All You Need to Know on Ayushman Bharat Digital Mission, Health IDs and Personal Records

India's latest health initiative marries technology to healthcare, although broader questions about consent remain.

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New Delhi: On September 26, Prime Minister Narendra Modi launched the Ayushman Bharat Digital Mission. At the virtual event, Modi said that the mission marks a new phase in efforts of the last seven years to strengthen health facilities.

How exactly will health facilities be strengthened with the Mission? And what concerns have been posed by legal, health and privacy experts? The Wire answers some frequently asked questions.

What happens under the Ayushman Bharat Digital Mission?

A digital health ID will be provided to all Indian citizens. It will be unique and will carry their health records.

Essentially, healthcare providers across the country will find it easier to access the medical record of a patient, if she consents.

How would this health ID function?

Personal health records can be linked to the ID and viewed by healthcare providers with the consent of the citizen. In addition, the mission will give access to a Healthcare Professionals Registry and a Healthcare Facilities Registry that will act as repositories of all healthcare providers across both modern and traditional systems of medicine.

This will ensure ease of doing business for doctors, hospitals and healthcare service providers, the government says.

The mission envisions a situation where presenting this health ID to a participating healthcare provider will allow a person to receive lab reports, prescriptions and diagnosis digitally from verified doctors and health service providers.

The government has compared the mission to the Unified Payments Interface or UPI, claiming that it can create interoperability within the digital health ecosystem.

How can I get a health ID for myself?

The health ID is a 14-digit number which can be obtained after registering at the government Ayushman Bharat Digital Mission portal (which is at the time of publishing was down). An interested citizen can also download the ABMD Health Records app on a phone.

Indian Express has reported that health IDs can be generated by participating health facilities too.

An illustration on the Ayushman Bharat Digital Mission’s official site.

What information do I have to give to get a health ID?

According to the official website, the system will collect details including “demographic and location, family/relationship, and contact details.”

The ID will offer opportunity to update contact information easily. The stated purpose of the ID will be threefold: unique identification, authentication, and threading of health records with the informed consent of the patient, across multiple systems and stakeholders.

Do I need Aadhaar?

The official site says that the health ID can be linked with an Aadhaar or mobile number, but reports have said that Aadhaar is not mandatory and just a phone number is enough to generate a unique health ID.

If you are using your Aadhaar number to get a health ID then a One Time Password will be sent to the mobile number that is linked to your Aadhaar number. In case your Aadhaar is not linked to your phone number, then you have to visit a participating health facility to get a biometric authentication done, Express reports.

Also read: How a Villager’s ‘Wild Chase’ to Retrieve Aadhaar Number Reflects a Crushing Lack of System

Is this whole system voluntary or mandatory for Indian citizens?

It’s voluntary, but aspects of the roll-out have already raised concerns. For instance, multiple media reports have noted that people who have enrolled in the COVID-19 vaccination programme using their Aadhar number have had their UHIDs created without either obtaining their specific consent or being given the option to opt out.

As the Bangalore-based Centre for Internet and Society has pointed out: “This is concerning as this done has been done based on the data entered by citizens and is linked to their Aadhaar, despite clarifications from the Government that Aadhaar is not mandatory for getting a UHID”.

Once I get a health ID, am I automatically in the system?

You will have to set up a unique username and password for your Personal Health Records (PHR) first. This will also offer opportunity to manage consent.

What is PHR?

PHR is an electronic application through which patients can maintain and manage their health information (and that of others for whom they are authorised) in what the government says is a private, secure, and confidential environment.

Multiple PHR addresses can be created by using one mobile number.

Once you link yourself to a health facility where you have received care, you can ideally fetch your health records from the particular facility on the PHR mobile app.

You can also manually upload scanned reports to the PHR app.

Also read: Despite Ayushman Bharat Cards, Free Medical Service Still a Pipe Dream for Many in UP

Will shared records stay with the doctor forever?

The official website says that viewing duration can be customised prior to sharing records. Only the records created and uploaded by doctors and the user will be on the mobile application.

What about data security?

The patient will be the owner of all the data, the government has claimed. The health ‘lockers’ integrated with ABDM can also be used for keeping the health records secure in the ‘lockers’, says the government.

However, a recent analysis by the Centre for Health, Equity, Law & Policy (C-HELP), ILS Law College, and Internet Freedom Foundation (IFF) raises broader questions regarding the consent policy of the ‘National Digital Health Mission: Health Data Management Policy (NDHM-HDMP).

“…consent is required to be specific only as to the purpose for collecting and processing personal data. In effect, the data fiduciary can secure one-time consent of the data principal for collecting and processing personal data for one or more broad purposes, as identified by the NDHM. This is evident from the fact that the data fiduciary is required to collect fresh consent only in the event of any change in its privacy policy or in relation to any previously unidentified purpose,” the analysis notes.

“For example, the data principal will not be able to withhold consent to digitise specific information or even refuse consent to share specific digitised information, such as abortion, substance use/dependence, HIV/STI status, suicide attempt and other mental illnesses. In order to address this, a broad consent in the beginning must be accompanied with specific consent taken at each instance of data processing and
sharing. The specific consent must include the entity with whom information is to be shared, the specific purpose for sharing, and the information that is necessary to facilitate the purpose,” it adds.

Can I opt out of the ABDM ecosystem?

The government says that an user will have the option to deactivate, reactivate and delete their health ID. While this indicates that records will be automatically deactivated, reactivated and deleted, there is no express assurance of this yet.

So each time I visit a hospital, will my health records be updated on the app?

If you consent to it and if the hospital is part of the ABDM ecosystem, then yes. You will need to scan the QR code displayed at the health facilities which will automatically link and authenticate the health ID and PHR address with the health facility.

Also read: Under Ayushman Bharat, Poor Patients Are Not Going Cashless but With Less Cash

How will I know if a hospital is part of the ABDM?

You will need to check the Health Facility Registry, which is a comprehensive repository of all the health facilities of the country across different systems of medicine. It includes both public and private health facilities including hospitals, clinics, diagnostic laboratories and imaging centres, pharmacies, etc.

Enrolment is voluntary and not all healthcare facilities will be listed, therefore.

However, all health facilities in India belonging to modern medicine (allopathy), dentistry, physiotherapy, Ayurveda, Unani, Siddha, homeopathy and Sowa-Rigpa systems of medicine will be accepted into the registry, the government has said.

Certain facility details will be checked by officials, and approval will have to be sought before they are visible to the public.

An illustration on the Ayushman Bharat Digital Mission’s official site.

What about doctors?

The Healthcare Professionals Registry will be a repository of all healthcare professionals involved in delivery of healthcare services across both modern and traditional systems of medicine.

How will private hospitals enlist themselves?

The Prime Minister’s Office has said that a ‘sandbox’ will act as a framework for technology and product testing that will help organisations, including private players, intending to be a part of the National Digital Health Ecosystem become a health information provider or a health information user or efficiently link with building blocks of the mission.

A ‘sandbox’, in computing terms, is a testing environment in a computer system in which new or untested software or coding can be run securely without affecting the application, system or platform on which they are run.

Will this help people for whom access to healthcare is a problem?

The government says that the initiative is aimed at the middle class and poor, yet the number of steps involving technology and access to internet in the ABDM ecosystem raise a question as to how accessible it will end up being.

(With inputs from agencies and the official website)