Challenges in Implementing the Ayushman Bharat Digital Mission in India: A Perspective from a Private Personal Health Record Implementer

The Ayushman Bharat Digital Mission (ABDM) represents one of the world's most ambitious national digital health initiatives, aiming to create a federated, interoperable, and citizen-centric digital health ecosystem for India.While substantial progress has been made in building core digital infrastructure, including unique health identifiers, Ayushman Bharat Health Account (ABHA), registries, and consent-based health information exchange, translation of this infrastructure into meaningful health system impact remains limited.Drawing on policy analysis, emerging empirical evidence, and first-hand experience as a private personal health record (PHR) platform operating within the ABDM ecosystem, this perspective critically examines the sociotechnical, governance, and implementation challenges confronting ABDM.We argue that the current phase of ABDM is characterized by an "infrastructure-utilization gap, " where account creation outpaces real-world use, record linkage, and clinical integration.Key challenges include digital inequities, low awareness and trust, provider-side integration burdens, workflow disruption, privacy anxieties, and misaligned incentive structures for private ecosystem players.We conclude with targeted, actionable recommendations for policymakers to move ABDM from a compliance-driven infrastructure program to a value-driven, citizen-and provider-embedded digital public good.