Tuesday, June 1, 2021

Telemedicine Hut: Solutions for Rural India

Lesson from the Covid19 Pandemic – Leveraging Telemedicine and Digital Health to offer 'Appropriate Care' in Rural India

Download Here! 

The Second Wave of Covid19, in a manner of speaking, was a ‘Baptism by fire’ for Public Health Governance in India.

Besides streamlining of provisioning of material resources, one of the key lessons learnt in managing the crisis was clearly, that ‘Appropriate Care’ i.e. Triage was able to take care of about 80% of patients reporting Covid-like symptoms and allowing them to be treated with simple and minimal protocols, at home without overburdening Hospitals in the secondary and Tertiary care segment and thus ensuring better outcomes and better patient experience. Resources could remain available for suitable cases.

Less could Indeed be more!

Now that we see the disease making inroads into Rural India which is relatively poorly served in terms of first line of care, and anticipate larger numbers that need to be provided ‘Appropriate Care’ we need to develop methods to do so.

Access Health Digital has developed a simple concept for Leveraging Telemedicine and Digital Health Technologies to offer Triage in Rural India with minimal infrastructural requirements and easily available solutions. Please see attached slides on how Telemedicine can be leveraged to do so.

A more detailed vision Document is being developed in partnership with a leading Academic Institution and will follow soon. Watch this space!

Download Here!

Wednesday, May 12, 2021

NABH to NDHB Mapping


National Accreditation Board for Hospitals and Healthcare Organizations #NABH, Chapter 10, Information Management Systems [IMS] should now been seen in the light of the National Digital Health Blueprint #NDHB Standards Notified by Govt of India in Nov 2019.
ACCESS Health Digital [AHD] has done the mapping of the #NABH Chapter 10 IMS to #NDHB and the NDHB based Building blocks designed by AHD.

Going forward this NABH-NDHB mapping will become a guiding light for NABH Auditors/Assessors evaluating the Hospitals and Healthcare Facilities from a IMS perspective. The same mapping can be extended to Joint Commission International [JCI] management of information [MOI].

Tuesday, April 13, 2021

Provider Working Group - Final Report



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.


Saturday, August 22, 2020

eClaims - Payer eObjects

This document presents the design specifications for electronic claim objects and associated standard processes for their exchange between Payers and Providers, through a Health Claim Platform that was recommended in the report “Common IT Infrastructure for Health Insurance Claims management” by IRDA-NHA joint working group. 

The health claim platform is intended to improve current claim processes, enforce transparency and facilitate on time provider payments for Health insurance Claims in India. Usage of Standard Electronic Claim related objects will facilitate auto adjudication of claims by both Public and Private Health Insurance Payers with reduced operational costs.

eDischarge Summary Object: Pick the eDischarge Object from Provider eObjects v2

Standard Value Sets for eClaims Objects

Standard Value Sets for eDischarge Objects

Summary of Insurance eObjects

The eObjects concept was introduced by ACCESS Health in Theme papers in Nov 2018, that became the Chapter 5 of the book ‘Health Systems for New India’, published by Niti Aayog in Nov 2019. Prof Dennis Streveler and Dr Pankaj Gupta are the Authors of the Chapter 5 in the Health System for New India book. The eObjects concept was again recommended in the ‘NHA-IRDA joint working group report’ to facilitate electronic, codified data exchange between providers and payers. The eObjects concept was then detailed out into Provider and Payer eObjects including the data standards recommended in the National Digital Health Blueprint. ACCESS Health has now released the eObjects design and code in opensource under MPL 2.0 license.

eObjects are evolving, check with us for the latest versions. Reach out to us for any help to understand or implement the eObjects. We can set up a group call with all of you to explain these eObjects in detail or even can set up one to one calls.

Thank You for your continuous association with us.

-- ACCESS Health Digital --

Contact for Clarifications:
Access Health Digital

Sunday, July 26, 2020


Digital Health 101 is a basic set of webinar recordings from AHD Academy. Suitable for Doctors/Nurses/Clinicians, Public Health and Healthcare Managers, Government Administrators and Technologists interested in Digital Health. The Courses are spread across Basic, Specialist and Expert Levels. It is a video based learning model and It is free. 

Disclaimer: AHD Academy is a Library of Live Webinar Recordings from AHD on various Digital Health topics. It is opensource material meant for learning from experts at your own pace. This is Not an Academic Course material. Please do not confuse these webinar recordings with regular recognized courses run by universities/colleges. You may contact your College, University, Organization for properly moderated Lectures, Trainings, Courses on Digital Health.

Basic Course for Digital Health Enthusiasts: Suitable for Clinicians, Healthcare Managers, Govt Administrators and Technologists interested in Digital Health. Will take approximately 40 Hours to read up the material and listen-in to these 101 webinars.


Reading Material Lesson 1. Note: This is a preparatory Lesson that will open your mind and help you understand the higher lessons. Reading material for this Lesson is based on white paper written by Dr Pankaj Gupta on the same topic.

Reading Material for Lesson 1: HEALTHCARE IT IS DIFFERENT


Reading Material for Lesson 2. Note: This is a preparatory Lesson that will open your mind and help you understand the higher lessons. Reading material for this Lesson is based on white paper written by Dr Pankaj Gupta on the same topic.

Reading Material for Lesson 2: GOVERNANCE AND FINANCIAL LEVER


Note: This is a preparatory Lesson that will open your mind and help you understand the higher lessons. Reading material for this Lesson is based on white paper written by Dr Pankaj Gupta on the same topic.

Reading Material for Lesson 3: FUZZY BOUNDARIES FOR GOVERNANCE


Note: This is a preparatory Lesson that will open your mind and help you understand the higher lessons. Reading material for this Lesson is based on white paper written by Dr Pankaj Gupta on the same topic.

Reading Material for Lesson 4: LINES ARE BEGINNING TO BLURR!


Reading Material for Lesson 5




Reading Material for Lesson 8


Additional Reading material: 


Specialist Course: Suitable for Healthcare Managers wanting to Specialize in Digital Health. Will take approximately 50 Hours to listen-in to these 101 webinars. Pre-requisite is Basic Course for Digital Health Enthusiasts. Technologists can jump to the Expert level Course.

Reading Material for Lesson 1






Additional Reading material:


Expert level Course: Suitable for Technologists aspiring for Expertise in Digital Health. Will take approximately 60 Hours to listen-in to these 101 webinars. Pre-requisite is Basic Course for Digital Health Enthusiasts. Specialist Course is not required for Technologists. 





LESSON 5: Bootcamp 2 PART 1
Discussions on NDHB, Federated Architecture, HDD, Registries,

LESSON 6: Bootcamp 2 PART 2
Discussions on SNOMED,

LESSON 7: Bootcamp 2 PART 3
Discussions on eObjects, FHIR,

LESSON 8: Bootcamp 2 PART 4
Discussions on Microservices,

LESSON 9: Bootcamp 3 PART 1
Discussions on eObjects Implementation,

LESSON 10: Bootcamp 3 PART 2
Discussions on SEA Members eObjects Experience,

LESSON 11: Bootcamp 3 PART 3
Discussions on Microservices Implementation,

LESSON 12: Bootcamp 3 PART 4
Discussions on HIEAF,

Additional Reading material:


Masters level Course: Suitable for Academic Excellence in Digital Health. Content similar to Basic, Specialist and Expert level course is used in Last semester of the Masters course, but obviously with more in-person teacher-led classroom sessions.



Congratulations! This completes the AHD Academy's Digital Health 101 Webinars. Best of Luck for implementing the concepts on the field.

Your feedback is welcome, Write to digital.health@accessh.org

Note: All Content is released under MPL 2.0 License. It is free to use with proper attributions.

AHD Academy Partners and Collaborators for Digital Health capacity building, research, content and pedagogy: 

More MoU in pipeline...

Monday, July 20, 2020

Social Entrepreneurship Accelerator

Social Entrepreneurship Accelerator [SEA]

ACCESS Health Digital [AHD] is a a not for profit think tank working on NDHB Digital Health Standards for India. We run a Social Entrepreneurship Accelerator [SEA] for helping Indian HealthTech startups and vendors to implement Open Digital Health Standards that are applicable globally. #AtmaNirbharBharat #VocalForLocal

SEA Silver Club

Silver Club has implemented the Standards and achieved our Stamp of Confidence.

SEA implements the eObjects Interoperability framework. eObjects were first written by Prof Dennis Streveler and Dr Pankaj Gupta in a white paper in Nov 2018 that was published by Niti Aayog in the book Health Systems for New India, Chapter 5 - Reimagining India's Digital Health Landscape Wiring the Indian Health Sector in Nov 2019.

SEA Objectives

SEA Cohort 1

SEA Cohort 2

In late October 2020, India's National Health Authority' Market ACCESS Program [MAP] put 12 startups under mentorship of ACCESS Health Digital's Social Entrepreneurship Accelerator [SEA] -- the second of three cohorts to join the SEA family, now home to almost 40 startups that range in sector and specialty from primary care delivery and telemedicine to electronic health records and disease management. Like the previous cohort, SEA aims to provide its newest members with mentorship, market access, and a stamp of confidence, among other basic building blocks that will situate them in the digital health landscape. Together, they're working toward a single transformative purpose: building a vibrant national digital health ecosystem.

SEA Cohort 3

Parallelly Cohort 3 has also started to take shape, mostly on reference from Cohort 1 and requests from Partner organizations.

The Social Entrepreneurship Accelerator launched by ACCESS Health Digital has become an official Amazon AWS Activate Provider. AWS Activate works with accelerators, angel investors, and venture capital firms to provide startups with free AWS credits, technical support, training, resources, and more. These exclusive benefits are designed to help startups quickly get started on AWS and grow their business. Startups associated with an AWS Activate Provider are able to apply for AWS Activate Portfolio.

The new partnership with Amazon Web Services will help the Social Entrepreneurship Accelerator create new opportunities for its startups, providing them with access to Infrastructure as a service [IaaS], Platform as a Service [PaaS] and Software as a Service [SaaS]. This gives the startups entry into a Plug-and-Play integrated software development environment. Just adopt the PaaS and all startups in the accelerator can turn into SaaS companies.

SEA is an Exponential Organization (ExO) whose impact will be disproportionally large as compared to its peers because it leverages exponential technologies.

Additional Reading material:

Will update soon...keep checking this space..

-- ACCESS Health Digital --

Contact for Clarifications:
Access Health Digital

Thursday, July 9, 2020

Beneficiary Registry Recommendations for India

Since the start of the Millennium, India has been trying to overcome the problem of interoperability and fragmented healthcare delivery ecosystem across states, health policies and vertical health programs to deliver seamless or uninterrupted continuum of care. With the launch of the Pradhan Mantri Jan Arogya Yojna (PMJAY), that covers & provides free healthcare to approximately 40 % of the Indian population, it has become critical to identify each patient uniquely. The criticality for unique identification of individuals got highlighted when India was hit by the COVID 19 pandemic – when patient tracking and relevant health information on comorbidities was not available for effectively and efficiently executing surveillance. States and government could only collect aggregated data in non-standard and an unstructured format via door to door screening, which was extremely inefficient and poorly suited for response planning and to effectively combat a pandemic of this size and scale.

UHID is a critical building block from a Universal Health Coverage perspective and is also the missing link in enabling a true longitudinal health record for the patient. This is critical in providing all individuals, equal access to quality healthcare at all times. The first step towards enabling UHC for a country is to identify uniquely all individuals who seek healthcare as patients. 

Many developed countries as well as some developing countries have already implemented the concept of UHID. These can provide valuable inputs to India, in finalizing our UHID implementation policy. It was found that different countries have followed varied methodologies and approaches for UHID implementation at the National Level. In the more advanced countries with robust civil or social protection laws, UHID is generated and assigned at the time of birth and is utilized for every healthcare transaction throughout a person’s life.

India is a democratic country where health is a state subject with flexible regulations, which gives States and citizens freedom of choice to adhere to the health policies they want to adopt. In such an environment, to enable access to quality healthcare for all, it is critical to define a well thought out UHID strategy that can seamlessly encompass various use cases and scenarios specific to India. 

The recommended UHID approach is - Create a National Unique Health Identifier for every person in the country and link it with Aadhaar or with any Government verifiable ID for authentication and validation of the persons information.

The categories and recommended approaches are provided here for ready reference. 


Various use cases were identified and studied to arrive at the recommendation. The population can be divided into 5 major categories with an associated approach to assign a UHID to the identified population group. The minimum data elements recommended for the Beneficiary Registry are also provided. 

We are also publishing the recommended minimum data elements for the Health Delivery Information Systems minimum viable product for Personal Health Records [PHR].


NDHB has also recommended a Health Locker to Maintain the Personal Health Records of the Individuals in the Health System. The Health Locker is a standards‐based interoperability specification that can be implemented by multiple players to enable the creation of a Personal Health Record. A personal health record, or PHR, is an electronic application through which patients can maintain and manage their health information (and that of others for whom they are authorized) in a private, secure, and confidential environment. The healthlocker either stores patient’s record in digital format pushed by various providers or can store eObject pointers to the patient record or summary stored in a source system against the Unique Health ID of the patient.

The health lockers enable creation of a longitudinal health record from the various eObject links/pointers available and enables retrieval and storage of the EHR for continued clinical decision making. All the related eObject pointers and ID documents can be loaded to the Healthlocker for the PHR, giving the individuals the right to their information and control the information which they may like to share with other stakeholders.

-- ACCESS Health Digital --

Contact for Clarifications:
Access Health Digital