Ayushman Bharat Health Account (ABHA) Integration in Action: Identifying Operational Barriers at a Tertiary Care Center in Eastern India

Background and aim The Ayushman Bharat Health Account (ABHA) forms the backbone of India's digital health mission, enabling the creation of unique, interoperable digital health identities. Despite government mandates, integration at the facility level remains challenging. This study aimed to evaluate the implementation of ABHA creation and linking services at the All India Institute of Medical Sciences (AIIMS), Kalyani, and to identify the principal barriers to successful integration. Methods A prospective observational study was conducted from 19 June 2024 to 29 November 2024 in the outpatient department (OPD). Daily data were recorded for the following four predefined hurdles: no smartphone, no signal reception, refusal, and miscellaneous. Descriptive statistics and Pareto analysis were used to identify major contributors to integration failure. Results A total of 5,873 (100%) hurdle events were recorded, with the leading barriers being lack of network signal in 2,427 events (41.3%), absence of a smartphone in 1,802 events (30.7%), patient refusal in 1,303 events (22.2%), and miscellaneous factors in 341 events (5.8%). Pareto analysis showed that the top two hurdles, i.e., poor signal reception and lack of a smartphone, accounted for 72.0% of all integration failures (n=5,873). During the study period, the total OPD footfall was 80,497, with 30,786 ABHA tokens generated and 13,085 ABHA linkages completed, yielding an average daily OPD attendance of 1,183.8 patients, with a mean of 427.6 ABHA tokens generated and 181.7 ABHA linkages completed per day. Conclusion Poor network connectivity and lack of digital access among patients were the predominant barriers to ABHA integration. Addressing these two core issues could resolve nearly three-fourths of integration failures. Strengthening digital infrastructure and deploying assisted digital registration services are critical to improving ABHA adoption.