Governance

Objective

Specifications are fundamental to the success of the envisioned claims network. Specifications need to create consensus amongst a broad base of health system stakeholders to ensure that they can act as this common foundation. This document proposes a governance approach for the open specifications in line with key design principles outlined in the National Digital Health Blueprint and further contextualized for HCX specifications.

Proposed Governance Approach and Process for Specifications at Swasth during the pilot period

As evident, creating functional specifications will require a robust process and deep collaboration between multiple stakeholders. The process must:

1. Enable the delivery of universal health coverage (UHC) in India

2. Drive healthcare outcomes and inclusion as well as patient safety and privacy

3. Foster consensus*

4. Ensure content is fit for purpose*

5. Ensure content is implementable*

6. Establish an appropriate implementer community*

7. Ensure ongoing maintenance of the standards*

(* Points 3 to 7 have been adopted from the must-have criteria followed by HL7)

Hence, the development and maintenance of standards must follow an open and consultative process with widely inclusive, committed groups that can bring together necessary skills, viewpoints, and networks.

Swasth proposes to maintain and enhance specifications using an inclusive, open, and consultative process. The broad outline of the process would be:

1. Swasth will form a governance council for specifications with representation from across the healthcare ecosystem (insurance, TPA, patient groups, provider representatives, small provider associations, academic institutions/experts in the area, the regulator, and relevant public bodies)

2. The governance council will facilitate the formation of topic-specific working groups

3. Working groups will create clear criteria for the evaluation of a proposal

4. Ideas for new specifications/enhancement is proposed by one of the group members

5. The working group evaluates the idea

6. If approved, development/enhancement begins

7. Resultant specifications/enhancement will be reviewed by peer group for implementability

8. The resulting specifications/enhancement will be put out for public consultation

9. The working group reviews public consultation feedback and incorporates the necessary changes. (Any inputs not included will receive responses too)

10. Specifications will be published for wider adoption

11. Specifications will be maintained in open repositories like GitHub, Confluent (or similar) based on the nature of the output

12. Specifications are made available through most permissible licenses like MIT or Creative Commons

13. Swasth will also create a fully independent ethics and conflicts committee to act as an appellate authority for all our work, including stewardship of specifications

14. All deliberations, minutes, and documents produced by the ethics and conflicts committee, specifications governance council, and working groups will be made publicly available

Proposed Governance Approach for Specifications at iSPIRT

Post one year of finalizing the first version of these specifications, iSPIRT Foundation proposes to govern all the health claims specifications and develop additional specifications including Health Claims Protocol and associated protocols related to multi-party dispute resolution system, fraud registry, regulatory supervision, HCX gateway, and Policy markup language. Further APIs and Standards for Other claim artefacts will be developed by iSPIRT as and when required for use cases. iSPIRT will organize a governance group with Swasth as one of the members to govern the development of the specifications.

Questions for Consultation

Question 1

Is the governance approach laid out here practical and appropriate? What approaches, other than the ones mentioned in the Governance section, can be considered for managing and governing the HCX Open Specifications? Please provide details.