What is the timeframe that NHA has in mind for UHI implementation?