Tuesday, April 13, 2021

Provider Working Group - Final Report

Prologue

DIGITAL HEALTH ECOSYSTEM - ACCESS HEALTH DIGITAL VISION

Over the years economists and leaderships around the world have learnt that economic growth that is gained through the hard work of a creative, healthy and productive working population; is easily lost through healthcare costs arising from disease burdens that come with ageing or other public health challenges; which could be endemic communicable, lifestyle related or pandemics as in the recent experience.

This challenge becomes even more acute in the case of developing economies and economies with very young populations which will see longer life expectancies and higher healthcare burdens in the future.

The Sustainable Development Goals (SDG) framework elicited by the world community is an attempt to ensure that economic growth translates into real change in the lives of large populations around the world, lifting up their quality and experience of life.

Universal Healthcare is adopted as the third SDG in this framework but on closer examination has profound interconnections with all the other goals in the framework, and therefore is perhaps the most important one. In fact, it is so important that it is no longer possible to leave people to fend for themselves and pay-out-of-pocket for their healthcare costs. This report describes India’s policy initiatives for Universal Healthcare, along with a detailed discussion of, and solutions for, the hurdles that India faces in it’s drive towards implementation of Universal Healthcare.

Providing Universal healthcare in a way that is sustainable for economies requires a preventive, predictive and proactive approach to healthcare that is wellness centric and is both equitable and accessible to citizens.  There are a number of paradigms that need to be understood to effectively deliver on these approaches.

Firstly, it requires Healthcare to be seen as an ‘Eco-System’ or a collective environment, rather than disjointed entities / industries making overlapping or selective efforts that fail to address the issues holistically. Healthcare is not a single industry or a set of unconnected industries. Some of the issues arising from isolated efforts are discussed as ‘Fuzzy boundaries’ in the report.

Secondly, having realized that healthcare is an inter-dependent ecosystem, even more so when an entity other than the beneficiary or patient is paying for the services rendered; it becomes critical that all members (stakeholders) of the ecosystem work together in close cohesion with minimum administrative glitches and ensure economy of effort and resources used. The Size, Scale and Speed that is required to make this work, makes it essential for information to flow amongst the stakeholders in a seamless and meaningful way that is universal and helps decision making easy, rapid, transparent and non-discriminatory to the extent possible. For this to happen, Interoperability becomes critical and lack of Interoperability - fatal

The centrality and criticality of effective Interoperability calls for universally accepted structures, rules, processes and data standards. This is the core of the work that Access Health Digital has been doing over the recent years.  Access Health Digital (AHD) has expertise across Medicine, Technology, Public Heath, Governance and Policy, Healthcare Systems, Adoption, Capacity Building and Implementation; with at least 3 if not more cross functional disciplines available within each individual team member’s multi-decadal span of experience and qualifications.  AHD has Conceptualized, Designed the Building Blocks, Minimum Viable Product Designs and other Digital Health Assets for healthcare delivery information systems. The central purpose of this document, and the efforts behind the working group initiative, is to serve the nation by releasing this body of work into opensource for Public Good and secure majority agreement with stakeholders on these. This helps create an inclusive approach to the ecosystems instead of one that threatens or challenges the smaller stakeholders with financial ruin. The exclusiveness that is possible in other sectors of business is not viable in healthcare, as it would trigger a systemic collapse. Healthcare services are greatly personalized in nature since medicine is an extremely nuanced and evolved discipline, where a clinician often needs to factor in a lot of subjective information to make the best decision for the patient.

Essentially the Healthcare Space has three broad principal stakeholder groups namely:

  • Payers – These are entities that pay for healthcare services given to a patient. These could include the patient and his family, governments schemes, insurance providers – private and public. As discussed above, Universal Healthcare is striving to ensure that this burden is minimized for the patient.
  • Providers – These are entities, public or private, that provide care – ranging from the individual medical practitioner in a remote area, to the sophisticated urban hospitals; ancillary services eg. Labs and Diagnostics, telemedicine, medicines and so on. This is a vast area running into millions of entities.
  • Patients or Beneficiaries are those receiving healthcare services.
As is obvious by now, Healthcare is a domain that is vastly different to the more orderly areas like Banking, Payments, Finance, Retail, Telecom and so on, which have a very limited type and number of stakeholders and transactions that can easily be objectified.

Thirdly, given the fundamentally unique nature of healthcare and its diversity, and its need for a truly inclusive, country appropriate approach -  it is clear that integrating this ecosystem cannot be achieved by un-boxing and applying a playbook approach to India’s Healthcare Ecosystem, either from another country or even from another sector within India.

It can also not be achieved by just ‘replicating’ paper based processes by doing them electronically ie. merely Digitizing an existing process and carrying on the same way but with computers.

It would need a fundamental change to the way data is collected, organized, shared and acted upon in a way that decision making could be accurate and fast, while scale and safety went up exponentially with accessibility and equity. It also meant leveraging publicly available infrastructure and moving away from dependence on proprietary technologies that would create dependencies that no public system can survive, especially when it is a nation of 1.3 Billion people. Moreover healthcare is continuously evolving as our knowledge of the human  body, genetics, technology changes at speeds that have never been experienced in human history ! What we can do with a simple Mobile phone today, was never imaginable just 15 years ago! Lives and economies have truly been transformed by this ‘Digitalization’.

Healthcare needs Digitalization and not just mere Digitization since nuances and speed are not just important - they are critical, and could sometimes be the difference between life and death, in terms of outcomes.

Fortunately, since Universal Healthcare has been a high priority with the current government there has been a cascade of far-reaching measures following the National Health Policy of 2017 viz. PMJAY, The National Digital Health Blueprint, The National Digital Health Mission, the NEP-2020, and so on, initiated to remove hurdles towards achieving this goal.

Fourthly, Digital Health - as the Digitalization of Healthcare has come to be known, is a transformative discipline and is a complex specialization born through the convergence of multiple disciplines, just as most cutting edge innovation in the world is, today.

It is a matrix of Medicine, Technology, Public Heath, Governance and Policy, Management, Healthcare Systems, Adoption, Capacity Building and Implementation. At the primary level it required medical professionals to develop a familiarity with technology issues and for technologists to develop an appreciation for the nuances of healthcare and medical science, as the workplaces begin to adapt and change.

The recommendations in this report reflect the work of 200+ professionals, who have made that journey despite the extreme discomfort that this change represents, to reach a state of familiarity with the intricacies and nuances of this cutting edge area. The future requires a similar effort from all of us in Healthcare and Information Technologyu, with an urgency that has never been experienced in history.

Coming back to the three groups of stakeholders mentioned earlier in this discussion:

AHD’s Payer side recommendations were already discussed with the Payer industry and submitted to the National Health Authority.

This Provider Working Group Initiative seeks to serve the nation by evolving a set of tools that will allow for integrating the Provider Community and it’s diversity into a National Digital Health Ecosystem. Give all of the above, It’s importance to Universal Healthcare can hardly be overstated.

Nations must rise to protect themselves, professionals must step across the divides of habit, if we are to meet the challenges of the future. Covid19 makes it essential to build healthcare eco-systems that are adequate to spot and address threats predictively across geographies, besides keeping large populations healthy by preventing disease.

India stands at an inflection point today quite similar to the one that she witnessed when mobile telephony arrived in the 1990s’. The bottlenecks of the old, infrastructure heavy, fixed line telephony were gone in one fell swoop; and as they say, the rest is history. It led to a transformation of the country in exponential terms, in every sphere of life.

The work done by AHD will go a long way in helping the realization of this critical national priority as the proverbial ‘stitch-in-time’. Access Health Digital as a Not for Profit, Technology Knowledge Leader has been making catalytic, India specific, design, innovation and adoption initiatives to remove bottlenecks in the healthcare domain to make it possible to adopt and implement the recommendations of the National Digital Health Blueprint.

We have sought to address the lack of Interoperability between members of this vast ecosystem, which has so far been impeding the scale and speed of data and knowledge flow, which is vital to make universal healthcare achievable.  The National Digital Health Blueprint has been the set of guiding principles to our initiatives.

We have gone further and convened extensive working group discussions in each of these areas across academic, industry and policy makers; to secure majority agreement and make sure that adoption of digital health was not obstructed, and interoperability became inherent to the Building Blocks, Minimum Viable Products and Architectures that AHD proposed and shared as open-source, digital health assets for the public good. Our intent is to help India leapfrog the current state into a bold new future in digital health and also lead the global healthcare community by example.

As a Medical, Technological Governance and Policy Maker, Management or Public Health Professional, or even as a student or educator in these diverse domains, we believe this report will help you  navigate the future and be a worthy investment of your time to read.

We earnestly submit to the Government, that this rarely seen agreement / consensus and set of recommendations across a very wide spectrum of stakeholders in healthcare, be seized upon as a ‘once in a generation’ opportunity for the country to benefit it’s citizens immediately. It would also enable India to leapfrog and lead the global healthcare community for the benefit of all patients everywhere.


 

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