This Article has been written by Yashita Bharadwaj of Nirma Institute of Law.
INTRODUCTION
During this pandemic, our country realised the importance of an effective and efficient healthcare sector. In order to transform healthcare in India, on the occasion of 73rd Independence Day, the honourable prime minister of India, Shri Narendra Modi, launched the National Digital Health Mission with an aim of starting a campaign in which technology will play a big role.This mission comes under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana. Nation Digital Health Mission will create individual Digital Health ID's which will store every individual's medical records. Digital Health ID's will help people in getting treatment with the help of technology. This Digital Health ID will work as a digital health account of a person and will include every single detail about the health condition of that particular person. It would contain every test, medical report, or any diagnosis along with all medicine details in it. Our Prime Minister aimed this mission as a one-stop healthcare solution for each citizen of the country. The government rolled out the mission in six union territories namely Chandigarh, Andaman and Nicobar Islands,Dadra and Nagar Haveli, Daman and Diu, Ladakh, Lakshadweep, and Puducherry.[1]So, currently, only the citizens living in these territories can generate their Health ID from the portal available at Nation Health Authority.
WHAT IS NATIONAL DIGITAL HEALTH MISSION
National Digital Health Mission was proposed by NITI Aayog, under which all health-related information will be stacked in one place. This mission will focus on providing every citizen with good quality health services, which can be accessed from every part of the country. National Digital Health Mission will be a great revolution in the healthcare industry and aims to equip more than 1.3 billion citizens of India. This mission will create and include various digital health services like telemedicine, e-pharmacy, personalized medicines, and many more which will create an ecosystem that can assimilate existing health information systems. Under this mission, every citizen will be provided an Aadhaar-like 14 digit health ID. This mission will also be a great step towards accomplishing United Nations Sustainable Development Goal 3.8 of Universal Health Coverage.[2] This ID will store and track every citizen's health. Now, the most important question in today's technological advance society is how this ID will work, whether it is safe or not, does it infringe one's privacy or not. These questions will be addressed in the further part of this article.
WHAT IS DIGITAL HEALTH ID
The digital health ID is a form of mobile application which asks for either Aadhaar Card if you want to avail government benefit schemes or mobile number for generating the ID. Similar to any mobile application this portal will ask you for basic details like your name, date of birth, state, gender, etc. The NDHM portal also asks for creating an alias along with a password that could be used for further signing in. Any public hospital, community health centres or any other healthcare provider who is a part of the National Health Infrastructure Registry can also help us in creating a Health ID card. For children below the age of 18 years, parents have the authority of creating a health ID, and under this system, individuals can also make nominees view and manage their health ID. These digital health ID's will keep a record from admission to treatment and even discharge of the patient. Insurance companies can also collect health details of their clients directly through their digital health ID's.
IS DIGITAL HEALTH ID SAFE
The government claims that this health ID is completely safe and does not infringe anyone's privacy. This system has a consent-based mechanism in which a person can hide certain information from selected healthcare providers by allowing the feature of partial consent only. Only the registered doctors or healthcare bodies who have consent by the person can access the healthcare information provided by him/her in their health IDs. Unlike Aadhaar this system has a voluntary opt-in mechanism which also has a door of opting out. So, whenever any citizen doesn't feel safe or no longer want to associate themselves with this unified healthcare data, then they can delete their IDs and can request for erasing their data. The NHDM portal also encrypts the information entered by the informant before its transmission and receipt. For better functioning and more security reasons, the government is planning to develop a National Policy on Security of Health Records to handle these records.
IS DIGITAL HEALTH ID PROTECTED BY VALID LEGISLATION
In India, digital health ID is not governed by any specific law, and it leaves it open to the states to decide whether to mandate its use for any other purpose or not. Currently, National Health Stack(2018)[3], along with National Health Policy(2017)[4] and the National Digital Blueprint Report(2019)[5], governs the use of the digital health ID. These policies have not been passed by the parliament therefore cannot be considered as valid law. The main aim of National Health Policy (2017) was to strengthen the trust of the common man in the public health care system, so the policy identified it as a problem because until and unless we have a valid law to govern, people will rarely trust the system.
The National Health Stack and National Digital Blueprint Reportdoes not specifically tell us about the uses of ID but mandates the adoption of some basic standards to ensure sufficient control over the ID system. Although the National Digital Health ID has the feature of partial consent it doesn't specifically mention who can access the system and who are restricted, therefore this digital ID system mandates everyone to register themselves with the directory which enables "Identity and Access Management" for health apps that use the Digital ID system.
If the Digital ID system fails to protect the data and interest of the patients then data protection laws address the gap. Legislations like Personal Data Protection Bill (2019), Digital Information Security in Healthcare Act, etc.
WHAT RIGHTS USERS HAVE
We do have the right to access our health records without any time or place restrictions but the healthcare provider may deny the access of certain information if the respective licensed professional has the opinion that the release of information may endanger the life of the patients. If any patient wants to correct or update the data in their health ID then they have to take prior permission and verification from the licensed healthcare provider.[6] Patients have the right to hide information from healthcare providers to whom he/she doesn't want to share the details.
CONCLUSION
This National Digital Health Mission is a revolutionary step in digital healthcare. This mission aims to use technology to ease the healthcare system. The NDHM is a part of the National Digital Blueprint Report, which also wants to centralise the whole healthcare system in India so that every individual is connected to every healthcare professional living in any part of the country. Although this initiative will transform the healthcare system, however, this mission gives rise to various challenges and privacy concerns. Since the government is collaborating with numerous private as well as public hospitals, insurance companies, diagnostic centres, and various other healthcare providing institutes, there is a high risk of exposing individual digital data to hacking and malafide commercial purposes. Also, if this mission is planning to centralise the health data of the country, it is difficult for the people from rural areas to be included in this scheme as they don't have access to the internet and there is a lack of digital education. So, before applying this digital health ID system to society, various things are there which should be discussed and addressed like: who will own the data uploaded on the digital ID, will the owner of the data be similar, like explained, in Digital Information Security in Healthcare Act or there will be any other criteria, who will maintain the digital repository of citizen's health data, whether the data can be transferred within the service providers, how much information can be accessed by insurance companies,and many more. So, before implementing this system in our country the potentials and pitfalls of digital health ID must be reconsidered.
[1]"National Digital Health Mission rolled out on pilot mode in 6 union territories", THE ECONOMIC TIMES,(15th,August,2020),https://m.economictimes.com/industry/healthcare/biotech/healthcare/national-digital-health-mission-rolled-out-on-pilot-mode-in-6-union-territories/amp_articleshow/77565945.cms [2]Sustainable Development Goal 3.8 of Universal Health Coverage, Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all. [3]"National Health Stack", July,2018, NITI Aayog, https://niti.gov.in/writereaddata/files/document_publication/NHS-Strategy-and-Approach-Document-for-consultation.pdf [4]"National Health Policy", April2017,MINISTRY OF HEALTH AND FAMILY WELFARE, https://www.nhp.gov.in/nhpfiles/national_health_policy_2017.pdf [5]"National Health Blueprint Report", April 2019, MINISTRY OF HEALTH AND FAMILY WELFARE, https://www.nhp.gov.in/NHPfiles/National_Digital_Health_Blueprint_Report_comments_invited.pdf [6]Electronic Health Record Standards, 2016.
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