Mapping digital health maturity models and accreditation-linked standards: a scoping review to position the National Accreditation Board for Hospitals & Healthcare Providers (NABH) digital health standards of India

TL;DR

This paper compares India's NABH digital health standards with global models to identify strengths and gaps in areas like AI governance and cybersecurity.

Contribution

The paper provides a comparative analysis and gap map of NABH-DHS against global digital health frameworks, highlighting areas for improvement.

Findings

NABH-DHS aligns well with global standards in core domains like governance and data management.

Gaps include AI governance, cybersecurity maturity, interoperability metrics, and health equity.

Recommendations suggest integrating external frameworks like NIST CSF 2.0 for future-proofing.

Abstract

Digital transformation in healthcare is guided globally by digital health maturity models and accreditation-linked standards. In India, the National Accreditation Board for Hospitals & Healthcare Providers (NABH) introduced landmark Digital Health Standards (DHS) for hospitals (2025 draft). This provides a national framework, but its positioning within the complex global landscape is unclear, making it challenging for stakeholders to benchmark progress and plan strategically.

The primary objective was to map the features, domains, and assessment approaches of prominent international digital health maturity models and accreditation-linked standards. The secondary objective was to conduct a comparative analysis of these frameworks against the NABH-DHS to identify areas of convergence, divergence, and critical gaps.

A scoping review adhering to PRISMA-ScR guidelines was conducted. Peer-reviewed databases (PubMed, Embase, Scopus) and grey literature sources were searched from inception to 26 July 2025. We included sources describing national or international maturity models or accreditation standards for healthcare provider organizations. Data were charted using a customized form, synthesized narratively (SWiM), and comparatively analysed using a conceptual crosswalk matrix and thematic gap map.

38 sources were included, comprising systematic/scoping reviews (n = 8), official reports/standards (n = 17), and primary studies (n = 13). Key international frameworks mapped include HIMSS EMRAM, NHS England’s WGLL, WHO-PAHO IS4H, JCI, and Australian models. The NABH-DHS (structured across 8 chapters) shows strong alignment with these frameworks in core domains: Leadership, Governance, Clinical & Patient Safety, and Information & Data Management. However, the comparative analysis identified emerging gaps vis-à-vis global best practices. These include absent or minimal coverage for explicit AI governance, advanced cybersecurity maturity (e.g., alignment with NIST CSF 2.0), granular interoperability maturity assessment, a dedicated health-equity lens, and the systematic integration of Patient-Generated Health Data (PGHD).

The NABH-DHS provide a robust and comprehensive foundation for core digital assurance in India, converging well with international best practices on foundational elements. Our mapped findings are presented as external policy guidance. We recommend that future NABH revisions incorporate pragmatic, light-weight requirements to address the identified gaps (AI governance, advanced cybersecurity, interoperability metrics, and equity). This can be achieved through annexes or tiered ‘Digital Plus’ badges that reference mature external frameworks (e.g., ISO/IEC 42001, NIST CSF 2.0), ensuring a future-proof, phased implementation that safeguards patient trust as the Indian digital health ecosystem matures.

The online version contains supplementary material available at 10.1186/s12913-026-14301-y.

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