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Digital Health Ecosystem in India: Present Status, Challenges, and Way Forward

Preprint · November 2022

DOI: 10.4103/DYPJ.DYPJ_27_22

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Suraj Kapoor
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 DYPJ_27_22

Review Article
 1  1
 2  2
 3  3
 4 Digital Health Ecosystem in India: Present Status, Challenges,  4
 5  5
 6 and Way Forward  6
 7  7
 8 Suraj Kapoor
 8
 9  9
Department of Community Medicine, Armed Forces Medical College (AFMC), Pune, Maharashtra, India
10 10
11 11
12 12
Abstract
13 13
14
AQ2 Xxxx 14
15 15
16 Keywords: Artificial intelligence, digital health, India, pandemic 16
17 17
18 18
19 Digital technology has been a revolutionary foray in various Digital technology has been a revolutionary foray in 19
20 sectors and domains such as education, industry, research, various sectors and domains such as education, industry, 20
21 and recently, healthcare. The concept of digital health is research, and recently, healthcare. The concept of digital 21
22 an evolving entity and has gained tremendous importance health is an evolving entity and has gained tremendous 22
23 in the time of the Pandemic with social distancing and importance in the time of the Pandemic with social 23
24 lockdowns forcing the entire globe to adopt digital health distancing and lockdowns forcing the entire globe to adopt 24
25 and health technologies on a large scale. With digital health digital health and health technologies on a large scale. 25
26 increasing its presence and importance in the country, it is The digital health concept was first introduced in 2000 by 26
27 imperative to assess the present digital health system in Seth Frank,[1] which largely encompasses Internet-based 27
28 the country, its challenges, and the way ahead. Secondary applications and media to enhance medical subject matter, 28
29 data from Govt. official sites, press information, latest commerce, and connectivity. With the advancement in 29
30 articles, and newspapers were extracted and discussed technology, digital health has expanded to encompass a 30
31 in the article. Digital health tools are used in various much wider set of scientific concepts and technologies, 31
32 domains of health right from grass-root workers to health including the Internet of things, big data technology, 32
33 planners in India. Although digital health appears to be artificial intelligence techniques, genomics, analytics, 33
34 a new norm in pandemic times, still there are issues of wearables, mobile applications, and telemedicine. The 34
35 accessibility, transparency, and confidentiality. Training various domains of digital health have been explained by 35
36 of users and healthcare provider is equally important World Health Organization (WHO) in 2018.[2] 36
37 along with capacity availability in the expansion of digital 37
With the advancement in digital health and literacy 38
38 health across the country. There is a need for a capacity
rate in the country, The Government of India laid 39
39 building like availability and accessibility of Internet in
importance on digitalization in India’s healthcare sector 40
40 the periphery, and training for building an effective digital
in the National Health Policy, 2017 using the National 41
41 healthcare system in the country. There is a necessity
42 to emphasize the first important step of collection of a 42
43 “good quality” data point through the implementation Address for correspondence: Dr Suraj Kapoor, 43
44 of electronic medical records (EMR) by the healthcare Department of Community Medicine, Armed Forces Medical College 44
45 (AFMC), Solapur Road, Wanowrie, Pune 411040, Maharashtra, India. 45
providers. Health literacy in the community is an equally
E-mail: suraj7989@gmail.com
46 important entity. 46
47 47
Received: 08-Apr-2022, Revised: XX-XX-XXXX, Accepted: 20-Sep-2022, AQ6
48 Published: XX-XX-XXXX 48
49 49
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50 Access this article online
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53 For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com 53
54 54
DOI: How to cite this article: Kapoor S. Digital health ecosystem in India:
55 10.4103/DYPJ.DYPJ_27_22 Present status, challenges, and way forward. D Y Patil J Health Sci 55
56 2022;XX:XX-XX. 56

      © 2022 D Y Patil Journal of Health Sciences | Published by Wolters Kluwer - Medknow 1  
 AQ1
Kapoor: Digital health ecosystem in India

 1 Digital Health Mission (NDHM) which can act as the Digital Health at the Community Level  1
 2 foundation on which national digital health ecosystem  2
 3 can be built. On the occasion of the 74th Independence
Electronic health record (EHR) cards  3
The government of India intends to introduce a uniform  4
 4 Day, the Government of India embarked on its journey
system of EMR/EHR by the Hospitals and healthcare  5
 5 to achieve Universal Health Coverage by launching
providers throughout the country.[4] With NDHM  6
 6 NDHM.[3]
launched across the nation, EHR cards may aid in effective  7
 7
NDHM aims to build a holistic, integrated, and and faster surveillance.
 8  8
comprehensive digital health ecosystem that will lay
 9  9
10
the foundation of a strong public digital infrastructure, Digital health tools/gadgets 10
digitally empower individuals, patients, healthcare staff, 11
11 With digital literacy in the country improving at a
and health institutions, and aid streamline the healthcare 12
12 greater pace and the existence of a relatively younger
delivery system of the country. This will help inequitable, 13
13 population, it enables the advancement and increase user
14 affordable, and accessible health care to all. It may be 14
availability of various digital tools like apps, gadgets, and
15 useful for health planners and policymakers as well in 15
wearables useful in monitoring, screening, adherence of
16 monitoring and surveillance of health-related events 16
diseases as well as monitoring of risk factors. With the
17 better and in an efficient way. 17
epidemiological transition and rise in life expectancy,
18 With digital health increasing its presence and importance lifestyle and non-communicable diseases are bound to 18
19 in the country, it is imperative to assess the present digital get prevalent in India which is reflected in NFHS-5 data 19
20 health system in the country, its challenges, and the recently published. India has a prevalence of diabetes of 20
21 way ahead. 13% in females and 15% in males. Similarly, the prevalence 21
22 of hypertension is estimated to be 21% in females and 24% 22
23 Methodology: Secondary data from Govt. official sites, 23
in males.[5] These diseases particularly require long-term
24 press information, latest articles, and newspapers were 24
monitoring of risk factors like diet and exercise as well as
25 extracted and discussed in the article. 25
adherence to drugs which can be aided by easily available
26 Existing digital healthcare delivery system: The digital online tools like apps, wearable, gadgets, etc. Equally 26
27 health ecosystem in the country as per healthcare important are the helplines for substance abuse counseling 27
28 hierarchy is highlighted in Table 1 . The details of the like quit tobacco helpline, and the helpline for diseases 28
29 digital healthcare system in India are highlighted below: associated with a stigma like HIV. Ministry of Health and 29
30 30
31 31
32 32
Table 1: Existing system of digital health in India 33
33
34 User Technology 34
35 Community level 35
36 AWW(Anganwadi worker) ICDS-CAS (integrated child development services) common application software 36
37 ASHA (accredited social health activist) ASHA-Nidhi 37
ANM (auxiliary nurse midwife) ANMOL app (ANM online) 38
38
Individual • E-Health record card (to be implemented)
39 39
• Helplines
40 • Adherence, lifestyle-related digital apps 40
41 Pregnant women Kilkari app 41
42 Subcenter level 42
43 Patient–doctor Telemedicine 43
44 PHC/CHC level 44
45 Patient–doctor Telemedicine/national teleconsultation service: (e-Sanjeevani) 45
46 Healthcare system RCH portal (reproductive and child health) 46
47 Immunization • eVIN (electronic vaccine intelligence network) 47
48 • CoWIN app 48
49 Surveillance • GIS technology (ecosystem surveillance) 49
50 • Arogya setu app 50
• SAFAR-India (app) (system of air quality and weather forecasting and research)
51 51
• IHIP (integrated health information platform)
52 52
Communicable diseases • Tuberculosis-NIKSHAY, DOTS-99 (directly observed treatment short course), MERM
53 (medication event reminder monitor) box 53
54 • Leprosy-NIKUSHTH 54
55 • HIV-SOCH (strengthening overall care of HIV beneficiaries) 55
56 Miscellaneous • Artificial intelligence 56

      
2 2  D Y Patil Journal of Health Sciences ¦ Volume XX ¦ Issue XX ¦ XXXX-XXXX 2022
 Kapoor: Digital health ecosystem in India AQ1

 1 Family Welfare, Government of India Mera Aspataal (My Immunization  1

 2 Hospital) enterprise to gather patient feedback on the  2
Electronic Vaccine Intelligence Network (eVIN) is an
 3 services availed from both public and empaneled private  3
innovative technological solution aimed at supporting
 4 health facilities. It works through various communication  4
vaccine supply chain systems across the country. It is
 5 mechanisms, including short message service (SMS),  5
a blend of information technology (IT) structure and
 6 outbound dialling (OBD), a mobile application, and a  6
skilled human resources to enable real-time monitoring
 7 web portal.  7
of stock and storage temperature of the vaccines kept in
 8  8
multiple locations across the country. IT infrastructure
 9 Digital tools for grassroot workers  9
consists of software and SIM-enabled temperature loggers
10 To achieve equitable health, decentralization of the health 10
(product) specially designed to improve vaccine stock
11 sector with community participation and empowerment 11
keeping practices and temperature monitoring (processes)
12 is very important. Community health grass-root workers 12
across eVIN states.[9] One of the largest vaccination drives
13 such as ASHA (accredited social health activist), ANM 13
initiated in India used CoWIN app for the registration of
14 (auxiliary nurse midwife), and AWW (anganwadi worker) 14
beneficiaries.
15 have been empowered with certain digital tools with 15
16 proper training which was effectively utilized during 16
17 the COVID-19 pandemic times. ICDS-CAS (common
Surveillance 17
18 Surveillance is a continuous process, and the use of digital 18
application software) has been specifically devised to
19 tools like geographical information system (GIS) enables 19
improve the Service Delivery System as well as the system
20 the process easier, more effective, and time-saving. Arogya 20
for real-time monitoring (RTM) for nutritional outcomes
21 Setu for effective surveillance, risk assessment, and 21
in the anganwadis.[6] Digital tracking of services of
22 contact tracing for COVID-19 was used extensively during 22
ASHA has been implemented in various states like ASHA
23 the pandemic. The role of the integrated surveillance 23
Nidhi, an initiative by the government of Karnataka. It
24 project (IDSP) and the inclusion of the integrated health 24
is an online system that enables to obtain beneficiary-
25 information platform (IHIP) are highlighted in Table 2. 25
wise lists of services given by ASHA to the community.
26 Simultaneously there is a provision for Online payment of 26
27 ASHA to their bank accounts.[7] ANMOL(ANM online) Communicable diseases 27
28 is a tablet-based version of the RCH (rReproductive There are various software for various infectious diseases 28
29 and child health) portal which tracks eligible couples, as highlighted in Table 1, which enables real-time 29
30 and pregnant women for ANC and tracks childhood monitoring, notification, and case management purposes. 30
31 immunization. 31
32 Artificial intelligence 32
33 The use of machine learning, the Internet of things, and 33
Digital Tools in Health Institutions other artificial intelligence tools in screening, diagnosis, 34
34
35 Under the Ayushman Bharat scheme, with upgradation and management of health-related events is a novel 35
36 of existing subcentre to health and wellness centers to strategy that needs further advancement in the country. 36
37 provide holistic health to the community. There is a 37
38 provision of teleconsultation under the scheme at the Challenges in digital health in India 38
39 subcenter. In this specialist opinion can be taken and Although digital health appears to be a new norm in 39
40 there will be the provision of availability of regular and pandemic times, still there are issues of accessibility, 40
41 routine medications at the subcenter itself, like for non- transparency, and confidentiality. 41
42 communicable diseases. National Teleconsultation Service 42
43 of the Ministry of Health and Family Welfare is the first 43
44 of its kind online outpatient department (OPD) service Table 2: Comparison of integrated diseases surveillance 44
45 offered by a country’s government to its citizens. National project (IDSP) and integrated health information platform 45
46 Teleconsultation Service aims to provide healthcare (IHIP) 46
47 services to patients in their homes. Safe and structured IDSP IHIP 47
48 video-based clinical consultations between a doctor in It captures aggregate data It captures 48
49 a hospital and a patient in the confines of his home are disaggregate data 49
50 being enabled.[8] No interlinkage between Syndromic, Interlinkage of data 50
Presumptive, Laboratory (S, P, and
51 L) surveillance
51
52 Reproductive and child health 52
Reports are generated weekly basis Real-time information
53 Reproductive and child health (RCH portal) is specially 53
dissemination
54 made for the reproductive lifecycle of women and Paper-based Electronic 54
55 monitors the health condition of both newborn babies Eighteen diseases are included More than 33 diseases 55
56 and pregnant women. included 56

      D Y Patil Journal of Health Sciences ¦ Volume XX ¦ Issue XX ¦ XXXX-XXXX 2022 3  
 AQ1
Kapoor: Digital health ecosystem in India

 1 Linking complex confidential health-related information socioeconomic realities in the future. The benefits of  1
 2 with the Aadhaar identification system may present public goods, results, and services under this group must  2
 3 concerns of potential breaches of privacy, data ownership be maximized, with minimum disruption to the society.  3
 4 and use, and the autonomy of individuals.[10] There are  4
 5 ethical concerns as well as concerns about the quality Financial support and sponsorship  5
 6 of health care through digital health.[11] The migrant Not applicable.  6
 7 population, lack of bandwidth, infrastructure, lack of  7
 8 scalability and sustainability of the digital solutions, Conflicts of interest  8
 9 and unavailability of timely information are some of There are no conflicts of interest.  9
10 the challenges to adoption.[12] Health literacy of the 10
11 community especially among the rural, tribal, hard-to- 11
12 reach population is a matter of concern in empowering
References 12
1. Frank SR. Digital health care: The convergence of health care and
13 them with digital health. the internet. J Ambul Care Manage 2000;23:8-17.
13
14 2. World Health Organization. Classification of digital health 14
15 Way ahead interventions v1. 0: A  shared language to describe the uses of 15
16 digital technology for health (No. WHO/RHR/18.06). World Health 16
Data-driven machine learning (ML) and other artificial Organization; 2018. AQ3
17 intelligence tools have emerged as a promising approach 3. Bajpai  N, Wadhwa  M. India’s National Digital Health Mission. 17
18 for building accurate and robust statistical models from 2020. 18
19 medical data, which is collected in huge volumes by 4. Available from: https://www.EHR Standards | National Health AQ4
19
Portal of India (nhp.gov.in). 20
20 modern healthcare systems and may be useful in various 5. Available from: https://www.National Family Health Survey
21 domains like early diagnosis, screening, treatment and (NFHS-5) (rchiips.org). 21
22 monitoring of morbidity and mortality trends.[13] However, 6. Available from: https://pib.gov.in/Pressreleaseshare. 22
23 in the current system, a lot of data, including OPD data aspx?PRID=1536456 23
7. ASHA-MIS (karnataka.gov.in).
24 and operation theater (OT) data, are not captured, which 24
8. Available from: https://esanjeevaniopd.in.
25 leads to the loss of vital information. There is a need for 9. Electronic Vaccine Intelligence Network (eVIN) | National Health 25
26 a capacity building such as availability and accessibility Portal Of India (nhp.gov.in) 26
27 of Internet in the periphery, and training for building an 10. Gopichandran  V, Ganeshkumar  P, Dash  S, Ramasamy  A. Ethical 27
challenges of digital health technologies: Aadhaar, India. Bull
28 effective digital healthcare system in the country. There World Health Organ 2020;98:277-81.
28
29 is a necessity to emphasize the first important step of 11. Dhingra  D, Dabas  A. Global strategy on digital health. Indian 29
30 collection of a “good quality” data point through the Pediatr 2020;57:356-8. 30
31 12. Ramachandran A, Sarbadhikari SN. Digital Health for the 31
implementation of EMR by the healthcare providers.[14]
post-COVID-19 Pandemic in India: Emerging Technologies for
32 Health technology assessment is required to ensure Healthcare. 2021 8th International Conference on Computing for
32
33 that technology choice is participatory and is guided by Sustainable Global Development (INDIACom), 2021, pp. 244-9. 33
AQ5
34 considerations of scientific evidence, safety, consideration 13. Rieke N, Hancox J, Li W, Milletarì F, Roth HR, Albarqouni S, et al. 34
35 The future of digital health with federated learning. Npj Digit Med 35
on cost-effectiveness, and social values.[15] Health literacy 2020;3:119.
36 in the community is an equally important entity. 14. Das AV. People to policy: The promise and challenges of big data for 36
37 India. Indian J Ophthalmol 2021;69:3052-7. 37
Digital health is a rapidly emerging and evolving entity
38 15. Sarbadhikari  SN. Digital health in India–As envisaged by the 38
with an overwhelming impact on geopolitical and National Health Policy (2017). BLDE Univ J Health Sci 2019;4:1.
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