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iSPIRT’s Official Response to Union Budget 2021

Boost for HealthStack, but no gains for Industry

The Pandemic had decided much of the flow of financial planning in a country like India. The emphasis on Atma Nirbhar Bharat right at the outset in PART A of speech is on expected lines in a changed scenario post pandemic. Health being given importance forming the first pillar of six pillars was also expected based on ongoing developments.

For decades, India has underinvested (both in public and private spend) in the overall health of the population, and it took a global pandemic to dedicate a new Pillar of the budget to improving health outcomes and increase funding by 130%. It is heartening to see a substantial budget allocation of 64,000 Crore towards the Aatmanirbhar Swasth Yojana to improve primary, secondary and tertiary care. With the National Health Authority ​getting veteran RS Sharma (former Chairperson of TRAI and UIDAI) as its new CEO, this scheme could be implemented in a digital-first manner taking advantage of the advanced architecture of the National Digital Health Mission.

At iSPIRT we are pleased to see this development, and look forward to a year of accelerated efforts to establish key public digital infrastructure that could improve healthcare.

It was also encouraging to see Innovation and R&D mentioned as one of the pillars; this is a sign the Government is keen on supporting an innovation driven economy and the Indian products eco-system. The National Research Foundation outlay of 50,000 crores over 5 years is applicable across all sectors. Production linked incentive (PLI) schemes were announced for 13 sectors. This is a welcome move to bring in a thinking of promoting Indian Product Champions. However, the details of structure and which sectors and playgrounds the Government is attempting to promote will determine the success in the global landscape.

At iSPIRT we have been advocating development of niche playgrounds in sectors where India has a competitive advantage such as Software products in all sectors including defense, telecom etc. Whether the outlay of 1.97 lakh crores, over 5 years starting FY 2021-22 will be enough is to be tested.

The Continued emphasis on digital payment promotion with a new proposal of 1,500 crores and not losing sight of startups movement is heartening for the Software product industry. Improving norms to formation of a 1 person company will encourage innovation, entrepreneurship and startups. The Government seems to also be inclined to use technology to improve compliance via faceless assessment and a reduced limit on reopening of assessment limits, which are also efforts in a positive direction.

The biggest missed opportunity was around support to MSMEs – which are the key to driving scalable innovation. The MSME sector continues to need life support post the pandemic. While the Government slotted in a 2X budget estimate for MSMEs, it is not clear what this will go towards or that it will help the sector at scale. What remains to be addressed is critical changes that could MSMEs, ease frictions to accelerate growth.

We wanted to see more action on Ease of doing business, especially around removing bottlenecks for tech companies across sectors. In a digital economy, the small business sector is the lifeblood of future growth, and the government will need to think hard about the true means of galvanising this sector.

About iSPIRT Foundation

We are a non-profit think tank that builds public goods for Indian product startup to thrive and grow. iSPIRT aims to do for Indian startups what DARPA or Stanford did in Silicon Valley.

iSPIRT builds four types of public goods – technology building blocks (aka India stack), startup-friendly policies, market access programs like M&A Connect and Playbooks that codify scarce tacit knowledge for product entrepreneurs of India. visit www.ispirt.in

For further queries, reach out to Sudhir Singh​, email: ​[email protected] Or ​Karthik KS​, email: ​[email protected]

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Announcing Healthathon 2020

  1. Context
  2. Format
  3. Ideas & Themes
  4. Speakers & Judges
  5. Event Calendar
  6. Sponsors & Partners
  7. Prizes
  8. Registration Details

Context

Those of you who have been following this blog would know that as we speak, India is rolling out a piece of public digital infrastructure known as the National Health Stack (NHS). This project, which is being put into place to futurize the nation’s health technology ecosystem, has exciting and important ramifications for the entire country.

The ground reality in India is that the doctor:patient ratio in the country is low and inequitably distributed. Moreover, the digitization of health data is minimal and the availability of care facilities is sporadic. Taken together, these factors contribute to a relatively subpar standard of public health, which in turn affects happiness and productivity. In a country like India in which each percentage point of productivity and growth corresponds to millions of people moving out of poverty, it is doubly important to bring up the standard of public health as quickly as possible.

One of the components of the NHS which can do this is the Personal Health Records (PHR) system. This system establishes a standardized interface for storing, managing, and sharing medical data, all with user consent. If users can assert greater control over their own health data, they can derive more utility, convenience, and value. This might take expression through easier access to teleconsultations, or perhaps through a better consumer interface to canvas second opinions about some test reports or medical images. The PHR could also allow for individuals to securely and voluntarily contribute their anonymized healthcare data towards data sets used to map and manage public health trends over time.

The possibilities for the PHR system are many, but it will require a collaboration between the public sector, private sector, and medical community to make the most of this technology. For this reason, we are excited to announce the launch of the Healthathon 2020.

This four-week long virtual conference aims to bring together different stakeholders to work on solutions and products stemming from the PHR system. One key group of stakeholders is the public sector bodies like the NHA and MoHFW,  without whose support this initiative can never reach all of the 1.3 billion Indians. The second group is the private sector players such as health tech companies, entrepreneurs, private equity investors, and technology providers – without their creativity, capital, and execution capacity, it will be hard to make any project sustainable or scalable. The last stakeholder group is the medical community of doctors, hospitals, labs, and others; it is clear that without the buy-in and support of this group, no technology intervention can pinpoint or solve the most pressing problems. 

Format

The Healthathon 2020 will feature two competitions: the Hackathon and Ideathon. The Ideathon is a 2-week long event aimed at students, medical practitioners, and non-technical parties. During this event, teams will compete to come up with the best business plans and product ideas around the PHR system. 

In contrast to the Ideathon, the Hackathon is a 4-week long event aimed at startups, corporates, entrepreneurs, developers, and health tech enthusiasts. As part of the Hackathon, teams of developers will work on building projects on top of the new PHR APIs provided by our sandbox providers. 

Participants in both competitions will receive the mentorship, guidance, and resources they need to put out the best possible submissions. Panels of judges will then award prize money to the best teams from each competition. 

In addition to the Ideathon and Hackathon, there will also be a slew of masterclasses, panel discussions, and other events. These sessions are intended to generate engagement, awareness, and innovation around the PHR system, and they will all be recorded and open to the public. 

We hope that the event will draw in participants from different fields and backgrounds, united in the purpose of leveraging technology to make India healthier, more inclusive, and more efficient.

Hackathon & Ideathon Themes

Some of the themes that teams could choose to work on for the two competitions could include:

End Use Apps:
  • Apps that can read healthcare reports and provide some additional context or insight using AI
  • Platforms to help create real time monitoring and alerts for doctors using their patient’s wearable device data
  • Doctor-facing apps that help unify and analyze patient’s health records across different data sources
  • Health lockers for secure and convenient long term storage of health data
  • Matching systems that pair patients with the right kind of care provider given a medical report or treatment history
  • Anonymised health trends/dashboards for epidemiological studies
  • Preventive care applications that promote healthy living by tracking health markers and gamifying healthy living
  • Applications that provide and track continued & personalized care plans for chronic disease patients (eg. cancer care) 
  • New insurance products, possibly featuring fraud prevention and auto-adjudication based on PHR 
Consent Management:
  • Apps that help the user discover, link, and share access to their medical data
  • Building assisted and accessible consent flows for low-literacy or non-smartphone users
  • Systems to delegate patient consent in case of emergencies or other extenuating circumstances
  • Consent lifecycle management systems ie. generating, storing, revoking, and  safeguarding consent
  • Easy and informed consent experiences eg. “scan to share data”, “understand what you are consenting to”
Middleware and Utilities:
  • Secure data storage and management facilities
  • Tools to help medical institutions adopt and use the PHR system
  • AI utilities to decipher and parse medical data
  • Developer tools to simplify and abstract the workflows for PHR development 

Speakers and Judges

Here is a list of some of the speakers and judges for the event:

  • Kiran Mazumdar Shaw, Executive Chairperson, Biocon
  • Dr. C. S. Pramesh, Convener, National Cancer Grid
  • Sanjeev Srinivasan, CEO, Bharti Axa General Insurance
  • Arvind Sivaramakrishnan, Group CIO, Apollo Hospitals
  • Nachiket Mor, Commissioner, Lancet Committee on Reimagining Healthcare in India
  • Shashank ND, CEO, Practo
  • Gaurav Agarwal, CTO, 1mg
  • Dr. Ajay Bakshi, CEO, Buddhimed
  • Dr. Aditya Daftary, Radiologist, Innovision
  • Kiran Anandampillai, Technology Advisor, NHA
  • Dharmil Sheth, CEO, PharmEasy
  • Pankaj Sahni, CEO, Medanta
  • Veneeth Purushotaman, Group CIO, Aster Healthcare
  • Yashish Dahiya, CEO, Policybazaar
  • Abhimanyu Bhosale, CEO, LiveHealth
  • Prabhdeep Singh, CEO, Stanplus
  • Rajat Agarwal, Managing Director, Matrix Partners India
  • Tarun Davda, Managing Director, Matrix Partners India

Prospective Talks and Masterclasses

  • “An overview of the NHS architecture and objectives”
  • “A deepdive into the PHR APIs”
  • “Medical imaging data: Changing the Status Quo”
  • “Using delegated consent to bolster efficacy in emergency care”
  • “Technology challenges and opportunities for hospitals and labs”
  • “Health Tech in India: successes and areas of improvement”

Sponsors and Partners

Principal Sponsors
  • Matrix India Partners
  • Swasth Alliance
Knowledge Partners
  • CHIME India
  • HIMSS India Chapter
Sandbox Providers
  • National Health Authority
  • LiveHealth
Organization Partner:
  • Devfolio

Cash Prizes

Six teams in the hackathon will be eligible to win prizes of Rs. 50,000 each

Five teams in the ideathon will be eligible to win prizes of Rs. 20,000 each.

Dates, Registration, and Outreach

Registration Link (for both events): https://healthathon.devfolio.co

Registrations Close (for both events) : 22nd October, 2020

Opening Ceremony: 24th October, 2020

Ideathon submissions: November 6th, 2020

Hackathon submissions: November 19th, 2020

Closing Ceremony: 22nd November

Outreach: [email protected] (Email subject: “Healthathon”)

Blog Post Image Source: SelectInsureGroup.com

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Technical Standards of the Personal Health Records (PHR) component of the National Health Stack

We have an exciting announcement for you all today!

We are publishing a draft of the technical standards of the Personal Health Records (PHR) component of the National Health Stack (NHS)!

As a refresher, these standards govern the consented sharing of health information between Health Information Providers (HIPs) – like hospitals, pathology labs, and clinics –  and Health Information Users (HIUs) like pharmacies, medical consultants, doctors, and so on. The user’s consent to share their health data is issued via a new entity called a Health Data Consent Manager (HDCM). 

This is a big deal. The problem today is that the electronic health records listed in one app or ecosystem are not easily portable to other systems. There is no common standard that can be used to discover, share, and authenticate data between different networks or ecosystems. This means that the electronic medical records generated by users end up being confined to many different isolated silos, which can result in frustrating and complex experiences for patients wishing to manage data lying across different providers. 

With the PHR system, a user is able to generate a longitudinal view of their health data across providers. The interoperability and security of the PHR architecture allows users to securely discover, share, and manage their health data in a safe, convenient, and universally acceptable manner. For instance, a user could use a HDCM to discover their account at one hospital or diagnostic lab, and then select certain electronic reports to share with a doctor from another hospital or clinic. The flow of data would be safe, and the user would have granular control over who can access their data and for how long. Here is a small demo of the PHR system in action. 

The standards document released today offers a high level description of the architecture and flows that make this possible. You can find version 0.5 of the document embedded below.

Health Information Flows Technical Standards – V 0.5 from ProductNation/iSPIRT.

All the exciting progress we are making on this new digital public infrastructure for healthcare is all thanks to you, the community. We are grateful for your support and look forward to engaging with you further!

The blogpost is co-authored by our volunteers Aaryaman Vir, Saurabh Panjwani and Graphics by Dharmesh BA.

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Bending India’s COVID-19 Curve Through Science & Data-Led Models

Powered by data-led scientific rigor, the India COVID-19 SEIR Model delivers early infection trends for every district in India. The model is geared to help Indians from all walks of life plan life and work decisions around their region’s projected trends over the next 15-30 days. Hospitals can use the model to plan for a surge in demand for resources (beds, ICUs, ventilators); local and national level leaders across private and public sectors can use the model to decide how best to contain the spread of the disease and re-open safely. Epidemiologists can use the model to define how different behavioural and environmental factors affect disease transmission. We introduce 3 use cases in this blog post—the first in a series aimed at promoting scientific and modelling capability. 

Wherever the Coronavirus curve has bent to our will, it has happened on the back of behaviour changes based on data-led insights. Everywhere, simple shifts in behavior—staying at home, wearing masks, sanitizing hands—have been informed by predictive models that showed us the mirror to a dystopian future if we didn’t edit our lifestyles. As a digital public good for a billion Indians, the value of the India COVID-19 SEIR Model lies in its reach and widespread use. 

Until a vaccine is developed, we have to make sense of today’s numbers in the context of all our tomorrows. Individuals, policymakers—and everyone in between—can make smarter decisions if they know the evolving shape of the outbreak, and the India COVID-19 SEIR Model aims to do just that by enabling identification of potential trends and patterns in the next 15-30 days. 

The approach taken by the model provides flexibility and utilisation from both a view of trends as core model adoption/enhancement.

We can all use it to bend India’s curve. That’s the ultimate use case, really — where the model tells us where it’s going and we, in turn, steer it in an entirely other direction. Models will change and that’s a good thing. It means we are responding. The power of models and data science in this particular moment is the ability to assist a very scientific approach to scenario planning during an ongoing pandemic.

We can turn the course of this pandemic and transform what this model tells us, every 24 hours. We are already watching the shape-shifting in real-time. It’s in your hands. Go on, try it. 

Use Cases

User — Individuals & Businesses (PDF format)

User — Scientists (PDF format)

User — Policy-Makers (PDF format)

About the contributors: The blog post is co-authored by our volunteers Yashvi Jaju, Nikhila Natarajan and Srikar V Cintalagiri

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NHS Open House Discussion #4: Doctor Registry, Enrollment APIs And PHR

On 13th June, iSPIRT hosted the fourth open house discussion on the National Health Stack (NHS). For anybody unfamiliar with the NHS, here are some introductory blog posts and videos.

In the session, our volunteer Vikram Srinivasan deep dived into the Enrollment APIs of the electronic doctor registry. These APIs are called when a new doctor is being added to the registry, or when a doctor’s information is being uploaded. 

Vikram also spoke about the attestation APIs, which come into play when an attesting institution (such as a state medical council, medical college, or hospital) confirms some data about a doctor. This is crucially important for building trust in the registry and preventing the proliferation of false profiles. With the release of these enrolment and attestation APIs, all the APIs pertaining to the electronic doctor registry are now available here.

After Vikram’s presentation, he and our other volunteer Siddharth Shetty answered some technical questions submitted by the community. Here are some of the questions they fielded:

  • Doctors have multiple identities (from different medical councils), how are these unique IDs handled by the electronic registry?
  • Can anybody access the doctor information in the registry, including phone numbers and photographs of doctors?
  • Who can healthcare companies partner with in the Health Stack Ecosystem?
  • How does the federated network architecture of the PHR system deal with downtimes, incorrect data, and other failure? Is this architecture scalable for a system with 1000s of participants?

As always, these were great questions. You can watch Sid and Vikram answer these questions and walk through their presentations below. Please keep the questions coming by sending them in through this form: https://bit.ly/NHS-QAForm.

If you would like to get involved with Health Stack, we encourage you to watch the recordings of the previous Health Stack open house discussions before reaching out.

Furthermore, if you are interested in the Health Stack and wish to build on top of it or contribute to the working groups being formed, you should reach out to [email protected]

Please note: The fifth open house on PHR Implementation was previously planned for 27th June. This has been postponed to 11:30 am on 4th July due to unavoidable circumstances.

To confirm your participation, continue to register on this form.

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NHS Open House on PHR & Doctor Registry #3: Summary And Next Steps

On 6th June, we marked the third open house discussion of the National Health Stack (NHS). At the beginning of the session, iSPIRT volunteer Sharad Sharma offered a brief recap of the NHS and painted a roadmap for future developments in this initiative (including timelines, agendas, and future open house sessions). Sharad also discussed the content of the most recent open house session, in which Kiran Anandampillai explained the concept of the electronic registry system. After reiterating the vision for the NHS and the registry system, Sharad passed the floor to iSPIRT volunteer Vikram Srinivasan to dive into the registry APIs.

As a refresher, the electronic registry system is a mechanism for managing master data about different entities in the healthcare ecosystem. In today’ session, Vikram focused on the doctor registry. As the name suggests, the doctor registry will contain information about the doctors licensed to practice in India.

The doctor registry has the following design principles:

  1. Self maintainability: Doctors should be able to enrol themselves and update their own data
  1. Non-repudiable: The data in the registry should be digitally signed by a relevant attester (such as a State Medical Council) so that it can independently be verified by anybody
  1. Layered access: There should be a clear demarcation between public and private data in the registry, with only consent-based access to private data (eg. a doctor’s name and registration status should be public, but mobile number and photo should be private)
  1. Extensible schema: The data in the public registries should be as minimal as possible, allowing private players to build their own extensions around the core schema
  1. Open APIs: The data in the registries should be available via open APIs 
  1. Incentive aligned: The registry must enable convenient use cases so that doctors have an incentive to keep it up to date (eg. doctors can use their registry profile to electronically sign prescriptions, insurance claims etc. or doctors can use their registry profile to streamline and digitize the process of renewing their medical licenses)

After discussing the design principles behind the registry, Vikram dived straight into the details of the doctor registry APIs, which can be broken into the following categories:

  1. Enrollment APIs: These APIs allow doctors to enrol in the registry and update their data
  1. Consented APIs: These APIs allow a doctor to authenticate themselves, share their data/profile, and electronically sign documents
  1. Search APIs: These APIs are used to access the registry to query a doctor’s public data or search for any other publicly available information 

After covering these topics at a high level, Vikram released the API specifications for the Consented APIs and the Search APIs. The Swagger documentation for the same can be found here. The enrollment APIs will be released during next week’s open house session.

Upon completing his walkthrough of the doctor registry APIs, Vikram handed the floor over to our volunteer Siddharth Shetty. In the beginning of his segment, Siddharth answered the community’s technical questions around the NHS. Here are the questions he answered:

  • Is it mandatory to use the Open Source Project Eka codebase that has been published for the Consent Manager, API Bridge, and Gateway? 
  • In case of the Schema Standardization, during the 1st schema-less phase, are HIPs allowed to share data formats like JPEG, PDFs etc? 
  • Can the consent manager give the health locker (as an HIU) a standing consent to keep pulling the user’s information from various HIPs on an ongoing basis i.e. bypass the consent manager for future requests
  • Can the API bridges be configured such that instead of just sending the links to the information based on a request from an HIU (health locker in this case), the information can be sent such that it can be copied into the health locker?
  • Will the consent artifacts be encrypted between parties using any asymmetric key mechanism which will be valid between the services?
  • Is there any defined/recommended timeout for the data transmission from HIU – Bridge – CM- HIP and then HIU – HIP?

These were all great questions, and hopefully Siddharth’s answers helped clarify any doubts. If anybody wishes to ask any other questions around the NHS, please send them in to [email protected] with the subject line “NHS Questions”. Siddharth will continue answering the community’s technical questions during next week’s session (business-related questions will be answered in subsequent sessions).

To close off the open house discussion, Siddharth laid out the different working groups in the NHS ecosystem. Since the NHS is an open, public ecosystem, it is crucial for industry players and interested citizens to contribute to its development and pitch in with their feedback, knowledge, and engagement. Here are the working groups that are currently being formed:

  1. Technical Architecture Group: Responsible for working on open technical problems such as circuit breaker flows and time-out mechanisms. Also responsible for extensions and changes to the tech architecture
  1. Data Dictionary Group: This working group deals with moving away from the current schema-less architecture towards a standardized data vocabulary (leveraging existing medical schema projects and also coming up with new ideas relevant to the Indian context)
  1. Pilot Group: This group is comprised of people who have already started building on the NHS components (or would like to start building on the components). 
  1. Ecosystem Incentives Group: This group is looking at the incentive structures that power the NHS ecosystem (monetary and otherwise)

Any readers who are interested in learning more or joining these working groups are invited to reach out to [email protected]. A complete recording of the 6th June’s open house discussion can be found below

During next week’s session, we will be covering the Personal Health Records system (PHR), particularly as it relates to hospitals, and we will also be diving deeper into the Doctor Registry Enrollment APIs.

Readers are advised that next week’s NHS open house discussion will take place from 11:30 am – 12:30 pm on Saturday, June 13th.

The registration form for next week’s session can be found here. 

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iSPIRT NHS Open House Session #2: PHR and Doctor Registry

iSPIRT hosted the second open house session on the National Health Stack (NHS). 

In this session, our health stack volunteers dived deeper into the Personal Health Record (PHR) system and also covered the concept of the Electronic Doctor Registry.

In the first part of the session, our volunteer Siddharth Shetty answered technical questions pertaining to the PHR system. These questions, which were all submitted by the community, covered topics ranging from blockchains and zero-knowledge proofs to assisted consent flow for low tech-savvy users. A link to a recording of the session can be found at the end of this post.

In the second half of the session, our volunteer Kiran Anandampillai explained the concept of the doctor registry. The electronic registry system is a mechanism for managing master data about different entities in the healthcare ecosystem. Although some of these entities do appear in existing databases, these legacy systems are often incomplete, outdated, and seldom accessible via APIs. In contrast, the registries in the NHS are intended to capture trusted, non-repudiable data and enable self-maintainability. These registries will also have open APIs and will allow for secure authentication and data sharing. 

In the context of doctors, the electronic doctor registry can be used to:

  • Prove their identity and credentials as doctors
  • Electronically sign documents such as prescriptions, insurance claims, operating theatre notes, and more
  • Streamline workflows such as joining or telehealth application or registering for CME points (Continuing Medical Education points necessary for renewing a doctor’s license)

A recording of the entire session, including a breakdown of the design principles, APIs, and timelines behind the doctor registry, can be found below.

Inquisitive readers are also encouraged to submit their technical questions around the NHS to [email protected].

We will be answering those questions at the start of next week’s open house session, which will begin at 11:30 am on Saturday, 6th June. An invite to that session will be sent out to all participants who sign up at this link: https:// www.bit.ly/NHS-OHD

Although these sessions have so far been focusing on technical features of the NHS, the business and design aspects are also crucially important and will be covered in short order.

The blog post is authored by our volunteer Aaryaman Vir and he can be reached at [email protected].

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iSPIRT Open House Sessions on NHS: Summary & Next Steps

Yesterday afternoon, we hosted our first Open House Session in partnership with Swasth Alliance on the National Health Stack (NHS). For those unfamiliar with this infrastructure, it is helpful to picture the NHS as a multi-layer cake designed to elevate the capacity of the Indian healthcare ecosystem.

At the base layer is a set of generic building blocks. These building blocks, which include bank accounts, digital identities, and mobile numbers, form the basic rails needed to identify, transact with, and communicate with individuals and businesses. Many components of IndiaStack – such as eSign and DigiLocker – leverage and augment these building blocks. 

The next layer of the NHS is the ‘plumbing layer’. This layer contains fundamental pillars needed to enable simple, intelligent, and secure healthcare solutions. The three main pillars of the NHS plumbing layer are electronic registries, a personal health record framework, and a claims engine. A brief summary of these pillars is provided below:

  1. Electronic Registries: these registries  allow for efficient discovery and authentication of doctors, hospitals, and other healthcare providers
  2. Personal Health Records System (PHR): a system that allows individuals to enjoy a longitudinal view of all their healthcare data and exercise granular control over how this data is stored and accessed
  3. Claims Engine: a software engine that reduces the cost of processing insurance claims, enabling insurers to cover more kinds of healthcare procedures, such as preventive checkups, walk-in consultations, and other low-cost but high-value procedures that are currently excluded from Indian insurance policies

The third layer of the NHS is an augmentation layer which is intended to utilize the three pillars of the NHS to bring greater efficiency to the Indian healthcare ecosystem. The doctor: patient ratio in this country is relatively low, and cannot be changed overnight.

Having said that, increasing the efficiency of each doctor would have a similar effect to increasing this doctor: patient ratio. The augmentation layer of the NHS is designed to drive up doctor efficiency through the use of technology. Examples of this kind of technology could include a matching engine to pair patients with the most relevant doctor, or a system to help doctors securely and remotely monitor the bio-markers of their patients. Unlike the plumbing layer, the augmentation layer of the NHS is not close to completion, but we do envisage the augmentation layer playing an important role in the ascent of Indian healthcare quality. Both the plumbing layer and the augmentation layer are designed as open, standardized interfaces. These layers serve as digital public infrastructure accessible to public and private entities wishing to build atop them.

That brings us to the fourth and final layer of the NHS: the application layer. This layer comprises all the government and private sector applications that aim to serve the diverse needs of Indian patients. The first three layers of the NHS exist so that the innovators and change-makers of the fourth layer are optimally empowered to organize, access, and process the data that they need to deliver the best service to their users.

National Health Stack Overview

The first session on the NHS followed this schedule and published the entire webinar on our official Youtube channel:

  •  An introduction to iSPIRT and our values
  • An overview of the NHS
  • A deep-dive into and demonstration of the PHR pillar of the plumbing layer
  • A question-answer session with the audience

The objective of the session was to drive awareness of the NHS components, objectives, timelines, and design philosophies. We want participants from all walks of healthcare to be engaged with the NHS and take part in building it.

In keeping with this objective, we will be hosting weekly open house sessions to keep diving deeper into the National Health Stack. The next such event will take place on Saturday (30th May) at 11:30 am. The focus of this second session will be on another pillar of the plumbing layer – the electronic registry system. More specifically, the session will focus upon the doctor registry. 

Readers who wish to learn more about the NHS are encouraged to share this post and sign up now for the session below or click here.

Readers may also submit questions about the NHS to [email protected] We shall do our best to answer these questions during next Saturday’s open house discussion. 

About the Author: The post is co-authored by our volunteers Aaryaman Vir, Siddharth Shetty and Karthik K S.

Further Reading

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#1 India’s Health Leapfrog – Towards A Holistic Healthcare Ecosystem

In July 2018, NITI Aayog published a Strategy and Approach document on the National Health Stack. The document underscored the need for Universal Health Coverage (UHC) and laid down the technology framework for implementing the Ayushman Bharat programme which is meant to provide UHC to the bottom 500 million of the country. While the Health Stack provides a technological backbone for delivering affordable healthcare to all Indians, we, at iSPIRT, believe that it has the potential to go beyond that and to completely transform the healthcare ecosystem in the country. We are indeed headed for a health leapfrog in India! Over the last few months, we have worked extensively to understand the current challenges in the industry as well as the role and design of individual components of the Health Stack. In this post, we elaborate on the leapfrog that will be enabled by blending this technology with care delivery.

What is the health leapfrog?

Healthcare delivery in India faces multiple challenges today. The doctor-patient ratio in the country is extremely poor, a problem that is further exacerbated by their skewed distribution. Insurance penetration remains low leading to out-of-pocket expenses of over 80% (something that is being addressed by the Ayushman Bharat program). Additionally, the current view on healthcare amongst citizens as well as policymakers is largely around curative care. Preventive care, which is equally important for the health of individuals, is generally overlooked.  

The leapfrog we envision is that of public, precision healthcare. This means that not only would every citizen have access to affordable healthcare, but the care delivered would be holistic (as opposed to symptomatic) and preventive (and not just curative) in nature. This will require a complete redesign of operations, regulations and incentives – a transformation that, we believe, can be enabled by the Health Stack.

How will this leapfrog be enabled by the Health Stack?

At the first level, the Health Stack will enable a seamless flow of information across all stakeholders in the ecosystem, which will help in enhancing trust and decision-making. For example, access to an individual’s claims history helps in better claims management, a patient’s longitudinal health record aids clinical decision-making while information about disease incidence enables better policymaking. This is the role of some of the fundamental Health Stack components, namely, the health registries, personal health records (PHR) and the analytics framework. Of course, it is essential to maintain strict data security and privacy boundaries, which is already considered in the design of the stack, through features like non-repudiable audit logs and electronic consent.

At the second level, the Health Stack will improve cost efficiency of healthcare. For out-of-pocket expenditures to come down, we have to enable healthcare financing (via insurance or assurance schemes) to become more efficient and in particular, the costs of health claims management to reduce. The main costs around claims management relate to eligibility determination, claims processing and fraud detection. An open source coverage and claims platform, a key component of the Health Stack, is meant to deal with these inefficiencies. This component will not only bring down the cost of processing a claim but along with increased access to information about an individual’s health and claims history (level 1), will also enable the creation of personalised, sachet-sized insurance policies.

At the final level, the Health Stack will leverage information and cost efficiencies to make care delivery more holistic in nature. For this, we need a policy engine that creates care policies that are not only personalized in nature but that also incentivize good healthcare practices amongst consumers and providers. We have coined a new term for such policies – “gamifier” policies – since they will be used to gamify health decision-making amongst different stakeholders.

Gamifier policies, if implemented well, can have a transformative impact on the healthcare landscape of the country. We present our first proposal on the design of gamifier policies, We suggest the use of techniques from microeconomics to manage incentives for care providers, and those from behavioural economics to incentivise consumers. We also give examples of policies created by combining different techniques.

What’s next?

The success of the policy engine rests on real-world experiments around policies and in the document we lay down the contours of an experimentation framework for driving these experiments. The role of the regulator will be key in implementing this experimentation framework: in standardizing the policy language, in auditing policies and in ensuring the privacy-preserving exchange of data derived from different policy experiments. Creating the framework is an extensive exercise and requires engagement with economists as well as computer scientists. We invite people with expertise in either of these areas to join us on this journey and help us sharpen our thinking around it.

Do you wish to volunteer?

Please read our volunteer handbook and fill out this Google form if you’re interested in joining us in our effort to develop the design of Health Stack further and to take us closer to the goal of achieving universal and holistic healthcare in India!

Update: Our volunteer, Saurabh Panjawani, author of gamifier policies, recently gave a talk at ACM (Association for Computing Machinery)/MSR (Microsoft Research) India’s AI Summit in IIT Madras! Please view the talk here: https://www.microsoft.com/en-us/research/video/gamifier-policies-a-tool-for-creating-a-holistic-healthcare-ecosystem/