ABDM: Understanding Healthcare in the India Stack

Welcome to back to Tech Scrubs!

This piece has been in sitting in our drafts for a while since we wanted to perfect it for you. There are few resources out there that can explain the Ayushman Bharat Digital Mission (ABDM) and even fewer that do it well. So we tasked ourselves with it and brought it straight from the source (a 4y NHA veteran and co-author of this publication).

If you've somehow managed to dodge the flurry of headlines and LinkedIn posts about ABDM over the past year and a half - good job. But, if you're like most of us, you've noticed this particular four-letter acronym creeping into your peripheral vision. That's because India is in the midst of another grand digital experiment - just this time, its in healthcare.

Yes, I know ABDM... But actually, what is it again? 

For the uninitiated, ABDM - the Ayushman Bharat Digital Mission - is an audacious attempt to reimagine how healthcare information flows across India's massively fragmented ecosystem (a problem the Western world is severely struggling with now).

Launched in September 2021, its a blueprint to create a nationwide digital health infrastructure. Think of it as the healthcare equivalent of what UPI did for payments or what ONDC is attempting to do for e-commerce.

Why ABDM Matters?

The problem ABDM tries to solve is painfully familiar to anyone who's navigated Indian healthcare. Let me paint you a picture:

Imagine a caregiver with a family member suffering from diabetes. Over time, this involves:

• Multiple diagnostic tests at different labs

• Prescriptions from various doctors

• Hospital visits for complications

• Specialist consultations for related conditions like diabetic foot or heart disease

Today, all this information exists in fragments - some in physical files, some in hospital systems, some in lab reports, some in insurance claims. When the patient visits a new doctor, the entire medical history needs to be pieced together from scratch.

ABDM aims to stitch this fragmented picture into a seamless longitudinal health record, accessible at the click of a button (with the patient's consent, of course).

And the progress so far has been impressive:

• 4.65 lakh healthcare professionals registered

• 3.28 lakh health facilities onboarded

• 66 crore ABHA IDs created (covering ~45% of India's population)

• 41 crore digital health records linked to these IDs

• ₹37 crore in incentives distributed to 8,759 health facilities

  • Under the digital health incentive scheme, each doctor gets Rs. 20 / digital health record created

Also, check out this very cool dashboard from them. 

Adapting the UPI Playbook to Healthcare

Digitial Public Infra plays allow for public infra to foster private innovation. And we can see the same in ABDM: 

1. Government builds the core infrastructure and standards

2. Private players innovate on top of it, creating user-friendly experiences

3. Network effects kick in as more users and providers join

We've already seen 200+ partners onboard to the ABDM ecosystem, with consumer health apps like EkaCare, DRiefcase, Plus91, NIC E-sushrut, and Bajaj Finserv Health emerging as early adopters. These platforms are helping individuals create ABHA IDs, link their health records, and navigate the digital health landscape.

States like Uttar Pradesh, Karnataka, Maharashtra, and Gujarat are leading adoption rates, primarily enabled by these private ecosystem players. One particularly successful initiative is "Scan and Share" - which has already issued 4.5 crore+ tokens for OPD registration at government facilities like AIIMS Delhi, Bhubaneswar, and Bhopal.

Roadblocks Opportunity 

1. Infrastructure gaps

Tier 2 and 3 cities still struggle with basic digital infrastructure. However, the rise of mobile-first solutions offers a potential workaround. Just as India leapfrogged from minimal banking to UPI (skipping the credit card era), healthcare might leapfrog from paper records directly to mobile-based digital health. Lots of potential for founders who can build with low connectivity / multilingual interfaces. 

2. Manpower constraints

Small clinics and busy practices often lack the staff to handle digitization. This is where AI-assisted workflows and self-serve options for patients can be game-changers. Imagine: 

• Digital check-ins

• Self-assessment questionnaires before you even walk into the waiting room

• Voice-to-EMR tools that capture doctor notes in real-time

• Workflow automation that turns 3-person administrative teams into 1-person operations

3. Data security fears

Large healthcare providers worry about data security, but ABDM's architecture specifically addresses this concern through on-device, consent-based sharing. Opportunity areas include:

• Patient-friendly consent management interfaces

• Granular access controls beyond ABDM's baseline

• Audit trails that make data usage transparent

• Security certifications and compliance packages for healthcare providers (like HIPAA in the US / GDPR in the UK)

The startups that turn security from a concern into a selling point will find eager customers among privacy-conscious providers and patients.

4. Revenue protection instincts

For hospital chains, the worry of patients moving out of their ecosystem is a significant barrier. However, pros of National Health Claims Exchange (NHCX) outweigh the cons with benefits like claims management and reducing operational overheads. IRDAI in collaboration with NHA, have already launched NHCX with almost all major health insurers and TPAs already a part of the ecosystem. To address hospital chains’ worry, we see potential for software to be built around: 

• Improving patient engagement and retention by building trust with a brand + strengthen provider relationships 

• Enhanced predictive analytics to identify at-risk patients

• Value-added services that leverage portable health records

• Cross-provider coordination tools that make hospitals central to care journeys

With NHCX already processing 350+ transactions just last month (enabled by provider platforms like IHX, Vitraya, and Claimbook), the economic benefits of embracing rather than resisting ABDM are clear. Startups that help providers turn seemingly potential threats into revenue opportunities will find themselves with a rapidly growing customer base.

The Power of Open-Source and Emerging TSPs

The development of the ABDM wrapper in collaboration with Google Research represents an interesting trend - making integration easier through open-source contributions. This democratizes access to ABDM's infrastructure, allowing smaller players to participate without massive technical investments.

However, healthcare organizations often lack the technical expertise to navigate this transition independently. This opens the door for a new category of Technology Service Providers (TSPs) specialized in ABDM integration.

These TSPs can handle the technical heavy lifting, similar to how specialized entities in ONDC have enabled businesses to join the digital commerce revolution. By acting as intermediaries, TSPs can accelerate ABDM adoption, similar to how specialised entities in the Open Network for Digital Commerce (ONDC) have enabled businesses to go digital. More such TSPs with better business models need to be onboarded to ABDM for wider adoption across a wide spectrum of healthcare facilities, which are today at the fence whether to invest time and contemplating effort vs reward for ABDM integration. 

From Sick to Preventive Care

While ABDM's current focus is on creating infrastructure for traditional healthcare, the real goldmine might be the expansion into preventive care.

Imagine if your fitness tracker or smartwatch could feed data directly into your ABHA, creating a comprehensive health profile that tracks not just your medical history but your daily wellness metrics over time. This kind of integration could shift the entire paradigm from treating illness to maintaining wellness.

Picture a consumer wearing an Ultrahuman ring or Apple Watch where activity metrics are uploaded (with consent) to their health locker, creating longitudinal health data alongside clinical records. This combined dataset could provide unprecedented insights into maintaining health rather than just treating disease.

Health and fitness companies are ideally positioned to drive this transformation, but they may need partnership with tech-savvy TSPs to prioritize ABDM integration. This collaboration could spawn models that not only capture data but educate consumers on how lifestyle choices impact long-term health.

Bottom Line: This Is Just the Beginning

As we stand at this inflection point in India's healthcare journey, it's worth remembering that transformative infrastructure projects rarely reveal their full impact immediately. When UPI launched in 2016, few predicted it would process 10 billion transactions monthly and become the envy of payment systems worldwide.

ABDM is not just a policy initiative; its what the ideal healthcare system looks like. Having been in this industry for the last 10+ years spent time across India, Singapore and the UK, I have just the right mix of practicality and optimism. “Revolutionising” India is within our grasp and coming closer to reality with each day. This isn't just about digitizing existing processes. It's about fundamentally reimagining how healthcare works in a country of 1.4 billion people. It's about building a system where a farmer in rural Maharashtra can access her complete medical history at a tertiary care center in Mumbai. Where a doctor in Kochi can instantly view test results ordered by a colleague in Kolkata. Where preventive care becomes the norm rather than the exception.

That’s a future worth shaping and we hope you are going to help mould it. 

If you're building in this space, particularly looking to build on top of ABDM, or if you're a healthcare provider looking to navigate this digital transition - we'd love to hear from you.

P.S. If you enjoyed this piece, please let us know! We’ve barely covered any ground on the potential of ABDM but thought this was enticing enough to get started :)