Skip to main content

Unified Health Interface

Introduction​

On 27th May, 2021, a press release from the Prime Minister’s Office mentioned the impending roll-out of the Unified Health Interface (UHI) and characterised its purpose and functioning within the National Digital Health Mission as follows:

“This interface shall enable public and private solutions and apps to plug in and be a part of National Digital Health Ecosystem. It will allow users to search, book and avail necessary healthcare services such as tele-consultations or laboratory tests. The system will ensure that only verified healthcare providers join the ecosystem. This is likely to unleash a digital health tech revolution with innovations and various services for citizens. In such a manner, healthcare infrastructure and human resources can also be utilised in a more efficient manner across the nation.” //49

On 23rd June, 2021, the NDHM released the consultation paper on the Unified Health Interface (UHI). //48 The UHI will be the main foundation for the NDHM, and is envisioned to “expand interoperability of health services in India through open protocols”.//48

//48

Consultation paper details​

The Paper envisioned UHI as “an open protocol for various digital health services” //48 where the UHI open network will comprise two aspects: End User Applications (EUAs) and participating Health Service Provider (HSP) applications. EUAs are the applications that the users will access and can range from mobile apps to virtual assistants using different languages. The HSP applications will be used by health service providers to offer digital health services to users, where these services can include appointment bookings at hospitals / clinics, tele-consultation bookings, checking available critical care beds and nearby pharmacies, ambulance bookings, etc.

The stakeholders mentioned in Chapter 3 of the document include end-users/patients, health service providers (HSPs), and technology service providers. The objectives of the UHI intend that every health service provider gets the opportunity to have their services fairly discovered, only genuine and verified doctors and HSPs participate in the network, financial transactions be transparent and secure for everyone, a feedback system be created, and that there be interoperability of health services, HSPs, and related health data. With an open API network, the UHI allows the application developers to “choose any technology for the development of EUA and HSP applications that can become part of the UHI Network.” //48

In Section 3.7, the Paper lays out the future scenario for how UHI will re-think and re-develop digital health services in comparison with the current scenarios. For example, in the present scenario, “Chronic patients who require regular care, reminders and review of their medical condition spend an outsized amount of time attending to their chronic condition,” but the UHI network aims to change this by doing the following: “Patients can sign up with Health Bots that will look at their medical history, send reminders, provide advice based on their trends and support doctors in managing chronic care.”

ChapterTitle
1Introduction and Background
2Creating an Open Network for Digital Health Services
3Creating an Open Network for Services in NDHM
4Ecosystem Adoption
5Unified Health Interface in Depth
6UHI Development, Governance and Management

Criticisms​

The responses to the Consultation Paper critiqued it for key issues such as the need for more diverse feedback, the risk of market capture by the private sector, the risk of digital exclusion, financial exploitation and service pricing, and the need for public digital infrastructure. //47

  1. Lack of diverse feedback

    The UHI framework was critiqued for not having public health groups and civil society as stakeholders, neglecting their entrenched and informative position on ground for better implementation of the UHI.

  2. Risk of private sector capture

    The possibility of market dominance by existing healthcare apps can be seen as giving them an unfair advantage, nullifying the “fair discoverability” objective.//48 Using the private sector to develop the software for the UHI gateway may result in increased costs for citizens. This will further exacerbate the ability of these players to exploit users through the proposed pricing scheme, due to exorbitant healthcare service costs.

  3. Risk of digital exclusion

    Just like the rest of the NDHM, the low internet penetration and digital literacy rates in India have caused experts to believe that there is a lack of digital infrastructural preparation, for which digital literacy schemes and appropriate training processes are needed.

NDHE (National Digital Health Ecosystem) + National Digital Health Blueprint

  • Personal Health Records
  • DigiDoctor
  • Health Facility Registry

[Use Drishti link here: https://www.drishtiias.com/daily-updates/daily-news-analysis/national-digital-health-mission]

  1. https://pib.gov.in/PressReleasePage.aspx?PRID=1646045
  2. https://ndhm.gov.in/
  3. https://nha.gov.in/NHA
  4. https://nha.gov.in/NHA
  5. https://www.livemint.com/news/india/pm-modi-launches-national-digital-health-mission-11597467562654.html
  6. https://www.hindustantimes.com/india-news/health-ministry-approves-data-management-policy-to-digitise-healthcare-ecosystem/story-iDznpSynCwyo1nRt8Qo3zO.html
  7. https://abdm.gov.in/assets/uploads/consultation_papersDocs/Draft_HDM_Policy_April2022.pdf
  8. https://egazette.nic.in/WriteReadData/2021/224099.pdf
  9. https://internetfreedom.in/health-id-rules-explainer/
  10. https://drive.google.com/file/d/1giRHy6hNYwDenVaCQPG7xQ5AMH1txQ/view
  11. https://www.newindianexpress.com/nation/2020/aug/29/digital-health-mission-over-55000-ids-created-2189757.html
  12. https://drive.google.com/file/d/1Yt6O9tN2XzencHecXCgdH5FGTb4Wat15/view
  13. https://internetfreedom.in/second-times-not-the-charm-health-data-management-policy-misses-the-mark-again/
  14. https://www.healthit.gov/topic/patient-consent-electronic-health-information-exchange
  15. https://health.economictimes.indiatimes.com/news/health-it/national-digital-health-mission-rolled-out-on-pilot-mode-in-6-union-territories/77567210
  16. Sharma et al (2016). Quality of Health Management Information System for Maternal & Child Health Care in Haryana State, India. PLoS ONE 11(2): e0148449, pp. 7-10.
  17. https://datacommons.org/place/country/IND?utm_medium=explore&mprop=count&popt=Person&cpv=isInternetUser%2CTrue&hl=en
  18. Press Trust of India (Dec. 2020). Digital literacy remains a concern as most Indian women have never used the internet. Economic Times. Available at: https://economictimes.indiatimes.com/magazines/panache/digital-literacy-remains-a-concern-as-most-indian-women-have-never-used-the-internet/articleshow/79736857.cms?utm_source=contentofinterest&utm_medium=text&utm_campaign=cppst
  19. https://www.thequint.com/voices/opinion/in-pm-narendra-modi-govts-unique-health-id-push-consent-and-privacy-are-missing
  20. Dogra, Sarthak (May, 2021). Took Covid vaccine using Aadhaar? Your National Health ID has been created without your permission. India Today. Available at: https://www.indiatoday.in/technology/features/story/took-covid-vaccine-using-aadhaar-your-national-health-id-has-been-created-without-your-permission-1806470-2021-05-24
  21. Data masking or controlled access provides a means for patients to control disclosure of select information in EHRs. See, McGuire, A. et al. (2008). Confidentiality, Privacy, and Security of Genetic and Genomic Test Information in Electronic Health Records: Points to Consider. Genet Med 10, pp. 495–499.
  22. See, the National Digital Health Mission: Personal Data Processing Model Consent Form. Available at: https://ndhm.gov.in/documents/hdmpolicy/consentform
  23. https://www.drishtiias.com/daily-updates/daily-news-analysis/report-on-literacy-rate
  24. https://www.ideasforindia.in/topics/governance/the-digital-dream-upskilling-india-for-the-future.html#:~:text=Digital%20literacy%20levels%20in%20India&text=Based%20on%20the%20above%20definition,in%20India%20are%20digitally%20literate.
  25. https://www.statista.com/statistics/1232343/internet-literacy-index-by-category-india/
  26. Scroll Staff (September 6th, 2020). New health data policy may be misused for surveillance: Chhattisgarh minister writes to Vardhan. Scroll.in. Available at: https://scroll.in/latest/972361/new-health-data-policy-may-be-misused-for-surveillance-chhattisgarh-minister-writes-to-vardhan
  27. Rohin working paper
  28. https://uclouvain.be/en/discover/news/anonymising-personal-data-not-enough-to-protect-privacy-shows-uclouvain-s-new-study.html
  29. National Digital Health Mission. DigiDoctor FAQ. Available at: https://ndhm.gov.in/home/digidoctor_faq
  30. National Digital Health Mission. Health Facility Registry FAQ. Available at: https://ndhm.gov.in/home/health_facility_registry_faq
  31. https://main.sci.gov.in/supremecourt/2012/35071/35071_2012_Judgement_26-Sep-2018.pdf
  32. https://qz.com/india/1351263/supreme-court-verdict-how-indias-aadhaar-id-became-mandatory/
  33. https://inc42.com/buzz/aadhaar-linked-digital-health-id-pilot-in-indias-covid-vaccine-drive/
  34. See, Pati, Ipsita (Apr. 2021), _Aadhaar rules for hospital beds leaves many stumped. _Times of India. Available at: https://timesofindia.indiatimes.com/city/gurgaon/aadhaar-rule-for-hospital-beds-leaves-many-stumped/arti
  35. https://internetfreedom.in/joint-statement-ensure-equitable-access-to-covid-vaccines/
  36. https://internetfreedom.in/delhi-high-court-issues-directions-on-suggestions-to-improve-the-cowin-platform/
  37. Kharb, Sudhir Kumar (Aug. 2020). ‘Due to Ambiguity Over Valid ID Proof, I Was Denied COVID-19 Test’. The Quint. Available at: https://www.thequint.com/my-report/denied-covid-19-test-due-to-aadhaar-id-proof#read-more
  38. Dogra, Sarthak (May, 2021). Took Covid vaccine using Aadhaar? Your National Health ID has been created without your permission. India Today. Available at: https://www.indiatoday.in/technology/features/story/took-covid-vaccine-using-aadhaar-your-national-health-id-has-been-created-without-your-permission-1806470-2021-05-24
  39. https://www.thequint.com/tech-and-auto/govt-created-uhid-without-consent-say-vaccinated-indians#read-more
  40. Els, S. and Mark, L. (Eds.). (2008). _D4. 11: eHealth identity management in several types of welfare states in Europe. _Future of Identity in the Information Society. Available at: https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.522.6177&rep=rep1&type=pdf
  41. Rouillé -Mirza, S., Wright, J., ‘Comparative Study on the Implementation and Effect of the Directive 95/46/EC on Data Protection in Europe: General Standards’, in Beyleveld, D. et al. (eds.), The Data Protection Directive and Medical Research across Europe, PRIVIREAL, Ashgate Publ. Limited, UK, 2004a, 125-187.
  42. Mathew, Ashiln (June 5th, 2021); Modi government issuing national health ID stealthily without informed consent; The National Herald; Available at: https://www.nationalheraldindia.com/india/modi-government-issuing-national-health-id-stealthily-without-informed-consent
  43. Dogra, Sarthak (2021); Took Covid vaccine using Aadhaar? Your National Health ID has been created without your permission; India Today. Available at: https://www.indiatoday.in/technology/features/story/took-covid-vaccine-using-aadhaar-your-national-health-id-has-been-created-without-your-permission-1806470-2021-05-24
  44. Mithun, M.K. (Feb. 2021). Privacy concerns loom as Union govt begins Health ID enrolment in Puducherry. The News Minute. Available at: https://www.thenewsminute.com/article/privacy-concerns-loom-union-govt-begins-health-id-enrolment-puducherry-142987
  45. https://drive.google.com/file/d/1lDG86905959TyUpEa8P2A53g9AnLHoR8/view
  46. https://internetfreedom.in/ndhm-data-policy-delhi-hc/
  47. https://internetfreedom.in/read-our-submission-on-the-unified-health-interface-consultation-paper/
  48. https://abdm.gov.in:8081/uploads/UHI_Consultation_Paper_60a9201c1d.pdf
  49. https://pib.gov.in/PressReleasePage.aspx?PRID=1722132
  50. https://drive.google.com/file/d/1RdMEd1WBh22SqfptR7_N210bnFfFkA5v/view
  51. https://legislative.gov.in/documents/pre-legislative-consultation-policy
  52. https://ehealth.eletsonline.com/2020/09/nha-extends-the-consultation-date-of-draft-health-data-management-policy/
  53. https://internetfreedom.in/ndhm-data-policy-representation/ denied-covid-19-test-due-to-aadhaar-id-proof#read-more)
  54. Dogra, Sarthak (May, 2021). Took Covid vaccine using Aadhaar? Your National Health ID has been created without your permission. India Today. Available at: https://www.indiatoday.in/technology/features/story/took-covid-vaccine-using-aadhaar-your-national-health-id-has-been-created-without-your-permission-1806470-2021-05-24
  55. https://www.thequint.com/tech-and-auto/govt-created-uhid-without-consent-say-vaccinated-indians#read-more
  56. Els, S. and Mark, L. (Eds.). (2008). _D4. 11: eHealth identity management in several types of welfare states in Europe. _Future of Identity in the Information Society. Available at: https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.522.6177&rep=rep1&type=pdf
  57. Rouillé -Mirza, S., Wright, J., ‘Comparative Study on the Implementation and Effect of the Directive 95/46/EC on Data Protection in Europe: General Standards’, in Beyleveld, D. et al. (eds.), The Data Protection Directive and Medical Research across Europe, PRIVIREAL, Ashgate Publ. Limited, UK, 2004a, 125-187.
  58. Mathew, Ashiln (June 5th, 2021); Modi government issuing national health ID stealthily without informed consent; The National Herald; Available at: https://www.nationalheraldindia.com/india/modi-government-issuing-national-health-id-stealthily-without-informed-consent
  59. Dogra, Sarthak (2021); Took Covid vaccine using Aadhaar? Your National Health ID has been created without your permission; India Today. Available at: https://www.indiatoday.in/technology/features/story/took-covid-vaccine-using-aadhaar-your-national-health-id-has-been-created-without-your-permission-1806470-2021-05-24
  60. Mithun, M.K. (Feb. 2021). Privacy concerns loom as Union govt begins Health ID enrolment in Puducherry. The News Minute. Available at: https://www.thenewsminute.com/article/privacy-concerns-loom-union-govt-begins-health-id-enrolment-puducherry-142987
  61. https://drive.google.com/file/d/1lDG86905959TyUpEa8P2A53g9AnLHoR8/view
  62. https://internetfreedom.in/ndhm-data-policy-delhi-hc/
  63. https://internetfreedom.in/read-our-submission-on-the-unified-health-interface-consultation-paper/
  64. https://abdm.gov.in:8081/uploads/UHI_Consultation_Paper_60a9201c1d.pdf
  65. https://pib.gov.in/PressReleasePage.aspx?PRID=1722132
  66. https://drive.google.com/file/d/1RdMEd1WBh22SqfptR7_N210bnFfFkA5v/view
  67. https://legislative.gov.in/documents/pre-legislative-consultation-policy
  68. https://ehealth.eletsonline.com/2020/09/nha-extends-the-consultation-date-of-draft-health-data-management-policy/
  69. https://internetfreedom.in/ndhm-data-policy-representation/