National Health Stack: The Driving Force Of The Jan Arogya Abhiyan

Jan Arogya Abhiyan, or Ayushman Bharat, as it was known previously, shall encompass over 500 million Indians, offering approximately 110 million families an annual health cover of Rs 500,000. The scheme shall include the operationalisation of over 150,000 health and wellness centres, apart from players from the private sector.

Catering to a pool of over 500 million Indians requires a robust digital infrastructure. Conventionally, the public sector has relied on the service-based Information Technology industry for solutions pertaining to banking, taxation, and so on. Jan Arogya Abhiyan, however, marks the beginning of an era in the public sector moving towards a product-oriented approach with the inculcation of a platform called the National Health Stack.

For instance, several smartphone applications require the use of basic components that are either integrated within the operating system or are a part of it. Social media applications warrant the use of camera and GPS. Similarly, a ride-sharing app requires the use of GPS. Thus, multiple apps within the phone use overlapping components of the Operating System.

The working of the National Health Stack (NHS) is similar. The components within the NHS digital framework shall enable the Jan Arogya Abhiyan and other public and private healthcare solutions that might be implemented by private agencies or government ones at a state, district, or local level in the future.

A collection of cloud-based services, the NHS will have each service offering a certain capability for solutions that are and will be implemented in the health sector. The solutions will be accessible via open APIs (Application Programming Interfaces).

Using Big Data, Data Analytics, Machine Learning, and Artificial Intelligence, one of the many objectives of the NHS would be to garner raw data pertaining to multiple facets of healthcare in India. Thus, the NHS would facilitate the gradual transition from a disease-curing to an India driven by preventive care.

In its working, the NHS will be leveraging the layers of India Stack (presence-less, paper-less, and cashless and consent driven), thus integrating and centralising the entire process while eliminating instances of fraud and redundancy and inculcating accountability within the Jan Arogya Abhiyan.

The components of the NHS can be segmented into two layers.

The foundation of the NHS comprises of the National Health Registries layer which shall contain data about both the service providers and the beneficiaries. The components in the second layer shall aid in the operationalisation of the services.

The National Health Registry (NHR)

Firstly, the National Health Registry shall include the Provider Registry. This will contain data about healthcare service providers within the country from both the public and the private sectors. However, the registry shall also include information about labs, diagnostic centres, doctors, insurance agencies, information on drugs and other disease control measures.

Also, the second part of the National Health Registry will be the Beneficiary Registry which will contain information about the individuals including their healthcare records. This registry will be critical to the success of the Jan Arogya Abhiyan as it will enable agencies to move from offering an ad-hoc service to a personalised one, drawing conclusions from elaborate data analytics garnered across years for individuals, districts, and states.

Often, the lack of data in the first place, irregular or shabby maintenance, redundancy, and the lack of flexibility for updating the data make registries ineffective. Within the NHS, the NHR will allow service providers and beneficiaries to update their data in a manner that is verifiable, allow for a verifiable trail to track the history of data changes, ensure flexibility for the solutions that employ the NHS, and guarantee data integrity.

The Coverage and Claims Platform

Any health cover scheme warrants a robust coverage and claims platform that eliminates frauds, monetary leakages, and in this era of digitisation, ensures the release of the claims at the earliest. Within the NHS, the Coverage and Claims platform shall contain three sub-components.

Firstly, there will be a Policy Engine that shall contain all the insurance policies in a machine-readable format. APIs shall be employed by relevant agencies to update these policies. The policy engine, via the APIs, shall ensure that the beneficiaries are able to understand the policies in the easiest possible manner. The engine will also contain policies a beneficiary might have purchased from a private insurer.

Also, in order to ensure consistency between different software programs, the NHS would include a Policy Markup Language in a machine-readable format. This will be instrumental in helping the service providers define, update, correct, communicate, or access policies across different APIs or software programs.

In order to use the coverage and claims platform, any scheme will be required to have updated the policies in the policy markup language, for the NHS shall be an open-source platform for schemes beyond the Jan Arogya Abhiyan. Any public or private entity offering that scheme would have to attach their digital signature to the policy, thus validating it.

The second sub-component is the Claims Engine, which will be crucial to the working of the Jan Arogya Abhiyan, for, it shall facilitate the filing and settlement of the claims made.

Given that the policies shall be available in a machine-readable format, the entire monitoring of the claims process shall be automated. The engine will be responsible for notifying payments to relevant insurers. Also, certain designated entities will also be notified in order to ensure that the processing of the claims is not delayed. In this entire process, an elaborate data trail will be created containing the records of claims processed within the NHS. While this data can be used to analyse patterns across regions, it can also be used to detect frauds.

The final sub-component is the Fraud Management System (FMS). The FMS will be able to send audit requests to the claims engine to detect any wrongdoing, delays in claims processing, or any other frauds. The FMS will deploy Machine Learning and Data Analytics in its functioning and will improvise based on the innovation carried out in the realm of Big Data. However, care will be taken to ensure that individual privacy is not violated in the operations of the FMS.

The FMS will have the authority to put the claims on hold for any healthcare service provider that might be indulging in a fraud. For instance, the FMS could request for the history of the provider from the claims engine for audit. Public agencies in Centre and State, insurance providers, and other agencies are expected to employ teams with expertise in data to investigate probable frauds.

Digital Health ID

For claims and frauds to be detected with greater accuracy, Personal Health Records would be inevitable, for most frauds shall either be due to redundant tests or false claims. However, the use of a Digital Health ID (on the lines of Aadhaar) will be there in order to ensure that every beneficiary covered within any scheme is uniquely identifiable.

Often, patients have to face the brunt of repeated tests and the costs that come alongside. With a unique digital ID (and a personal virtual ID like in the case of Aadhaar), the beneficiary will be able to undergo treatment in any part of the country without having to worry about their past medical records. The delays in treatment due to redundant tests and other inefficient practices shall thus be eliminated. In order to enrol under any scheme, the beneficiary would be required to complete the Know Your Customer (KYC) process.

Centralised Personal Health Records Framework

The Jan Arogya Abhiyan holds an opportunity for India to emerge as a capacity building state for public platforms. Thus, with the scale of this scheme, having a centralised personal health records framework would be ideal.

The framework would offer an integrated, holistic, and analytical view of the data gathered across years via the registry, policy engine, claims processing engine, and frauds engine.

With data pertaining to medical history, medication, immunisation, labs and diagnostic centres, drugs control, disease control, radiology, cancer, non-communicable diseases, weight, height, age-groups, regions, and states available via the Jan Arogya Abhiyan, agencies will be in a position to assist healthcare agencies and other ministries with better policy-making and planning.

Trustees or Health Data Fiduciaries (HDF) shall ensure that the data transfer from the records framework is consent-driven, does not violate the privacy of any individual, and does not lead to profiling that may harm someone. Also, the PHR shall ensure data integrity and would comply with laws under data regulation and user privacy.

The role of HDF will be critical in the NHS, for, it is necessary for a patient to be able to exchange information without having to worry about their privacy being violated. At the end of it, the patient must have the final say when it comes to their data stored within the framework.

National Health Analytics Framework

Going forward, the Jan Arogya Abhiyan or any scheme should aid the publication of reports, analytics, statistics, and other findings based on the data garnered for a better understanding of disease control and preventing measures in India.

This is where the National Health Analytics Framework will come into play. Aligned with the virtues of the National Data Sharing & Accessibility Policy (NDSAP), the framework shall facilitate the publication of datasets that drive discussions, innovations, engagement, and improvisations for any healthcare scheme.

In the future, the records from this framework could be integrated with those from banking, education, or any other scheme in order to have a better understanding of the social structure and what constrains it. The framework will also enable better response to calamities, given datasets would have observations about multiple instances across years.

Since the birth of the IT industry in India, public sector solutions have moved towards digitisation. However, most of these solutions warrant an eternal collaboration between the public sector and the IT company offering the service. The latter refrains from any innovation, as it threatens to disrupt their stable cash flow, while the former without the lack of options, continues to rely on the same IT companies for solutions that are outdated.

Jan Arogya Abhiyan’s driving force is platform-oriented. It is a product that inculcates components from the NHS, which further leverages the JAM (Jan Dhan, Aadhaar, Mobile) trinity for its efficient functioning. The same components today fuel programmes like Direct Benefit Transfers, Jan Dhan Yojana, UJWALA, and many more in the future.

As the driving force behind the Jan Arogya Abhiyan, the National Health Stack is not only a disruption, but a stepping stone to progressive healthcare revolution across India.