Unified Health Interface(UHI) and how it will revolutionize the Indian health sector!
5 years back I had thought that- it will be so convenient to access health services and health records digitally without any hassle. There are so many players in the health sector that it needs to be unified and all can be benefited from this. 5 years later Unified Health Interface or UHI is tackling this problem. The Indian government under NDHM ( National Digital Health Mission) is working on providing seamless digital healthcare facilities through tech solutions. In this article, I have discussed the main concepts behind the NDHM and UHI. Most of the writing is taken from the consultation paper on UHI published by NHA(National Health Authority).
Before Diving into UHI there are a few key concepts of NDHM that need to be understood, starting from the Core registries.
Core Registries managed by Government:
Health Id: To standardize the identification process for the users across the healthcare provider. Every patient who wishes to have their health records available digitally may avail of the facility to create a Health ID. Each Health ID will be linked to a personal health record address (PHR) and health data consent manager. The Health IDs can be presented in e-card format(s) and issued to patients who need them. The Health ID card will also include a QR code that can be scanned to enable seamless patient registration at health facilities.
Healthcare Professionals Registry: Master data for the information of healthcare workers including doctors, nurses, and paramedical staff.
Health Facility Registry: This will consist of one record and a unique identifier for each healthcare facility in the country — hospitals, clinics, diagnostic centers, pharmacies, etc, across all systems of medicine and covering both public and private health facilities.
These are the NDHM building blocks and enable sharing of interoperable health data with patient consent.
HIP ( Health Information Provider) is an entity that wishes to share data with the patient. Eg A hospital creating and sharing a health record with specified standards is a HIP.
HIU (Health Information User) An entity that seeks to access data with consent. HIUs can be another hospital/ clinic, a mobile application, an insurer, etc. They can get access to the health records of a patient with their consent.
These NDHM building blocks have enabled new foundational capabilities including:
- A Health ID for every resident who wishes to obtain their health records digitally.
- Registered Health facilities can link health records with Health IDs. This helps create a longitudinal Personal Health Record (PHR) for the individual, i.e., a medical record across multiple patient encounters in different health facilities.
- A consent mechanism to empower patients to access and share their PHR data. This mechanism is fully aligned with the Draft Personal Data Protection Bill of India.
- Standardization of the formatting of health records like diagnostic reports, discharge summaries, prescriptions, consultation notes, and immunization records to make them interoperable.
- Digital identity for every verified health professional and health facility that participates in NDHM.
Key Challenges
India lacks the standards and infrastructure for health data that enable the accelerated adoption of digital health services.
Discovery — Reliable and accurate search for hospital beds, drugs, and O2
Booking — Easy scheduling appointments for vaccination or treatment
Fulfillment — Teleconsultation with verified professionals
- Process Challenges: Most digital health service delivery (e.g., teleconsultation) processes are platform-centric and tied to the provider's choice of market solution
- Technical Challenges: Prevalence of paper documentation and lack of infrastructure to enable digital capture and sharing of health data prevents continuity of care
NDHM Architecture.
The below diagram shows the layers of NDHM. The second layer is UHI which will act as a gateway for real-world applications and will connect end-user applications with all services.
Now we have an overview of the NDHM, the last three layers of NDHM will be managed by the government for now and the end user application will interact only with UHI through open APIs. UHI will be based on the open network. Will look at what Open Network is now.
Open Networks
Open Networks are based on open protocols, a set of technical standards accessible to everyone. No particular entity owns it. Email is an example of an open network based on SMTP Simple mail transfer protocol. It allows anyone to send and receive emails from any clients. Eg a Gmail user can send an email to a yahoo mail user.
A simple Open network approach will be used for digital health services. Open networks and Open Protocols for digital health services would enable interoperable connections over a nationwide, decentralized, open, secure, and inclusive network. Enabling Open access across diverse health service providers and patients can drastically expand demand-supply ecosystems.
UHI ( Unified Health Interface ) as an open network
UHI is the second layer in NDHM architecture. It will be an open protocol for digital health services. UHI Network will be an open network of End User Applications (EUAs) and participating Health Service Providers (HSP) applications.
- End-user application (EUA) is any application chosen by the users/patients to access health services.
- Health Service Providers may be individual doctors, hospitals, labs, pharmacies, companies that aggregate health services, etc. They provide digital health services using Health Service Provider Applications (HSPA) that support UHI.
- Technology Service Providers (TSPs): The application developers can choose any technology to develop EUA and HSP applications that can become part of the UHI Network. Applications can be mobile apps, web applications, voice interfaces, wearables, or any other format or technology desired by the developer
UHI ensures that a digital health service can be delivered between any EUA with any HSP in this ecosystem. A similar example is UPI(Unified Payment Interface) where users can choose any application(Gpay, Phonepe, Paytm, etc) to make payments with any bank account.
UHI Architecture
Key building blocks:
- Registries: Like Health ID, Healthcare Professionals Registry (HPR), and Health Facility Registry (HFR) for identification and verification of entities.
- UHI Gateway: The UHI Gateway is the building block that implements the open protocols for various health services as part of the open network
- Health Information Exchange and Consent Manager (HIE-CM): The HIE-CM building block enables the exchange of interoperable health records between the patient and care providers.
An interoperable UHI protocol example for teleconsultation can be visualized as follows:
The above diagram shows the flow of users trying to access teleconsultation services by logging into any app of their choice. All the digital aspects will be managed by apps and UHI.
Conclusion
There is immense potential in UHI to help India leapfrog in how health services are delivered. The use cases of this are many. For eg Doctors can collaborate on challenging cases of some patients and they can access the health records of the patient with consent with just the click of a button, no paperwork no hassle. Patients can also view their overall health history through apps. Easy discoverability, booking, and service fulfillment. Surely this will revolutionize the health sector after its adoption.
Reference
NHA Webinar Presentation
Consultation Paper