In today’s Finshots, we discuss the how's and the why's of the Ayushman Bharat Health Account (ABHA).

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The Story

Do you know what’s the most annoying thing about paper records? They go missing. And it’s hard to keep track. And they’re extremely fragile unless you’re meticulous. The issue becomes all the more pertinent when you consider medical records.

Imagine you’re trying to switch doctors and the new medical practitioner wants to access your past medical history. If you can’t find the file, you’ll have to go over your medical history orally and perhaps even commit to a few diagnostic tests before you can start making headway with this new doctor.

If you’re in an emergency, things could get a lot worse. If your medical records aren’t immediately accessible, the whole issue could turn into a matter of life or death.

So what do you do?

Well, you take a look at the Ayushman Bharat Digital Mission (ABDM).

The idea here is to have a system in place so that individuals can access their digitized health records anyplace anytime. How would it work?

Well, first you register and get yourself an Ayushman Bharat Health Account (ABHA) with a unique 14-digit identification number or an ABHA ID.

On the other end, hospitals and doctors will also be expected to enrol on the Health Facility Registry (HFR) and the Health Professionals Registry (HPR).

Finally, the ABHA ecosystem will then bring all of these components together. You will be able to upload your health records digitally at the click of a button. And doctors, pharmacists and diagnostic service providers will also be able to access your medical history with ease if you give them your health ID number and offer explicit consent.

Now, this may look eerily similar to what other platforms like Apollo, 1mg, NetMeds have already been doing. They digitize prescriptions, test results and other items for you to access them at your convenience.

However, there’s one key difference. It’s not a centralized system. Each platform has its own rules, systems, and standards. Also, you can’t just upload all your records in one place.

With the government’s central health data repository, you only have to do it once. And hospitals, clinics and insurers — both public and private will be able to access them without you having to remember an infinite number of health account usernames and passwords.

Also, policymakers can use it to understand the healthcare system better both geographically and demographically. And researchers could use the aggregate data to study how health and disease evolve in this country. Now obviously there is a long way to go before the system is fully robust.

Getting every laboratory,  hospital, and clinic in this country to buy into the idea is a gargantuan task. And it’s not easy to achieve interoperability. There’s also the fact that very few people know about ABHA in the first place. Sure, we’ve generated nearly 240 million health ID’s and this may convince you that adoption has been seamless. But the truth is, a good chunk of the 240 million people probably don’t even know that they have a health ID.

And the reason? Well, there are two big reasons. One is the Ayushman Bharat Pradhan Mantri-Jan Arogya Yojana (AB-PMJAY), a free health insurance meant for the poor and the marginalized. Reports indicate that every beneficiary with an Aadhar card is assigned a unique ID at the back end. Obviously, this is done with consent. But there’s a decent chance that most people don’t fully understand what they’re consenting to.

Also, if you registered on the CoWin platform (for vaccinations) using Aadhar, chances are you probably also have a health ID. So yeah, while the numbers may lull you into thinking everybody has taken to this scheme, a good chunk of the 240 million people may not even fully understand the benefits of ABHA.

Finally, there is the privacy issue.

A Mint report quotes an official as saying “Data privacy has emerged as a concern particularly in the healthcare sector. The digitization of health records has led to an increased risk of data breaches and cyber-attacks.

…We are working to use anonymization techniques to remove personal identifying information before using the health data for public health research, policy making, disease surveillance etc. Anonymization of data will ensure that the privacy of the individual is protected.”

The flip side is that, for now, ABHA is a consent-based system. You can choose to deactivate your account or even opt out of the ecosystem completely by deleting your data and the digital health account.

But if the government buckled down on safety and privacy concerns, and educated Indians about the seeming benefits, this could be a game-changer no?

What do you think?

Until then...

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