Embrace the national digital health mission, but with care and safeguards
Prime Minister Narendra Modi announced a National Digital Health Mission in his Independence Day speech. It is an ambitious plan to create a digital infrastructure for health care delivery, which will include personal health IDs and e-records for citizens. This will greatly facilitate tele-medicine, e-pharmacy, and collection, consolidation and inter-operability of health data. This is welcome. At a recent roundtable organised by the Digital Identity Research Initiative (DIRI) at the Indian School of Business (ISB), health experts, entrepreneurs, academics and thought leaders discussed agreed that digitisation of health care in India is the future that we must embrace, with speed and with care.
Personal data, especially health data, is sensitive, and its privacy must be protected. We now have the technology to ensure that happens. We can use Blockchain technology to guarantee that data that is created is encrypted and cannot be altered. Consent for accessing and storing individual data, in part or in whole, will stay with the individual and can be given to a trusted authority such as a physician, a pharmacy, a test laboratory or a research institution as necessary and deemed fit by the individual. So, for example, if you approach a doctor for a second opinion, you could allow the doctor to see the complete diagnosis and previous care provided. A test lab needs to only get the samples without the patient identifying information.
Consent must also be taken to anonymise personal data so that it can be made part of a public data set. Hospitals and clinics can, and must, anonymise individual data before sharing it with others who may aggregate it to create useful indices. Some of these indices can be made public to help detect patterns and predict the onset of health crises before they actually arrive in full-force so that public health agencies can intervene appropriately to manage these. Anonymisation ensures that if you are diagnosed with tuberculosis, for example, no unauthorised person should be able to infer this from the data. Aggregation, on the other hand, will be able to alert public health officials, for example, that a given geographic region is showing a spike in cases and further investigation and intervention might be needed.
Even the storage of aggregate data on cloud-servers need to be made hack-proof. First, the data that is stored must be encrypted. Second, the data must be distributed across several independent servers so that even if data is hacked and downloaded from one server, the original sensitive data cannot be recovered. Recent technological advances allow the creation of such a protocol. Third, the encrypted data should contain useful tags so that when it is downloaded with proper authentication and consent, only at the authorised level of aggregation, the data can be recovered for appropriate use. Again, recent advances in computer science allow, with a judicious use of symmetric and asymmetric private keys, retrieval that is fast and convenient using existing technology.
The use of health data and related health care services must create a level-playing field that encourages free-entry and entrepreneurship by small and big players, both in the private and the public sector. Inter-operability and public-good features of the health data will facilitate competition and entrepreneurship.
India is a large, growing country and its health care needs are immense. Advanced health care expertise is concentrated in large cities whereas a large population with health care needs is geographically distant from such expertise and facilities. Not everyone can get admitted to the All India Institute of Medical Sciences at short notice not only because such capacity is limited but also because costs and time constraints prevent most from being able to access such care. Tele-medicine can alleviate these limitations to a great extent. If the patient cannot reach the right doctor or the right facilities, the doctor can reach the patient through tele-medicine and test-results can be communicated electronically with speed. Only a fraction of the patients would need to be moved to facilities far away from home, and while the patient travels, the diagnosis, some palliative care and tests can continue seamlessly without interruption.
Many of the developed countries have created models of digital health with excess and waste, even as they reaped the benefits of digitisation. As India is embarking on an almost greenfield health care digitisation spree, we should take lessons from their experience — leapfrog for sure, but don’t commit similar infrastructural errors as this would be financially disastrous, given India’s scale. Hence it is imperative to have the veterans of industry, technology and business deploying needful and future-proof technologies in developing our model of digital health care.
India is a unique country in many ways and the effective solution for our needs will have to be uniquely Indian. We must create an infrastructure that allows us to do this not only to meet our needs effectively and in a cost-effective manner, but also to create something that much of the rest of the world can emulate.
Kris Gopalakrishnan is an IT and health care expert. Dr Rajeev Sharma is a medical doctor who has created a Blockchain platform for health care. Bhagwan Chowdhry, who co-authored the piece, is a professor at the Indian School of Business, Hyderabad
The views expressed are personal