A few months ago, a 70-years old ex-smoker, was referred for a CT scan guided lung nodule biopsy. I thought the nodule looked benign and non-cancerous, but there were no prior scans or radiographs to compare with. My coordinator kept pushing the patient and his relatives to check for old reports. They kept saying they didn’t have any. Finally, one day prior to the biopsy, the daughter-in-law came over with an X-ray of the chest done 10 years ago, as part of the pre-operative work-up for a gall bladder surgery. The same nodule that I was supposed to biopsy was present on that 10-years old chest X-ray…unchanged. Any lung nodule that remains the same for more than two years is assumed to be benign and left alone. When I told the patient and the family this, they were overjoyed…from a potential lung cancer, the diagnosis had changed to…”nothing abnormal to worry about”.
If only we had had a system that would have automatically alerted all of us to the presence of his 10-years old chest X-ray. The patient would have been saved one week of emotional and mental trauma along with the cost and stress of a CT scan, a PET/CT and the consultation fees of two senior physicians, amounting to around Rs 40,000.
A system that maintains electronic health records is generically called an EHR system for short. For the last two decades or so, smart engineers and doctors have broken their heads trying to create EHR systems that work well. While it is not that difficult to write code and create a working EHR, the challenge is getting the same EHR adopted widely and for different EHRs to connect with each other and share data and information.
We have a good EHR in our practice and we can easily access old records of all our patients going back six years and sometimes even more, but if the patient / person has been to another diagnostic centre or hospital in the interim, then we are back to square one. There has been no grid or network in the past that has allowed EHRs of different hospitals and diagnostic centres to talk to each other.
A few months ago, the ABDM – the Ayushman Bharat Digital Mission was launched. The ABDM now gives every Indian national a unique Health ID called ABHA(Ayushman Bharat Health Account), an electronic repository of all your health related records. If you give permission to your doctor or hospital to view your Health ID (and the permission can be date based and exclude records you don’t want them to see), then the doctor/hospital will be able to see your health status and reports. The ABDM already has an Android app and has created APIs, which allow other existing EHRs to send and retrieve data from your Health ID with ease…hence those like us who are heavily invested into our own EHR systems can continue using them without disruption, as long as our developers can connect with the ABDM and access your Health ID.
ABDM if it succeeds, will be a huge game-changer, especially for a country like ours with limited resources. While we are still not able to offer public screening for something as simple as fasting plasma glucose (FPB) to our entire population above the age of 20 or 30 years, each time in the future an opportunistic FPB test is done, the result will be automatically available in your health ID record. Even if you don’t know the significance of your test results, eventually the ABDM will be able to apply simple electronic rules or artificial intelligence (AI) based solutions that will flag abnormal results (without invading privacy) and send you alerts on the phone app or via SMS, urging you to see your doctor or a health worker or health coach.
This will also allow better record keeping and improve our ability, at a national and state level, to better determine disease incidence and prevalence and obtain other disease and health data required to allocate resources and plan interventions, both preventive and therapeutic, at a population level.
ABDM will work only when more and more people start presenting their ABHA IDs when they go to doctors or diagnostic centres or hospitals and also when all stakeholders (doctors, hospitals, insurance companies, pharmacies, laboratories) start incorporating ABHA into their software.
I believe each one of us should get our ABHA / Health ID at the earliest. It is simple and takes around 5 minutes on the ABDM site. If you’ve been vaccinated after May/June 2021, it is likely that you already have a Health ID number on your vaccination certificate, in which case all you have to do is to go onto the site, reconfirm and claim a name e.g. abcxyz@abdm.
In summary, the Health ID / ABHA, by giving us the means to maintain our records without the headache of remembering to upload them ourselves and by alerting us to potential situations that need remedy and eventually giving us more ammunition to monitor our health ourselves will help us in our atmasvasth quest towards a longer healthspan and lifespan. It may take a few years, but when it finally reaches critical mass, it will become a big game-changer for everyone…you, the treating doctors, hospitals and the health authorities.
Views expressed above are the author’s own.
END OF ARTICLE