PPPs can improve security and resilience of digital health infrastructures

Ruchin Kumar, Vice President – South Asia, Futurex, shares insights with Express Healthcare on the state of health IT infrastructure in India, the significance of partnerships, and the challenges faced in the sector

What is the current state of health IT infrastructure in India, particularly in tier 2 and tier 3 cities?

The current landscape of health IT in tier 2 and tier 3 cities in India is evolving rapidly from a cybersecurity perspective, but significant vulnerabilities remain. The increasing adoption of digital healthcare solutions, such as telemedicine, mobile health apps, and Electronic Medical Records (EMRs), has improved access to healthcare services in these regions. However, the digital transformation also expands the attack surface, making these cities more susceptible to cyber threats. While urban centers may have more resources to invest in cybersecurity infrastructure, many healthcare providers in smaller cities still rely on outdated systems and practices, leaving them vulnerable to data breaches, ransomware attacks, and other cyber threats.

Government initiatives like the Ayushman Bharat Digital Mission (ABDM) have accelerated the digitalization of healthcare services in tier 2 and 3 cities. Still, these advancements must be paired with robust cybersecurity measures. With more patient data being stored digitally, the risk of data breaches is heightened. Poorly implemented systems or lack of encryption on sensitive patient data can result in significant privacy violations, leading to compliance issues and loss of trust. This is particularly concerning, as healthcare institutions often handle large amounts of personal and sensitive data that, if compromised, can have serious repercussions.

Adopting advanced technologies, such as cloud-based health records, AI-driven diagnostics, and telemedicine platforms, introduces new vulnerabilities. These systems require sophisticated security controls, such as multi-factor authentication, end-to-end encryption, and continuous monitoring, to protect against unauthorised access and cyber-attacks. However, many healthcare providers in smaller cities may need more technical expertise and resources to implement these advanced security measures effectively. In addition, the increasing reliance on third-party vendors for cloud storage and software solutions adds another layer of risk, as these external providers must also comply with stringent cybersecurity standards to avoid potential vulnerabilities.

One of the most pressing concerns is the need for cybersecurity awareness and training among healthcare professionals in tier 2 and 3 cities. With proper education on recognising phishing attacks, implementing secure passwords, and maintaining secure networks, healthcare workers can easily open the door to cybercriminals. Ensuring that healthcare staff are regularly trained on cybersecurity best practices is essential to mitigate human error, which is often the weakest link in any security chain.

To address these challenges, healthcare providers must invest in strong cybersecurity infrastructures, including data encryption, secure access controls, and network segmentation. Encrypting patient data both in transit and at rest is essential to protecting sensitive information from malicious actors. Secure access control systems that implement zero-trust models and multi-factor authentication can help prevent unauthorised access to critical systems. Additionally, healthcare institutions must conduct regular security audits, vulnerability assessments, and penetration testing to identify and address potential weaknesses in their digital infrastructure before they can be exploited.

In summary, while health IT solutions are transforming healthcare delivery in tier 2 and tier 3 cities, robust cybersecurity measures must be integrated at every stage to protect sensitive patient data and ensure compliance with privacy laws. A proactive approach involving both technology investments and human capital development is crucial to mitigating cyber risks and building a resilient digital healthcare environment in these regions.

How has the Ayushman Bharat Digital Mission (ABDM) impacted healthcare digitisation

The ABDM has significantly impacted digitising healthcare infrastructure in India, especially in tier 2 and tier 3 cities. Its goal is to create a unified digital health ecosystem to provide essential healthcare services for all citizens, particularly those in underserved regions. Initiatives like electronic health records (EHR), digital health ID, and telemedicine platforms have greatly improved the delivery and accessibility of healthcare services. However, the rapid adoption of digital health systems also brings cybersecurity challenges that must be addressed to ensure the security of patient data.

From a cybersecurity perspective, the digitisation of healthcare infrastructure through ABDM increases the amount of sensitive patient data being stored and transmitted electronically, making it a prime target for cyberattacks. While digitalisation brings benefits in improved access and efficiency, it also expands the potential for attacks, exposing healthcare systems to risks such as data breaches, ransomware attacks, and unauthorised access. Relying on cloud-based solutions and third-party vendors to store and process health data adds another layer of complexity. These systems need robust encryption, secure access controls, and continuous monitoring to prevent malicious actors from exploiting vulnerabilities.

To address these concerns, healthcare providers must adopt comprehensive cybersecurity measures. Encryption of sensitive health data in transit and at rest is essential to protecting patient privacy and maintaining compliance with regulatory standards such as the Personal Data Protection Bill (PDPB). Implementing strong identity and access management (IAM) solutions, including multi-factor authentication and role-based access controls, ensures that only authorised personnel can access critical systems. Additionally, regular security audits, vulnerability assessments, and penetration testing can help identify and rectify potential weaknesses in the digital infrastructure before they can be exploited.

Furthermore, healthcare institutions must invest in advanced security solutions that offer scalable protection for their digital health systems. A unified platform that integrates multiple security functionalities—hardware security modules (HSMs), enterprise key management, and cloud-based encryption services—can provide a holistic approach to safeguarding sensitive health data. By consolidating all these security functions into a cohesive solution, healthcare providers can reduce the risk of breaches, lower operational costs, and simplify compliance with stringent cybersecurity standards.

In summary, while the ABDM has been instrumental in digitising healthcare infrastructure across India, pairing this digital transformation with strong, integrated cybersecurity measures is crucial. As healthcare services move online, healthcare providers must adopt a proactive approach to safeguard patient data and ensure the security of their systems in the face of evolving cyber threats.

What role do public-private partnerships (PPPs) play in advancing healthcare technologies and addressing cybersecurity challenges?

PPPs have become essential in advancing healthcare technologies, especially in the realm of cybersecurity. As India’s healthcare sector increasingly adopts digital solutions like telemedicine, EHRs, and AI-driven diagnostics, the need for robust cybersecurity has become critical. PPPs allow for the pooling of resources, expertise, and innovation from both the public and private sectors, enabling the development of secure, scalable, and adequate healthcare technologies.

From a cybersecurity perspective, the collaboration between the public and private sectors can significantly improve the security and resilience of digital health infrastructures. Private sector expertise in cutting-edge security technologies, such as cloud-based encryption, multi-factor authentication, and data privacy solutions, is crucial for addressing the vulnerabilities introduced by increased digitisation. For instance, the private sector in PPPs can provide comprehensive hardware security modules (HSMs) for secure key management, advanced enterprise encryption platforms, and data protection solutions that meet global standards like FIPS 140-2 and PCI DSS. These solutions help safeguard sensitive patient data by ensuring that information remains encrypted, whether in transit or at rest, reducing the risk of data breaches and unauthorised access.

Public-private collaborations also help in creating frameworks for continuous monitoring and security audits. While the public sector ensures regulatory compliance and frameworks like the Personal Data Protection Bill (PDPB), the private sector brings in expertise to implement these frameworks, providing real-time threat detection and response. In healthcare, where sensitive data such as patient health records is constantly under threat, the ability to continuously monitor systems for vulnerabilities and potential breaches becomes essential in preventing cyberattacks.

Integrating AI-driven security solutions within these partnerships can also enhance threat detection and incident response. In real-time, machine learning algorithms can detect abnormal activities, unauthorised access attempts, and potential vulnerabilities, enabling a swift response. This is particularly important in healthcare, where patient safety and data privacy are paramount.

Furthermore, secure cloud services and encrypted data storage solutions are key components in modern healthcare IT infrastructure. Public-private collaborations can facilitate the deployment of secure cloud environments that offer flexibility, scalability, and high protection for sensitive data. With secure cloud infrastructures, healthcare providers can protect data while benefiting from the ability to expand services and access remote expertise.

The shared responsibility model is one of the most significant advantages of PPPs from a cybersecurity perspective. Public agencies and private companies can establish secure data-sharing protocols and interoperability standards by working together to protect sensitive information across different healthcare systems and technologies. This helps to prevent the fragmentation of data security measures, which can leave gaps and increase the risk of attacks.

In conclusion, PPPs are instrumental in advancing healthcare technologies while addressing the critical cybersecurity challenges posed by the digital transformation of healthcare. By leveraging private sector expertise in secure data management, encryption, AI-driven threat detection, and cloud-based security solutions, these collaborations help build a resilient healthcare infrastructure that can defend against evolving cyber threats while maintaining patient trust and regulatory compliance.

What are the primary challenges in scaling health IT infrastructure?

Scaling health IT infrastructure presents several cybersecurity challenges that must be addressed to ensure the security, integrity, and confidentiality of sensitive patient data. As healthcare organisations expand their digital footprint with technologies like telemedicine, electronic health records (EHRs), cloud-based services, and AI-driven diagnostics, the attack surface increases, making systems more vulnerable to cyber threats. Here are some key challenges in scaling health IT infrastructure from a cybersecurity perspective, along with potential solutions:

Data protection and encryption:

As healthcare organisations scale, they manage increasingly large volumes of sensitive data, including personal health records (PHRs), medical images, and billing information. Protecting this data against breaches and unauthorised access becomes more complex as organisations expand their infrastructure. Inadequate data encryption—both in transit and at rest—can expose critical information to cybercriminals. To address this, healthcare providers must implement robust encryption solutions that safeguard patient data through secure hardware security modules (HSMs), cloud encryption, and end-to-end encryption. Ensuring that all patient data is encrypted across systems, applications, and devices is essential to maintaining data confidentiality and preventing breaches.

Compliance and regulatory challenges:

As Health IT infrastructure expands, healthcare providers must comply with increasingly complex data protection regulations such as HIPAA in the US or the Personal Data Protection Bill (PDPB) in India. These regulations mandate that healthcare providers ensure data is stored, accessed, and transmitted securely and complies with the law. Compliance becomes more challenging as the infrastructure grows and integrates third-party vendors, cloud providers, and remote systems. A unified data governance and compliance solution that automates compliance checks, manages encryption keys and offers real-time audits can help mitigate these risks. Solutions that integrate compliance into the IT infrastructure can ensure that healthcare providers meet regulatory requirements while scaling.

IAM:

Managing access to sensitive data and systems becomes more challenging as health IT systems scale. Inadequate identity and access controls can lead to unauthorised access due to weak authentication mechanisms, privilege escalation, or insider threats. To address this, healthcare providers must adopt advanced IAM systems that include multi-factor authentication (MFA), role-based access control (RBAC), and zero-trust architectures. These systems ensure that only authorised personnel can access sensitive data, minimising the risk of data breaches and ensuring accountability.

Third-party risk and vendor management:

As healthcare organisations grow, they often use third-party vendors for services such as cloud storage, telemedicine platforms, and software solutions. These third-party connections can create vulnerabilities if vendors do not adhere to strict cybersecurity practices. It is crucial to have effective vendor risk management solutions in place to assess the security measures of third-party providers and ensure they meet security standards. Organisations should conduct third-party risk assessments, establish security agreements, and continually monitor third-party activity to identify and address potential security risks.

Scalability of security operations:

As the infrastructure expands, managing cybersecurity operations becomes more complex. Healthcare organisations must ensure their security operations centers (SOCs) can handle increasing security alerts, threat intelligence, and incident response efforts. Implementing automated threat detection and response systems powered by AI and machine learning can help efficiently scale security operations. These solutions can monitor systems for suspicious activity in real-time and automatically respond to potential threats, reducing the need for manual intervention and minimising response times.

Cloud security and remote access:

As healthcare systems transition to cloud computing and provide remote access to care providers, ensuring the security of cloud-based applications and networks is crucial. Securing cloud environments involves protecting data across shared infrastructure and ensuring the security of access to cloud-based services. To address cloud security risks, healthcare providers should invest in cloud-native solutions that offer encrypted cloud storage, cloud access security brokers (CASBs), and continuous cloud monitoring. Additionally, it is vital to implement VPNs and secure access controls for remote users to maintain the security of remote access to healthcare data.

Cybersecurity awareness and training:

Expanding health IT infrastructure often increases complexity in the security environment, making it more challenging for healthcare staff to uphold cybersecurity best practices. Inadequate training and awareness among healthcare workers can lead to human errors that expose systems to cyber threats, such as phishing attacks or weak password practices. To tackle this issue, healthcare providers should invest in cybersecurity training programs for all staff to ensure they are well-versed in the latest threats and best practices for protecting sensitive data. Regular cybersecurity awareness training and simulated phishing exercises can help staff remain vigilant and reduce human error.

In conclusion, scaling health IT infrastructure poses significant cybersecurity challenges, including data protection, compliance, third-party risk management, and secure remote access. However, by implementing comprehensive encryption solutions, advanced identity and access management systems, cloud security measures, and automated threat detection, healthcare organisations can mitigate these risks and scale their infrastructure securely. Proactive cybersecurity measures and continuous staff training will ensure that healthcare’s digital transformation is efficient and secure.