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Commentary | Open Access

Inception of the Indian Digital Health Mission: Connecting…the…Dots

Gerard Marshall Raj1,2 (), Sathian Dananjayan3, Neeraj Agarwal4
Department of Pharmacology, All India Institute of Medical Sciences (AIIMS) Bibinagar, Hyderabad, Telangana, India
Hospital Management Information System (HMIS), All India Institute of Medical Sciences (AIIMS) Bibinagar, Hyderabad, Telangana, India
School of Computer Science and Engineering, Vellore Institute of Technology, Chennai, Tamil Nadu, India
Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS) Bibinagar, Hyderabad, Telangana, India
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Health Care Science
Volume 2 Issue 5,
October 2023
Pages 345-351
DOI: 10.1002/hcs2.67
Cite this article:
Raj GM, Dananjayan S, Agarwal N. Inception of the Indian Digital Health Mission: Connecting…the…Dots. Health Care Science, 2023, 2(5): 345-351. https://doi.org/10.1002/hcs2.67
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Features of National Digital Health Mission in comparison to the prevailing system.

Pre‐NDHMProposed NDHM
Isolated and functions in silo (Platform‐centric model)Integrated and interoperable—breaking barriers (Open‐source software products and standards)
Centralized and sometimes, even decentralized architectureFederated architecture• Regional‐level• State‐level• District‐level• Facility‐level
Fragmented and disrupted provision of healthcareContinuity of care at all levels – primary, secondary, and tertiary – public and private
Interrupted and complex health governanceImproved efficiency, effectiveness, and accountability in health service delivery
Contemplation on hidden chargesTransparency in pricing of services rendered
Previous Health Facility Registries• No real‐time updates• Fragmented• Not complete• Lack of confidentiality and transparencyHealth Facility Registry (HFR)• Dynamic—provision for real‐time updates• Universal—covers all systems of medicine and also both public and private organizations• Comprehensive—includes all relevant information (basic, financial, civil and medical infrastructure)• Data verified and audited regularly
Previous Registries• Less representative  ○ Predominantly doctors of modern medicine• Less participatoryHealthcare Professionals Registry• Encompasses all healthcare professionals  ○ Doctors (from all systems of medicine)  ○ Dentists  ○ Nursing professionals  ○ Allied healthcare professionals  ○ Miscellaneous health workers• Voluntary‐yet‐conducive for all stakeholders  ○ Medical Councils  ○ Medical Colleges/Universities  ○ Employer
• Electronic Health Records (EHR) are not easily accessible whenever required• Demand‐driven, consent‐based, authenticate, and secure access to Electronic Health Records (Unified Health Interface)
• Discrete and multiple EHRs (application‐centric)• Longitudinal, sequential, and standardized EHRs (citizen‐/patient‐centric)
• Health Identifier is facility‐specific• Universal, unique, and secure Personal Health Identifier [Ayushman Bharat Health Account (ABHA) number]
• Healthcare providers exist as mere health information generators• Healthcare providers act as Health Information Providers (HIPs) also referred to as Health Data Fiduciaries• Healthcare providers can also act as Health Information Users (HIUs)
• Only healthcare providers can generate health data• Incorporation of individual/patient generated data in the EHR is possible
• Multiple heath Apps with no transfer of content across parties, even when needed• Multiple front‐end Apps with provision for authorized transfer of data. However, they can neither download individual patient data nor act as data repositories.
• Each government health program/scheme has its own exclusive ID which leads to multiple IDs for each user• Government health programs/schemes can be accessed through a single Health ID (ABHA number)
• Each member in a family has discrete Health IDs• Proposal for linkage of Health IDs of all members in a family