Getting vitals right for a sustainable digital healthcare mission

Salonie Chawla, public affairs consultant, reasons that while the use of big data in healthcare can address the shortage of healthcare supply and enhance patient care in the country, the thrust of the National Digital Health Mission should also be to safeguard highly sensitive patient information as part of patient safety. She therefore believes that Mission can serve the nation well, but healthy and reliable practices and laws should guide it

Continuing with the tradition of making important announcements from the ramparts of Red Fort, this Independence Day, Prime Minister Narendra Modi, launched an ambitious and the most apt National Digital Health Mission (NDHM).

”It will bring a new revolution in India’s Health Sector. Technology will be used prudently to reduce the challenges in treatment. Every Indian will be given a Health ID. This Health ID will work like a Health Account of every Indian. This account will contain your details of every test, every disease, the doctors you visited, the medicines you took and the diagnosis. When and what was the report, all such information will be incorporated in the Health ID,” the PM’s I-Day speech shared the broad details.

Even as a comprehensive blueprint will have to be finalised, the NDHM would highly leverage technology, enabling all Indians to make a ”better and informed” decision about their health.

Technology alone without data would not be enough. It needs data which must be broken down into intelligent pieces of information about the state of health of every citizen. The rapid adoption of technology and increase in digital connectivity in the post COVID-19 period has generated huge amounts of data over the past few months. Now this data can be further mined and analysed to give a directional transformation to the way we manage our biggest concern, which is healthcare.

As per National Health Profile 2017, India has about 1 million doctors for a population of 1.3 billion. Besides, acute shortage of doctors, the COVID-19 outbreak has also given us a reality check on the lack of hospital infrastructure.

Given the calamitous inaccessibility of healthcare that exists across the country, especially in the rural India that comprises about 70 per cent of total population, the Prime Minister’s message on digital transformation of healthcare can pave the way for ‘Access to All’.

E-health can lead to significant changes within the healthcare system. It can make patients more empowered and lower the cost of patient care.  Equally important would be the crucial information available with the system, which can be used for critical research in disease control and treatment. The governments can be guided better to come up with appropriate healthcare policies, based on the directional guidance provided by the data.

Need for policy checks

However, health is quite personal to all of us. It cannot be in anybody’s case that the moment a patient is diagnosed with a medical, he/she is bombarded with marketing calls from product or service sellers.  The data sharing for healthcare is highly sensitive and completely personal. This data cannot be treated, like a credit score which is available across the financial system. The data must be guarded against at all costs.

In the past few months, Indians have generated big data from online transactions, emails, videos, audios, search queries, social networking interactions and mobile phone applications. But we must realise that application of big data in healthcare can raise many issues, primarily with respect to privacy, security and archiving, spanning concerns such as personally identifiable information, security of the information, and accuracy of publicly available data. The problem of misuse of information and disclosure of confidential data can not only risk privacy violation but also create mistrust between the patients and the healthcare providers.

To devise a sustainable and ethical system of digital healthcare, it would be critical for the government to put certain policy checks in place to keep a balance between patient safety and the advances in the new-generation technology sector. The creation of a unique Health ID for every Indian as part of building electronic health records and the involvement of private entities in the scheme poses risk of privacy violations, as the country is yet to have its data protection law. It is being said that till the pending bill before Parliament becomes a law, the provisions in the draft bill would guide implementation of the scheme, in the interim.

Telemedicine which is playing a critical role during the ongoing pandemic can also be a big source of data accumulation, processing, storing, retrieving and transferring clinical, and financial information of patients. This data must also be safeguarded against misuse.

Another potential red flag is the absence of social media intermediaries’ guidelines for platform liability, especially when telemedicine requires direct mobile communication between patients and doctors via several applications. A doctor-patient flow of information over an email or a social media app in absence of regulation poses the question of responsibility of data confidentiality between a doctor and social networking services, which should be critical to resolve.

The nuances of digital health systems need to be integrated into a strong-willed set of policies, including a protection of patients and clear monitoring of private players carrying out missions of public service.

Since India’s healthcare and technology players are largely in the private sector, entrusting digitalisation of healthcare to a handful of giants could lead to monopolising of the big data for generating profits in ways like misleading advertisements on medical products or quality of hospitals. It is true that we have the system of a consumer protection authority in the country, but it would be prudent to ensure that complexities around the data of the patients are dealt well.

The government may be open to fostering patient- doctor consultation using the internet, but another policy check that needs to be understood by decision makers will be the new payment method, to cap different prices for providing prescriptions and diagnoses to prevent over-pricing for patients. Digital solutions to healthcare can offer promising incentives in saving costs of the patients, but the financial autonomy of healthcare providers could be of concern, especially when patients will incline towards using tele health services of ‘highly trained and qualified doctors.’

With huge costs of private healthcare, extreme inaccessibility, consultation time reduced to bare minimum, the use of big data in healthcare can address the shortage of healthcare supply and enhance patient care in the country. However, the thrust of the National Digital Health Mission should also be to safeguard highly sensitive patient information as part of patient safety.

The Mission can serve the nation well, but healthy and reliable practices and laws should guide it.