India Digital Health Network

PLATFORM India Digital Health Network

A research and policy collaborative focused on advancing the science and practice of digital health implementation in India.

KIRAN ANANDAMPILLAI SATCHIT BALSARI ABHISHEK BHATIA BARBARA E. BIERER CAROLINE BUCKEE LEO ANTHONY CELI MERCÈ CROSAS URS GASSER ADRIAN GROPPER ABHIJIT GUPTA JOHN HALAMKA BHARAT KALIDINDI SEHJ KASHYAP TARUN KHANNA NISHANT KISHORE KENNETH MANDL RAHUL MATTHAN SUNITA NADHAMUNI TONY RAJ ANGSHUMAN SARKAR VIVEK SINGH VERGHESE THOMAS NITA TYAGI ABIJEET WAGHMARE

The India Digital Health Network (IDHN), led by Professor Satchit Balsari, Assistant Professor in Emergency Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, is a research and policy collaborative working towards advancing digital health implementation science and practice in India.

Shaping the Policy Landscape

Since 2016, the program has helped shape the design of India’s digital health information architecture. The team’s proposal for an API-enabled health exchange ecosystem was adopted and implemented by NITI Aayog in its approach paper for the National Health Stack—a government initiative to digitize personal health records and service-provider records—and then by the Ministry of Health and Family Welfare, Government of India (GoI), in its National Digital Health Blueprint. Key contributions include a) the inclusion of the term “machine-readable” while mandating the portability of personal health data, setting the stage for health data interoperability in India; b) inclusion of Regulatory Sandboxes in the Ayushman Bharat Digital Mission (ABDM), which are controlled-testing environments within which existing regulations may be temporarily relaxed to allow experimentation for novel technologies; c) the concept of organizing the core of India’s digital health ecosystem around personal health records as opposed to hospital-based electronic medical records. During the past year, the team also collaborated with a consortium of technology partners to analyze and publish policy responses to key proposed building blocks of the National Health Stack.

Prototyping Digital Health Innovations

The IDHN team is also working towards facilitating the operationalization of this proposed digital health ecosystem. Implementation-focused activities have been organized under two workstreams. The first workstream is aimed at testing real-world deployments of digital health solutions that combine technology and task-shifting for primary care. In part-

IDHN team works to advance digital health implementation in India.

Digital health innovation teams continue to struggle to develop contextually intelligent solutions, precluding interventions from scaling beyond pilots. Frontline clinicians, community health workers and the communities themselves are seldom at the design board.

—SATCHIT BALSARI

nership with the Government of Karnataka (GoK), DellEMC and St. John’s Research Institute in Bengaluru, the team evaluated the national digital platform for non-communicable diseases screening and management. This entailed devising novel methods, adapted for the Indian context, to evaluate the usability and use of the digital health platform. Subsequently, Bharat Kalidindi, Sehj Kashyap, Verghese Thomas and Abijeet Waghmare spent two months conducting field-based research in Karnataka, including 240 hours of observations, interviews and tests. Key design challenges that emerged were the need for rapid user training at scale and methods for enabling real-time use in the busy and chaotic workflows of frontline providers.

The goal of the second workstream has been to prepare the regulatory and operational infrastructure required to rapidly iterate and test digital solutions prior to widespread deployment. The team has set up Digital Health Innovation (DHI) hubs at 10 newly designated Health and Wellness Clinics in Karnataka to serve as labs for rapid iteration of new digital technologies in a clinical environment. Optimization of the GoI’s Non-Communicable Diseases (NCDs) Screening and Management tool is underway at these sites. The team has also begun to expand these DHI hubs into the private sector to facilitate widespread development of digital health solutions. Key partners include health IT platforms like the NCD platform, Accessible Medical Record via Integrated Technologies (AMRIT), and ImTeCHO; technology partners and entrepreneurs like iSPIRT, Dell EMC, and Social Alpha; as well as primary care centers in India.