India has seen great success in recent years in enabling the creation of a digital economy based on India’s increasing number of digital public goods (DPGs). Through this, the country has learned to fully leverage technological advancements and increasing penetration of connectivity and mobiles to unbundle a greater number of services and inject alacrity across industries. In the wake of COVID-19, the need for a similar revolution in the healthcare sector became increasingly apparent.

The implementation of a digital health ecosystem could unlock an incremental economic value of over USD 200 billion in the coming decade, as per estimates from FICCI. India already has close to 5,000 healthtech startups . There is scope for innovation from the entire  healthcare stakeholder spectrum, including traditional players like hospitals and labs, startups, members of the manufacturing value chain, or payers and providers.

If implemented successfully, India’s digital health ecosystem has the potential to unleash a new wave of innovation across the healthcare industry. Digital health initiatives in other countries have been in varied forms, either largely centrally controlled like the NHS in UK, or leading to aggregation of health information in the hands of a few major private players such as in the US. By adopting a unique open digital health ecosystem approach, India is instead providing a level playing field for all. In such an ecosystem,  government health entities and private health providers can unlock new mechanisms for providing better care to people.

Given India’s previous experiences in designing and implementing national digital ecosystems in the financial sector, it is expected that within a few years the healthcare digital  could also become increasingly mature. India envisions an open digital platform at the core of the health ecosystem to leverage India’s existing digital public resources such as Aadhaar (identity), UPI (payments), DigiLocker (storage), e-Sign (verification), etc.

A vibrant digital health ecosystem can not only ease access to health services, making  ubiquitous and streamlined, but also reduce out of pocket expenses in the long term. Furthermore, it could drastically reduce the cost of transactions and verifications for healthcare providers and exponentially increase accessibility to affordable health cover for all, aiding India’s journey towards Universal Health Coverage.

This could be a major opportunity for market players while causing  disruption for established practices and players. It would be prudent for all industry players to start assessing the opportunities and risks they could face.

An integrated digital ecosystem will allow  patients to access and share their health records across the ecosystem, based on consent. Longitudinal health history of a patient could not only help prevent repeated expensive/invasive tests but could also provide doctors a clearer picture to help provide better care. With consent-based sharing of health records, patients could benefit from innovative offerings targeting wellness, preventive, and/or curative care. At the same time, with the creation of digital health records, robust privacy and security mechanisms will need to be incorporated from the design stage itself. Mechanisms to control the access to records based on granular  patient consent and modalities to enable even offline access will be essential in driving security, flexibility, and inclusivity for citizens.

Public health stakeholders also stand to greatly benefit from aggregated and anonymized data, resulting in innumerable use cases, targeted interventions, early warning systems etc. As the health data becomes increasingly standardized and shifts towards a machine-readable format, it could enable the implementation of a Health Claims Platform. Reducing the time and cost of processing claims could be a major asset in helping healthcare payers and providers serve a greater number of Indians.

India’s 2022 budget  highlights the government’s increased focus towards digital health interventions, with allocations being made for the creation of a National Digital Health Ecosystem. There are numerous use cases across the entire healthcare ecosystem that could emerge from innovation in digital health across healthcare delivery, diagnostics, wellness, ambulatory care, wearables, and many more. If new markets merge and expand, more such cases could become practical and viable. Telemedicine, in particular, can help even doctors in clinics increase the range of their base, and accelerate the time taken to establish their practice. Telemedicine could also greatly reduce the cost of out of pocket expenses for  patients which is a major barrier to accessing healthcare today.

Government health programs are also actively integrating with the ecosystem. As this goes up, the creation of digital health records for beneficiaries should also increase. This could help different programs not only deliver better care for beneficiaries, but also ensure holistic healthcare journeys for them. For example, maternal anaemia tends to lead to adverse health outcomes for both the mother and the child, even later in their lives. However, the Reproductive and Child Healthcare (RCH) program cannot serve these needs in isolation. Under the upcoming ecosystem, once such a case is detected, the family can be seamlessly provided benefits under other applicable health and nutrition programs over the years, with portability across the nation. Availability of an individual’s longitudinal health history would help both public and private healthcare providers in better decision making.

If the digital health domain follows a similar trajectory as unified payments, it could enable easy access to teleconsultations in rural areas, seamless sharing of digital health records, and auto-adjudication of claims, within the next five to ten years. Public health services and researchers could also stand to greatly benefit from this mission. Even medical tourism could get a fillip from this initiative, formalizing cross border assisted consultations or second opinions.

Despite its potential, there are also great challenges in digitizing public health in India. As the mission expands, it will have to continue to balance concerns of privacy and  security, challenges of limited infrastructure, and entrenched behaviour of various stakeholders. These and other challenges have resulted in mixed responses when similar initiatives were attempted in other nations. However, if the implementation is successful, this could very well impact the way India manages its health services going forward, and bears keeping a close watch on.