E-Health, Digital India and Cyber (In)Security

By Shalini S

Under the government’s flagship initiative, Digital India, healthcare has been flagged as a sector awaiting reformation through enabling digital access. Across the world, the internet has increasingly come to serve as a platform for organized public healthcare delivery and has also demonstrated its potential in effectively increasing access to timely, specialized medical care in remote areas. Both e-health and m-health, public health models that use information and communications technology (ICTs) for the provision of both healthcare services and information, have been employed extensively to support physical healthcare infrastructure in several countries and is now finding its way into the Indian public health framework.[1]

The health initiative under the project, attempts to transform healthcare from an event-based intervention to an integrated, continuous delivery model by employing ICTs to remedy information asymmetry and substandard access. The initiative is also expected to partially remedy healthcare access issues extant due to insufficient healthcare infrastructure and manpower. However, the use of ICTs exposes the sector to a range of unique challenges that must be dealt with in order to harness the potential of ICTs for the healthcare sector. This brief post seeks to outline the dangers of digitally storing and transmitting electronic health records and suggests strengthening security and risk management capability to avoid breaches.

E-health Initiative

The health limb of the Digital India project aims to increase access to quality healthcare for all citizens by enabling information flow, facilitating collaboration through the use of ICTs and providing timely, economic health services. It seeks to do so by increasing transparency in healthcare delivery, eliminating structural opacity and multiple intermediaries. Additionally, it envisions the use of emerging technology in bridging the healthcare divide by connecting patients with specialized health professionals, who are geographically far-removed, for online diagnosis. E-health programs are expected to benefit those that have little access to quality healthcare services such as the urban poor and rural populations.

Using hospital management information systems (HMIS), healthcare delivery limb of the Digital India Initiative’s online registration system (ORS) rightly attempts to simplify registration and appointment process. However, each new registrant is assigned a Unique Health Identification (UHID) number which is linked to their Aadhaar number used primarily to seek appointments at registered hospitals and subsequently to access their health records including lab reports. Under the initiative patient’s health records are digitized and uploaded electronically in order to better maintain records and make it easily accessible to health professionals. Further, these health records are to be integrated into a digital locker that can be accessed both by the government and private establishments.

As a part of the above-mentioned Digital India program, the Government of India also proposed to setup a National eHealth Authority (NeHA) under which a “centralized electronic healthcare record repository” containing comprehensive health information of all citizens could be fashioned.[2] While this proposed statutory authority will be vested with the responsibility of managing the complexities birthed by use of ICTs in the healthcare sector and also act as a regulatory authority to ensure privacy, confidentiality and security of patient information, it is yet to be created. In the absence of demonstrable, technical cybersecurity capability and regulatory or legislative cybersecurity framework, this statutory body might remain an insufficient effort. Further, the implementation of privacy and security norms evolved by NeHA by healthcare providers could take years and sensitive patient information might be stolen by persons who stand to benefit from the use or sale of such personal information.

Sensitivity of health records

Healthcare records are primarily attractive to criminals as they contain personally identifiable information and are therefore highly vulnerable. In addition to threat of stolen health data being misused in multiple ways, health records stored and transmitted online can be tampered with and this can have implications on patient health. With the E-health initiative, this holds especially true as the Aadhaar linkage connects health records to other personal information. The proposed healthcare record repository must also address these concerns. Hosting of personal information, especially healthcare records on any internet-based platforms without adequate cybersecurity measures in place is an invitation for large-scale breach.

Why digitize health records and information

Public health has arguably been raised as a national security priority and a centralized information database will undoubtedly be a prodigious healthcare intelligence tool that will allow researchers to engage in disease surveillance in order to better understand the state of public health in any nation. This information is critical to the medical fraternity and policymakers in ensuring medical preparedness and developing prevention and responsive capabilities.

Independently, most private healthcare providers have already made the move to digitizing health records that contain sensitive patient data and storing them electronically on often poorly-secured hospital networks, fueling pertinent privacy and security concerns. These health information systems are designed to host big data in a highly accessible manner in order to leverage speedy access to patient information for newer modalities of treatment that are time and cost effective.[3]

While the potential of information technology in radically transforming healthcare is indisputable, protecting healthcare data against misuse, without impeding healthcare professionals’ access to patient information, remains the biggest security concern.

Way forward

While it might not be necessary to view cybersecurity in healthcare delivery as a novel issue, patient information must be recognized as sensitive information that needs to be protected from breaches. Thus, the overarching Digital India initiative must necessarily account for vulnerabilities in digitally storing healthcare records and develop risk management capabilities as a part of its existing governance. Further, as the healthcare initiative under Digital India hinges on collaboratively partnering with private healthcare providers to bridge the gap in access to advanced medical technology and specialized care, a minimum standard of cybersecurity must be mandated to be followed by all participating private healthcare providers to prevent localized breaches.

[1] Sanjeev Davey & Anuradha Davey, m-Health- Can IT improve Indian Public Health System, 4 National Journal of Community Medicine (2013), http://njcmindia.org/uploads/4-3_545-549.pdf.

[2] The Indian Express, Digital India programme: Govt mulls setting up eHealth Authority, 2015, http://indianexpress.com/article/india/india-others/digital-india-programme-govt-mulls-setting-up-ehealth-authority/ (last visited Nov 7, 2015).

[3] How technology is changing the face of Indian Healthcare, The Economic Times, 2014, http://articles.economictimes.indiatimes.com/2014-04-02/news/48801172_1_indian-healthcare-collaborative-data-exchange-healthcare-information-technology-market (last visited Nov 7, 2015).

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