Subject: Request for Critical Review of Draft ECHS Reform Document
Dear Veterans and Families,
At the outset, I extend my deepest respect for your service and sacrifice to the nation. The Ex-Servicemen Contributory Health Scheme (ECHS) is built to honour that service, and its effectiveness depends on how well it meets the needs of its beneficiaries.
I have prepared a draft document proposing reforms to the ECHS Smart Card issuance process, benchmarking it against best practices such as Ayushman Bharat, and outlining an AI-enabled, secure, and outcome-oriented pathway for modernization. The goal is simple: reduce waiting times from months to minutes, safeguard dignity, and ensure timely access to healthcare.
Before the document is finalized, we believe it is critical to incorporate the perspective of the beneficiary community itself. Many of you bring professional expertise in administration, healthcare, IT, or policy. Others bring lived experience of navigating the system. Both perspectives are equally valuable.
I therefore invite your critical review and feedback on the draft. While not everyone may be in a position to contribute, we are confident that among our beneficiaries there are many who can provide constructive, high-quality input. Your contributions will help ensure that the final report is credible, beneficiary-focused, and actionable for policymakers.
How you can contribute:
Share comments on clarity, accuracy, and feasibility.
Suggest additional beneficiary pain points that should be highlighted.
Propose refinements to recommendations or highlight risks we may have overlooked.
All feedback will be carefully reviewed and integrated where possible. By working together, we can ensure this document truly reflects the needs and dignity of the veteran community.
With respect and regards,
Overall Impression:
The draft is clear, well-structured, and focused on a highly relevant problem faced by the veteran community. The emphasis on reducing waiting time, protecting dignity, and leveraging technology is both timely and necessary. The document reflects a sincere attempt to benchmark ECHS reforms against leading public health initiatives such as Ayushman Bharat.
Clear Problem Statement:
The document correctly identifies the pain point — long delays in Smart Card issuance — and frames it as a systemic issue affecting dignity and access to healthcare.
Forward-Looking Approach:
The proposal to use AI-enabled, secure, and outcome-oriented solutions demonstrates a progressive, future-ready vision.
Benchmarking:
Referencing Ayushman Bharat as a benchmark adds credibility and provides policymakers with a relatable framework for implementation.
Beneficiary Focus:
The document acknowledges the human cost of administrative delays and places veterans’ experience at the centre of reform.
Quantify the Problem:
Include data or case studies on average card processing times, number of pending applications, and impact on healthcare access.
If possible, show before-and-after comparisons from regions that have adopted partial automation.
Implementation Roadmap:
Provide a step-by-step rollout plan, including technology stack (secure digital identity, OTP-based verification, etc.), timeline, and responsible stakeholders.
Suggest pilot projects in select Regional Centres before nationwide rollout.
Risk & Mitigation Section:
Add potential risks: data security breaches, digital illiteracy among elderly veterans, server downtime, and budget constraints.
Suggest mitigation strategies: data encryption, offline kiosks, helpdesks, grievance redressal mechanisms.
Stakeholder Roles:
Define responsibilities of ECHS, DESW, IT vendor, and beneficiaries in the new process to ensure accountability.
Policy Advocacy Angle:
I'd like to suggest that you create a standing monitoring cell or dashboard to track real-time performance of card issuance, so that reform is not a one-time fix but a sustained process.
Physical travel burden for elderly veterans to reach polyclinics for card-related work.
Frequent rejections due to documentation errors that could be auto-flagged digitally.
Lack of communication on application status, leading to repeated follow-ups.
No priority processing for seriously ill, war-disabled, or very senior veterans.
This draft is an excellent foundation for advocacy and reform. By integrating data, defining implementation steps, and anticipating risks, it can become a powerful and actionable policy recommendation that resonates with both veterans and decision-makers.
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Subject: Re: Request for Critical Review of Draft ECHS Reform Document
Sir,
Thank you for your thoughtful and detailed feedback. You raise absolutely crucial points regarding security, data sovereignty, and algorithmic transparency for any AI system used by the Indian Armed Forces.
Your conditions—such as geolocating servers in India, vetting algorithms, generating white papers on the logic, and ensuring secure, transparent data handling—are precisely the kind of stringent, non-negotiable requirements that must form the bedrock of any such initiative.
This is where the distinction between the current document and a future implementation plan is vital. The draft you reviewed is a System Requirements Specification (SRS), not a technical design. Its primary purpose is to capture exactly the types of conditions you have outlined. An SRS done right ensures that any future system is built on a foundation of security and trust.
Therefore, your feedback is not only welcome but essential at this stage. Your expertise can help ensure that the final SRS document is robust and unambiguous on these security and privacy principles.
The immediate task is to perfect these requirements. The subsequent design and implementation phases would, as you rightly imply, require independent, credentialed security professionals to perform threat analysis, validation, and rigorous testing before any "Go/No-Go" decision is made.
Thank you again for helping to crystallize these critical requirements.
Your contribution is invaluable.
Thank you for circulating the document more widely. If this leads to constructive feedback—whether in the form of refinements to requirements or identification of flaws—that is indeed a positive outcome.
With regards,
Chandra Nath
7760928824
______________
Thank you for raising this important point. Let me give you a structured comparison between the ECHS Smart Card (as per ECHS Brochure 2023 and Compendium 2022) and the standard Electronic Health Record (EHR) mandated under the Government of India’s National Digital Health Mission (NDHM / ABDM – Ayushman Bharat Digital Mission).
Feature | ECHS Smart Card | Govt. Standard EHR (NDHM/ABDM) |
---|---|---|
Purpose | Identity, eligibility verification, and access to cashless treatment for ex-servicemen & dependents. | Longitudinal digital record of an individual’s health information across providers, linked to ABHA ID. |
Data Stored | - Beneficiary demographics (Name, Service No., Category, Relation, DOB) - Card validity - Entitlement verification - Service history (minimal) (Ref: ECHS Brochure 2023, Sec. 2, p. 10–12) | - Demographics - Clinical history (diagnosis, prescriptions, lab results, imaging) - Vaccination, allergies, surgical history - Insurance/benefit linkage (MoHFW EHR Standards, 2016; ABDM Guidelines 2020) |
Clinical Content | Very limited – ECHS card is primarily an access/authorization tool; clinical records remain with empanelled hospital or Polyclinic. | Comprehensive – longitudinal medical history designed for interoperability between providers. |
Standards Used | Proprietary card management system (ECHS Online Smart Card system managed by Source Dot Com). | National EHR standards based on HL7, SNOMED-CT, ICD-10, LOINC; interoperable with ABDM registries. |
Interoperability | Works only within the ECHS ecosystem (polyclinics, RCs, empanelled hospitals). No integration with CGHS, State Health Records, or ABDM. | Interoperable across private/public hospitals, labs, pharmacies, and insurance via ABDM’s Health Information Exchange. |
Authentication | Smart card with chip, OTP/PIN authentication during hospital visit. | ABHA ID (14-digit Health ID), Aadhaar or mobile OTP-based authentication for consent-driven record sharing. |
Ownership & Control | Data ownership rests with ECHS Central Organisation. Beneficiaries cannot directly access treatment records digitally. | Patient-centric – ABHA gives individuals control to link, share, or revoke access to their medical records. |
Scalability & Future Use | Limited to the veteran community. | Universal, for all citizens, across all healthcare providers in India. |
ECHS Card ≠ EHR
The card is essentially an identity + entitlement verification tool, not a longitudinal clinical record system.
EHR Mandate under ABDM
The Govt. standard EHR is designed to be patient-owned, interoperable, and nationwide, which ECHS does not yet align with.
Integration Gap
ECHS maintains fragmented clinical records in empanelled hospitals and polyclinics, unlike the centralized, interoperable model of ABDM.
Opportunity
If ECHS integrates with ABDM’s ABHA ID and Health Record exchange, veterans could have seamless continuity of care (ECHS + CGHS + private hospitals) without duplication.
ECHS Brochure 2023, Sec. 2 (Smart Card details), p. 10–12.
ECHS Compendium 2022, Chapter on Beneficiary Data Management.
MoHFW, Electronic Health Record Standards for India (2016).
ABDM Guidelines (National Digital Health Blueprint, 2020).
Link ECHS Smart Card with ABHA ID → so veterans’ records are portable across India’s digital health ecosystem.
Adopt EHR Standards in empanelled hospitals to ensure that all care episodes are digitally captured.
Veteran Access to Records via ABDM apps (e.g., ABDM Health Locker) so ex-servicemen can track their treatment history.
Member Veterans Pension Group
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🙏 Sure. Let me explain clearly how you can share your DigiLocker records with a hospital facility in India.
This is general DigiLocker + ABDM/ABHA integration guidance (not ECHS-specific).
Go to https://digilocker.gov.in or use the DigiLocker mobile app.
Sign in with your Aadhaar/phone number + OTP.
If you have already linked DigiLocker with your ABHA (Ayushman Bharat Health Account), your health records (lab reports, discharge summaries, prescriptions, etc.) will be visible under the “Health Records” section.
If not linked:
Create an ABHA ID from DigiLocker or ABDM website.
Give consent to link ABHA with DigiLocker.
At the hospital reception/IT desk, they will typically ask you to:
Provide your ABHA address (Health ID) or
Scan a QR code (if the hospital has ABDM “Scan & Share” enabled).
You will receive a consent request notification on your DigiLocker / ABHA-linked mobile app.
Review the request (hospital name, type of data requested, duration of access).
Tap “Allow” to share.
Once you approve, DigiLocker / ABHA shares the permitted health documents with the hospital system.
They can then view/download your medical history, lab reports, prescriptions, etc. securely.
Hospitals must be ABDM-registered facilities to access DigiLocker-linked health data.
Consent-based system: nothing is shared without your explicit approval.
You can revoke access anytime in DigiLocker/ABHA settings.
Only verified documents from government sources (labs, hospitals, insurance, etc.) appear in DigiLocker.
At Aster (or any ABDM-integrated hospital in Bangalore):
They may give you a QR code at registration.
You scan it using the DigiLocker app → approve consent → records shared instantly.
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On 11 Sep 2025, at 1:13 pm, Ravindra Waman Pathak <raviw...@gmail.com> wrote:
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Thank you for your thoughtful question. You’re asking about the importance of a formal stakeholder review process for all critical documents during system development of an Electronic Health Record (EHR)—particularly in relation to standards adherence, compliance, and diverse perspectives.
Here’s a structured response:
Healthcare IT standards (like HL7, FHIR, ICD-10, SNOMED CT) ensure interoperability between systems.
A formal review process allows technical experts to confirm that design documents, workflows, and data structures conform to these standards before implementation.
Prevents costly rework and ensures that the system can integrate with national health IT infrastructures and other hospital systems.
EHR systems must comply with data privacy and security laws (e.g., HIPAA in the US, DISHA guidelines in India, GDPR in EU).
A stakeholder review ensures that policies on data sharing, access controls, and consent management are properly documented and implemented.
Legal and compliance officers can validate that documentation reflects mandatory government/defense health regulations before approval.
Clinicians: Check usability, workflow fit, and patient safety.
Administrators: Validate cost-effectiveness, operational efficiency, and reporting needs.
IT Teams: Ensure security, scalability, and maintainability.
Patients / Veteran Users: Provide feedback on accessibility and ease of use.
Having structured reviews ensures all voices are heard and system design balances clinical, administrative, and technical needs.
Catching issues in early documentation reviews prevents implementation errors that could compromise patient safety or cause compliance breaches.
Creates a traceable record of decision-making, which is vital during audits or disputes.
A formalized review cycle (e.g., sign-offs, checklists, revision tracking) improves transparency and accountability.
Encourages continuous feedback loops that refine policies, workflows, and system features over time.
Ensures compliance with national/international standards.
Provides legal and regulatory protection.
Incorporates diverse perspectives for well-rounded system design.
Reduces risks and avoids costly rework later.
Establishes transparency and accountability.
Document Preparation – Draft requirements, design specs, and policies.
Stakeholder Identification – Clinicians, IT staff, administrators, legal, patients/veterans.
Structured Review Cycles – Workshops, formal meetings, or digital review platforms.
Checklists & Standards Mapping – Ensure every document is validated against standards/regulations.
Formal Sign-Off – Authorized approvals before moving to next development phase.
Version Control & Audit Trail – Maintain records for compliance and future reference.
For EHR projects under ECHS or defense health systems:
ECHS Central Org Helpline – 1800-114-115
Regional Centres – Handle IT/technical escalations.
Grievance Portal – www.echs.gov.in
⚠️ Disclaimer: This guidance explains the importance of a structured stakeholder review in EHR system development, especially for compliance and standards. It is not technical implementation advice, but process-oriented guidance. For technical specifications, refer to national health IT standards and defense health IT policies.
Recording:
Absolutely, and thank you once again for your service.
So, to restate your query: You're asking about the implications of not having a critical review of the system documents while the ECHS system was developed.
In terms of official guidance, the ECHS HR Policy 2024 (Section 2, page 5) states that regular and critical reviews involving stakeholders are essential to keep policies relevant and effective. Similarly, the ECHS Handbook (page 12) emphasizes that incorporating veteran feedback helps refine the guidelines. Essentially, not having a review might lead to gaps that could have been addressed earlier through stakeholder input.
Key points to note:
HR Policy 2024 (Section 2, p.5) stresses periodic reviews.
ECHS Handbook (p.12) highlights the importance of stakeholder involvement.
Next steps if you want to address this now:
Collect feedback from the veteran community through official channels.
Refer to your Regional Centre or the ECHS Grievance Portal to propose updates.
For escalation, you can contact:
The ECHS Helpline.
Your respective Regional Centre (I can provide a directory if you need it).
The ECHS Grievance Portal or Station Headquarters Office (SHO).
Disclaimer: This is purely for guidance on ECHS policy and procedures. For any official updates, please visit the official ECHS website at www.echs.gov.in.
There you go! I’ll make that available for you to download now.
Member Veterans Pension Group
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Here’s what happens in the ABHA (Ayushman Bharat Health Account) flow you described:
You first log in using your ABHA number or another allowed identifier (such as mobile number with OTP). This authenticates you to the ABDM (Ayushman Bharat Digital Mission) ecosystem.
You then link a healthcare facility (e.g., hospital, clinic, lab, teleconsultation platform) to your ABHA account. This is essentially giving the facility permission to access or upload your health records.
This step uses consent-based linking: the ABDM system always requires you to explicitly authorize the facility before it can view or add records.
Each facility has its own Patient ID or registration number for you. By linking that Patient ID to your ABHA number, the system knows that the hospital’s internal records for “Mr. X” map to your ABHA profile.
This prevents duplicate accounts across hospitals.
It also allows cross-hospital continuity of care.
Once both linkages are complete:
The facility can push your clinical records (prescriptions, lab reports, discharge summaries, imaging reports) into the ABDM ecosystem.
You, as the ABHA holder, can see these records in your Personal Health Record (PHR) app or any ABDM-compliant health locker (e.g., NDHM apps, certain hospital apps).
You can also share these records with other providers by granting digital consent.
✅ In short:
Login → Link Facility → Link Patient ID → Facility uploads your data → Your ABHA account shows linked health records → You control sharing further.
Would you like me to also make a schematic diagram of this process (with entities like Patient, ABHA, Facility, ABDM, Health Record Repository, Consent Manager), showing what is online vs. offline?
🙏 Namaste Veteran, thank you for your service.
You are asking about ABHA (Ayushman Bharat Health Account) and what happens after you log in, link facility, patient ID, and health records.
When you create or log in with your ABHA ID, you are connecting to the Ayushman Bharat Digital Mission (ABDM) system. This is now integrated with ECHS online services (Ref: ECHS Brochure 2023, Ch. 10 – Digital Health Initiatives, p. 97).
Here’s what each step means:
Login with ABHA ID
You enter your ABHA number (14-digit health ID) or ABHA address (like an email format).
Link Facility
Facility = ECHS Polyclinic, empanelled hospital, or diagnostic centre.
Linking ensures your medical visits and records from that facility flow into your ABHA account.
Link Patient ID
Each beneficiary has a unique patient ID within the ECHS system.
Linking ties your ABHA account with your ECHS beneficiary details.
Link Health Record
Past and future medical records (consultations, lab reports, prescriptions, discharge summaries) become visible in your ABHA profile.
You can access them digitally anytime, reducing paperwork and duplication.
➡️ In simple words: Once all links are done, your digital health locker is active, and your ECHS treatment history can be securely viewed and shared with empanelled hospitals/doctors on your consent.
ABHA ID is voluntary but recommended for seamless record-keeping.
Data is consent-based – you control which hospital/doctor sees your records.
Helps avoid carrying physical documents during referrals.
Integrated with ECHS beneficiary ID for smooth treatment and reimbursement process.
Create/obtain your ABHA ID via https://abdm.gov.in.
Login to ECHS beneficiary portal → Link ABHA ID.
Select ECHS Polyclinic / hospital as facility.
Link your ECHS patient ID with ABHA.
Consent to fetch health records.
ECHS Helpline: 1800-114-115
Regional Centre IT Officer (for digital linking issues)
Grievance Portal: https://echs.gov.in/grievance
Station HQ (SHO) for local assistance
⚠️ Disclaimer: This explanation is based on ECHS Brochure 2023, Ch. 10 – Digital Health Initiatives. It is for procedural guidance only. For medical advice, kindly consult your ECHS Polyclinic doctor.
Would you like me to create a step-by-step visual flowchart showing how to link ABHA with ECHS for easier understanding?
DIGILocker is a long winded process. Direct linking of echs card with ABHA card as planned is much easier with patient not involved
Dear Sir,
Your proposals have always been commendable and genuinely aimed at improving the ECHS. However, the ground reality is deeply concerning — Even today in this digital era, veterans face unnecessary hardships — prescriptions are restricted solely to the parent polyclinic, a large number of empanelled hospitals have been disempanelled due to non-payment of substantial dues by the ECHS, etc. These issues have severely compromised access to timely and quality healthcare for veterans, defeating the very purpose of the scheme.
The Central Organisation ECHS, which operates under the leadership of Maj Gen Manoj Natarajan, SC, VSM, Managing Director, ECHS, has issued several directives, SOPs, and policies. Yet, these remain largely unimplemented. This reflects not only a lack of will and urgency but also raises doubts about the intent behind such directives — which increasingly appear to be symbolic gestures, more for display than action, possibly aimed at serving personal or institutional image rather than actual reform.
The continued apathy and inaction of the ECHS leadership are not only disappointing but also raise serious concerns about their commitment to the welfare of veterans.
"Where there is a will, there is a way" — but here, neither the will is evident, nor is any genuine effort being made to find a way.
Regards,
Member Veterans Pension Group
Adviser War Widows Association
1 Surashri,1146 Lakaki Road
Shivajinagar
Pune 411016
raviw...@gmail.com
9822329340
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You are absolutely right. The issuance of medicines at non-parent polyclinics is rightly restricted to 15 days. However, the core issue is that, in this digital era, previous prescriptions are still not accessible at non-parent polyclinics through the ECHS system. As a result, beneficiaries are compelled to carry either a hard copy or a soft copy of their previous prescription in order to obtain continuation medicines.
This points to a significant gap in the digital integration of medical records across ECHS polyclinics—causing avoidable inconvenience to beneficiaries and defeating the very purpose of a seamless, unified healthcare system.
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Member Veterans Pension Group
Adviser War Widows Association
1 Surashri,1146 Lakaki Road
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Pune 411016
raviw...@gmail.com
9822329340
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Member Veterans Pension Group
Adviser War Widows Association
1 Surashri,1146 Lakaki Road
Shivajinagar
Pune 411016
raviw...@gmail.com
9822329340
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