In February, prodded by the National Health Authority (NHA), the Bihar government issued a tender asking for a digital upgrade of the state’s healthcare system. 

The project’s parameters, on paper, were perfect: a patient would be able to track their journey online as they moved through the system, and a data pipeline would flow from frontline workers to district hospitals and beyond. 

Seven months later, though, the initiative is struggling to take off. The Ken has learnt that the Rs 191-crore ($24 million) tender was surprisingly awarded, in part, to a consultancy firm that primarily handles construction and road projects. Since the announcement, a rival bidder has filed a complaint asking for an inquiry into the matter, even as Bihar officials delay the project further by not signing a ‘memorandum of understanding’ with the tender winners.

In a nutshell, the happenings in the eastern Indian state of Bihar, and similar developments in other states across the country, point to how India’s frenetic plan to digitise and drag its healthcare system into the 21st century is running into wall after wall.

The underlying blueprint for the grand project comes from a government programme called the Ayushman Bharat Digital Mission (ABDM)—a sprawling Rs 1,600-crore ($200.4 million) initiative that, as The Ken wrote  aims at being a “unified health system for every citizen and the central verifier of all truths in healthcare”.

The project is closely connected to Pradhan Mantri Jan Arogya Yojana (PM-JAY), a government scheme that looks to cover healthcare costs of 100 million poor families for up to Rs 5 lakh ($6,273). 

The ABDM’s premise is simple: every patient is given a unique health ID that allows them to move from one healthcare provider to another. They can fetch their health records on their phone, show them to a doctor and then store it in a digital locker. Once you get hospitals and doctors onboard, you’ve created the Holy Grail of digital health—an interoperable and integrated system.

The problem, however, is that a unique health ID is doomed to be a useless string of numbers unless every hospital and medical facility in the corner of India is equipped to interact and interface with this integrated system. 

And this can only happen when state governments start digitising patient health records and set up systems that work smoothly with others across the country. Over the last eight months, more than a few states have tripped up in getting this exercise underway, frustrating the consultants working back home at the NHA. 

Multiple people with knowledge of the matter, including consultants working with the ABDM, confirmed that state-level tenders floated in Indian union territory Jammu and Kashmir, the northern state of Uttarakhand, Bihar, and the capital Delhi have failed to take off smoothly.