Alongside the private players, digital health technologies have gained the attention of public servants and policymakers. Under the genesis of the National Health Authority, the National Digital Health Mission (NDHM), Ministry of Health and Family Welfare, Govt. of India, aims to build a digital health ecosystem in the country Image: Shutterstock
Ensuring healthy lives and promoting well-being are essential and critical needs in any country (United Nations Sustainable Development Goal No. 3). The rise of digital health technologies has gained attention across clinical and non-clinical applications is believed to enable quality care and well-being of the citizens. Indeed, India is at the cusp of a digital health transformation, which can propel the country's economic growth and set an example for emerging economies if managed well. To address the inadequate healthcare infrastructure—leading to a supply-demand imbalance in India—digital transformation is likely to improve availability, accessibility, affordability, and the quality of healthcare.
Alongside the private players, digital health technologies have gained the attention of public servants and policymakers. Under the genesis of the National Health Authority, the National Digital Health Mission (NDHM), Ministry of Health and Family Welfare, Govt. of India, aims to build a digital health ecosystem in the country. It aims to use emerging technologies such as artificial intelligence, the internet of things, blockchain, and cloud computing to facilitate a holistic digital health ecosystem that can increase equitable access to health services, improve health outcomes and reduce costs. Ayushman Bharat is an exemplary initiative realised through NDHM.
One of the key aims of NDHM includes the digitisation of health data in India. This initiative is likely to make patients securely store and access their medical records (such as prescriptions, diagnostic reports, and discharge summaries) and share them with other healthcare stakeholders to ensure appropriate long-term care. Ideally, they would have access to more accurate information on health facilities and service providers and access health services remotely through telemedicine. This initiative would empower individuals with accurate information to enable informed decision-making through unique health identities for citizens and increase the accountability of healthcare providers, similar to a few other countries.
However, building a digital health ecosystem at the national level requires all stakeholders (private and public hospitals, doctors, citizens, policymakers, state, and central governments, diagnostic labs, pharmacies, insurance firms, and so on) to work together as an ecosystem. It is important to realise that digital intervention is a complex change. Given that 50-65 percent of digital deployments fail, there is an acute need to examine the readiness of the respective stakeholder entities for its success. For semantic clarity, readiness is defined as the stakeholder group's ability to smoothly imbibe the digitisation of health data initiative with the least resistance from the stakeholders and associated systems for its effective and sustainable use to achieve the targeted outcomes. Identification of readiness factors and examining them towards developing a readiness measurement instrument/scale sets an important agenda beforehand.
Three factors play a critical role in digital readiness towards building a digital health ecosystem—intent, infrastructure, and integration.
1. Intent: This factor is most important as it drives the other two readiness factors. Digitisation is both complex and costly, and every stakeholder needs to be convinced of its benefits. First, every stakeholder entity should understand the true intent behind building a digital health ecosystem. Digitising healthcare processes or records for the sake of digitisation would not lead to sustainable benefits. Clearly communicated digital strategy could drive this aspect. Second, every stakeholder group needs to see the big-picture at a national level without losing to a myopic competitive view. Intent drives investments, and looking beyond short-term returns at the service provider level would strengthen this factor. Third, intent needs to be realised as a two-way process between the government and other stakeholders of the healthcare ecosystem. Regulations and policy guidance should enable sustained intent and interest among these stakeholders.
2. Infrastructure: Building a digital health ecosystem needs to be examined from several infrastructural dimensions. First is the technological infrastructure (information, hardware, software). Assuming adequate financial resources to enable the digital change comes from the national budget, the clarity in ownership and accountability of technological infrastructure must be established. Second, given the shortage of physicians and other healthcare personnel, embedding clinical decision support systems so that doctors do not need to manage data redundancies is an important question to ponder. Third, enabling privacy and security of the health records poses another critical infrastructure readiness aspect. 3. Integration: This factor deals with integrating various health stakeholder groups and associated interfaces. It is essential to realise that building a digital ecosystem is not merely digitising a hospital or a set of hospitals with patient records—other key players like insurance providers, pharmacies, diagnostic labs and so on have important roles to play. Bringing them under the single digital umbrella by enabling integration of various systems, cultures, processes, and people determines the integration capability.
It is important to build national digital readiness on the above three factors before investing in building a digital ecosystem at the national level. Building a scale that could measure individual stakeholder groups' readiness to the digitisation and arriving at thresholds for each readiness factor is thus an important management research agenda. While building a national digital health ecosystem will undoubtedly lead to significant benefits both in the short and long run for every stakeholder entity within the healthcare sector, especially citizens of the country, without measuring readiness would lead to disappointing outcomes. By measuring the current level of readiness factors, policymakers and regulatory bodies could bridge the gaps to enable the successful execution of NDHM. A change without readiness is a royal road to confusion.
Vijaya Sunder M is an Assistant Professor (Practice) and BAT Research Fellow in the Operations Management Area at the Indian School of Business (ISB). He is also an affiliate faculty with Max Institute of Healthcare Management at ISB.