Balsari Satchit, Fortenko Alexander, Blaya Joaquín A, Gropper Adrian, Jayaram Malavika, Matthan Rahul, Sahasranam Ram, Shankar Mark, Sarbadhikari Suptendra N, Bierer Barbara E, Mandl Kenneth D, Mehendale Sanjay, Khanna Tarun
Beth Israel Deaconess Medical Center, Harvard Medical School, Department of Emergency Medicine, Boston, MA, United States.
Harvard FXB Center for Health and Human Rights, Boston, MA, United States.
J Med Internet Res. 2018 Jul 13;20(7):e10725. doi: 10.2196/10725.
In February 2018, the Government of India announced a massive public health insurance scheme extending coverage to 500 million citizens, in effect making it the world's largest insurance program. To meet this target, the government will rely on technology to effectively scale services, monitor quality, and ensure accountability. While India has seen great strides in informational technology development and outsourcing, cellular phone penetration, cloud computing, and financial technology, the digital health ecosystem is in its nascent stages and has been waiting for a catalyst to seed the system. This National Health Protection Scheme is expected to provide just this impetus for widespread adoption. However, health data in India are mostly not digitized. In the few instances that they are, the data are not standardized, not interoperable, and not readily accessible to clinicians, researchers, or policymakers. While such barriers to easy health information exchange are hardly unique to India, the greenfield nature of India's digital health infrastructure presents an excellent opportunity to avoid the pitfalls of complex, restrictive, digital health systems that have evolved elsewhere. We propose here a federated, patient-centric, application programming interface (API)-enabled health information ecosystem that leverages India's near-universal mobile phone penetration, universal availability of unique ID systems, and evolving privacy and data protection laws. It builds on global best practices and promotes the adoption of human-centered design principles, data minimization, and open standard APIs. The recommendations are the result of 18 months of deliberations with multiple stakeholders in India and the United States, including from academia, industry, and government.
2018年2月，印度政府宣布了一项大规模公共医疗保险计划，将覆盖范围扩大至5亿公民，这实际上使其成为全球最大的保险项目。为实现这一目标，政府将依靠技术来有效扩大服务规模、监测质量并确保问责制。尽管印度在信息技术发展、外包、手机普及率、云计算和金融科技方面取得了巨大进展，但数字健康生态系统仍处于起步阶段，一直在等待一个催化剂来启动该系统。这项国家健康保护计划预计将为其广泛采用提供这一推动力。然而，印度的健康数据大多未被数字化。在少数已数字化的情况下，数据也未标准化、不可互操作，临床医生、研究人员或政策制定者也无法轻易获取。虽然这种健康信息交换的障碍并非印度所独有，但印度数字健康基础设施的新建性质提供了一个绝佳机会，可避免其他地方已发展起来的复杂、受限的数字健康系统所带来的陷阱。我们在此提出一个以患者为中心、启用联合应用程序编程接口（API）的健康信息生态系统，该系统利用印度近乎普及的手机普及率、唯一身份识别系统的普遍可用性以及不断发展的隐私和数据保护法律。它基于全球最佳实践，促进以人为本的设计原则、数据最小化和开放标准API的采用。这些建议是与印度和美国的多个利益相关者进行18个月审议的结果，这些利益相关者包括学术界、行业和政府。
