eSanjeevani is first of its kind of a telemedicine service that is meeting the remote healthcare needs of the country from a single instance on the cloud. eSanjeevani has not only revolutionised primary healthcare in the country but it has also proved to be a life-saving modality for it is supporting specialised networks such as Tele-Stroke Management Network that connects secondary hospitals (as spokes) to a speciality (neurosciences) hospital as the hub. A national-scale telemedicine network on eSanjeevani can be configured and rolled out within a few hours. eSanjeevani conforms to the EHR Guidelines of MoHFW & also complies with international standards namely, SNOMED CT Nomenclature and DICOM.

Without having to move out of home, eSanjeevani facilitates health services (remotely) within 15 minutes to patients in the confines of their homes. It also enables the delivery of medicines too at home. eSanjeevani has stepped up quality & access to health services significantly.

• Since its rollout the National Telemedicine Service is continuously evolving. Since healthcare delivery systems of all 36 provinces are independent entities, they have their own processes and workflows some of these provincial governments keep asking for customisations by suggesting innovative workflows. Accordingly, innovative processes and flows are being incorporated in eSanjeevani.
• In order to empower doctors and patients, more and more integrations have been done with third-party healthcare IT applications. In some provinces, end-to-end processes have been computerised where in medicines are also being delivered at home. In a few provinces, special provisions for sending eprescriptions as SMS have been made in eSanjeevani for rural patients who do not own smartphone.

The success of eSanjeevani has been due to synergy amongst multiple stakeholders. The health ministry conceptualised it, the Centre for Development & Advanced Computing, an entity (of the IT Ministry) into cutting edge IT research, designed, developed, deployed, operationalised & managed the system. Authorities in all the provinces across India ensured uptake of eSanjeevani amongst all users was widespread and quick. Civil Society Organisations extended all support in the field to plug the gaps.

• Citizens, residing in rural & isolated areas now are able to get quality health services without having to move out of their villages
• Doctors & Healthcare workers are now a part of the digital health ecosystem
• Health Admns. & Policy Makers are also using innovation for monitoring as well as for surveillance
• Companies are now integrating their diagnostic devices with eSanjeevani to reach out to rural health centres
• Civil Society Organisations are gaining experience

eSanjeevani is supposedly the country's first public-facing digital health intervention. eSanjeevani has made the domain of digital health familiar and popular amongst patients as well as practitioners and health administrators. As per independent research conducted by a civil organisation, every consultation on eSanjeevani leads to a saving of up to USD 25 and also saves a journey of up to 18 km.

The innovation has so far served over 62 million patients, it has also enabled digital health services in over 102,000 health and wellness centres (primary healthcare). Over 85% of beneficiaries so far are from rural India and over 50% of the beneficiaries are women. Medical specialists Over 40 medical specialities can be consulted remotely.

eSanjeevani has set off a trend of digitalisation of health information, which is. beginning to aid policymakers to come up with effective and timely health policies.

Healthcare systems have been grappling with numerous challenges like scarcity of human resources & shortage of hospitals. Also, the Indian healthcare system is facing another serious challenge of skewed distribution of health services towards urban areas when over two-thirds of the Indian populace resides in rural areas. Accordingly, eSanjeevani has been able to address the following challenges:

• Since eSanjeevani was to be used countrywide, the workflows & processes were designed in a way that they were applicable all over.
• The Health & Wellness Centres were to be readied before initiating the deployment, & the users too had to be trained on using eSanjeevani. Visits were scheduled & rounds of training were conducted jointly with respective State Health Depts. to prepare non-IT savvy paramedics to use eSanjeevani.
• The eSanjeevani team had not handled any deployment of national-scale, hence the team had to quickly champion various aspects like scalability & Cloud hosting.

Although the innovation has been successfully operationalised and has been rapidly and widely adopted by users on both sides (doctors and patients/public). To ensure success the following are the necessities:

• Putting in place the policies, rules and guidelines by the government
• Financial resources for human and infra resources including IEC activities
• Strong leadership in the States/Provinces to implement the reforms/innovation
• IT infra including optimum internet connectivity
• Capacity building of the workforce (providers)
• Sensitising beneficiaries (the public)
• Support, feedback and grievance redressal mechanism

eSanjeevani - National Telemedicine Service architecture is highly modular (this facilitates customisations), scalable as it is hosted on Cloud (this encourages quick deployment) & the user interface is intuitive and the processes designed are citizen friendly (this ensures widespread adoption). These aspects not only make application favourable for population-scale use but highly replicable as well. The innovation has already been replicated & a portal for India's defence personnel & their dependants. The Indian Defence Ministry has set up Services eHealth Assistance & Teleconsultation, SeHATOPD is powered by eSanjeevani technology. Similarly, the innovation has been replicated for National AIDS Control Organisation (NACO) & National Telemedicine Network for PLHIVs has been set up & launched www.ehivcare.com. The innovation (eSanjeevani) has been offered as a part of India Stack Global for other countries to adopt.

The process of development, deployment and operationalisation of this mammoth innovation gave us enriching experience and learnings. These include:

• Thinking ahead and in advance put in place plans about addressing scenarios which could act as speed-breakers
• Aspects related to keeping the architecture modular and open enough to make changes on the fly
• Since eSanjeevani has been a pioneering effort, it was immensely important to ensure non-stop handholding besides institutionalising feedback and support mechanism
• Recurring consultative sessions to learn about the experience of users and also encourage them to share suggestions that could empower users further.

eSanjeevani, is first of its kind of an innovation that has revolutionised the primary healthcare system in the country in rural areas and isolated communities. It has bridged the rural-urban digital health divide and is promoting digital health ecosystem in the country. Such is the impact of the innovation that it has initiated a chain reaction where in many other healthcare IT application those were operational at regional level are working towards scaling their capacities to match eSanjeevani’s mammoth scale and capacities which is the largest public facing innovation that is serving every citizen in India. In a way eSanjeevani is leading the Digital Health revolution in the country. Further, the innovation has enabled provision of health services remotely to citizens round the clock and even on holidays i.e. 24x7 – 365 days.