Bahmni as Health Information Provider (ABDM/NDHM)

Project Overview

The Ayushman Bharat Digital Health Mission (ABDM) aims to develop the backbone necessary to support the integrated digital health infrastructure of the country. It will bridge the existing gap amongst different stakeholders of Healthcare ecosystem through digital highways. ABDM has laid out 3 milestones that facilities must incorporate in order to be certified by National Health Authority and integrate with the ABDM ecosystem. Bahmni would serve as a goto ABDM compliant Hospital Management System which facilities can adopt to integrate seamlessly with the ABDM ecosystem

Milestones and deadlines

The following image depicts the patient experience that can be leveraged after integration with the ABDM infrastructure.

Open

Patient experience under NDHM infrastructure

To leverage the above mentioned complete patient experience, ABDM recommends developing this experience in three milestones:

Scope

Milestone 1 : Health ID creation, capture and verification

1. Creation : As part of the requirement for milestone 1, the HIPs are expected to create health IDs for their patients. This can be done using several modes , with the help of mobile number, Aadhar number, biometrics and so on. In Bahmni, we are using the “modal popup” mode of creation, where the user is redirected to the ABDM site for health ID creation. If the need arises, and the ensure that the user stays on the same page, we can look at building our UI for creation of health ID.
   
   

2. Capture : The health ID of the patient can be captured using 3 different modes and Bahmni has successfully integrated all 3 of the modes. The different modes of capturing are :

   1. Patient verbally shares the ABHA address/number - Here the receptionist manually enters the ABHA number or address shared by the patient in the modal present in Bahmni and proceeds to verification

   2. HIP scanning the QR code - In this workflow, the HIP scans the QR code of the patient , which is found in the ABHA card , using the webcam. The demographic details of the patient are subsequently fetched from ABDM to the HIP

   3. Patient scans the QR code - Here, the patient scans the QR code of the HIP, which would be pasted in the counters using the PHR app. The patient subsequently receives a token number in the PHR app
      
      

3. Verification : In case the patient shares the health ID verbally, then the mobile number associated with the health ID or the mobile number associated with the Aadhar number (In case the health ID was created using aadhar) is used for verification. The patient receives an OTP on their registered mobile number which can be shared verbally with the receptionist for verification. In case of scanning of QR codes, the demographic mode of verification is used. Bahmni has not implemented Direct mode and Password mode of authentication yet.

Milestone 2 : Building Health Information Provider (HIP) services to share digital records via PHR apps

1. Creating a care context : In Bahmni, a care context is equivalent to a visit. ABDM leaves it upto the discretion of the HIPs how a care context should be defined. Previously, Bahmni used “visit type” as a care context, however moving forward, a single visit is one care context. Bahmni supports the following types of health reports:

   1. Prescription

   2. Diagnostic report

   3. OPD notes

   4. Discharge summary

   5. Immunization Record

2. Building HIP services: As part of the requirement, Bahmni is able to respond to discovery requests from consent manager, support patient initiated linking of old medical records, acknowledge Consent Manager requests for health data and save the consent artifact and facilitate flow of medical data against consent artifact as per specified format (FHIR, encrypted).

3. Send notification to patients when record is ready : Bahmni ensures that an SMS is sent to patients, irrespective of whether they have Health ID linked or not, once the record is ready to be shared. The SMS contains a deep link with ABHA Number (if available), HIP ID and with a trigger to ABHA Mobile Application.

Milestone 3 : Building Health Information User (HIU) capabilities to share patient’s longitudinal history with healthcare workers with consent

1. Create a consent request: The HIU should be able to create a consent request against a patient, irrespective of whether the patient was treated in the same facility or not. This consent request is posted to the patient’s ABHA mobile application. The HIU should honour the consent artifact , ie, the duration for which consent is active.

2. Integrate serviced to receive medical data : Bahmni has integrated services that allows Bahmni to receive medical data from facilities that have care contexts linked to the patient's ABHA Number.

3. Share medical data : Bahmni has the ability to parse & organize medical data to share with consulting doctor/technician on their respective systems. Bahmni also honours the consent artifacts, ie, in case the consent is revoked, denied, modified, then Bahmni treats it accordingly in the system. Therefore, at any given time, the patient has the ability to control their medical information.

Architecture diagram

Bahmni ABDM is

• Core Bahmni Product along with ABDM specific extensions (additional set of s/w components and subsystems) that augment Bahmni to become compliant for HIE-CM. Thoughtworks has developed and open sourced the extensions as MIT License.

• Bahmni went through the sandbox process successfully, having demonstrated functional flows and compatibility, and also passed through the WASA assessment.

The above architecture shows the integration of Bahmni as a Health Information Provider and Health Information User with the NDHM ecosystem. The following components exist:

1. HIP Service + ABDM FHIR Lib + ABDM UI Extension: Written in C#, React.JS (with an HIP Backend module written in Java as a Bahmni module). The UI Extension is used for HealthID pop-up/verification before pulling it into Bahmni. The HIP service uses a Postgres DB for data storage.

2. HIU UI + HIU Service: Written in Java + JS, to provide clinicians with a UI for viewing users past health records (after consent). The HIU service uses a Postgres DB for data storage.

Code Repository

• Github Repo containing all the modules / code: BahmniIndiaDistro

• Docker version of Bahmni with ABDM for local / server installation: https://github.com/BahmniIndiaDistro/bahmni-india-package

• Terraform/Helm charts for AWS Kubernetes Deployment: https://github.com/BahmniIndiaDistro/helm-umbrella-chart

• Dev Setup Steps

Demo Video of Bahmni with ABDM Workflows

https://www.youtube.com/watch?v=WO5YKM0u1xA

ABDM Training Conducted by Thoughtworks team

Please see this page: ABDM and Bahmni (Training)

FAQs

FAQs on ABDM and Bahmni compliance

Reference materials

• ABDM Sandbox (for testing purposes)

• ABDM Sandbox (Bahmni page)

• ABDM On Github (NHA repository with diagrams)

• ABDM Ecosystem

• https://medblocks.org/abdm-for-the-ap-government-a-honest-review/

• ABDM Policy Guidelines for HIP, HRP, HIU and Health Lockers

• ABDM Checklist for certified products like Bahmni

• ABDM HIP use-cases

• ABDM HIU use-cases

• ABDM Swagger APIs collection