ABSTRACT
The devastating impact of the novel corona virus pandemic on the healthcare sector of the country has prompted the search for novel devices and mechanism to mitigate the effect of this medical crisis. The digital healthcare industry is playing a significant role during this harsh time. India is the second-most populous country in the world and the lack of digital infrastructure has certainly posed difficulties in the growth of this industry. Undoubtedly, digital healthcare is capable of doing wonders, but at the same time, it also raises some issues related to data privacy and confidentiality. To tackle such problems, the Indian government has issued certain guidelines and regulatory policies. This article maps the impact of digital healthcare in the era of COVID-19, identifies hurdles in the growth of digital healthcare and deals with the legal and regulatory policies in this sector.
INTRODUCTION
Technology is increasingly spreading in the realm of social and medical health care. With the development and the evolution in information technology, the countries around the world are advancing speedily. Internet-enabled devices for medical observation and disease surveillance have rapidly gained acceptance.
Healthcare technology has come a long way since then and with each day passing, it is expanding the horizons and widening the scope and opportunities. It is not just premised upon ordinary technology but includes novel features too. Digital Health technology in India is rapidly advancing and has become a decisive pillar in providing exceptional care across the healthcare continuum in the country. It is based on the ever-rising amounts of data about people’s habits, their lifestyle, pathophysiological attributes and clinical histories. According to ย ย the World Health Organization (WHO), digital health is a broad overarching term which includes telehealth, eHealth, genomics, artificial intelligence and several other emerging areas. As per the US Food and Drugs Administration (FDA), digital health encompasses categories such as mobile health (mHealth), telehealth and telemedicine, health information technology and personalized medicines. Thus, the term in itself possesses what we call an ‘evolving health data ecosystem’.
In this COVID-19 era, where almost all the hospitals and medical centres in the country are working round the clock for treating the COVID-19 patients, it is the digital health technology that is dedicated to save and help the suspected COVID-19 patients. The use of technology in the health sector is one of the most comfortable things that the doctors are experiencing today. The current global crisis has reopened the domain of ‘digital health’ by providing myriads of benefits to all the citizens.
DIGITAL HEALTHCARE IN CORONA TIMES
In this back-breaking times of unprecedented medical crisis, where it has become impossible to reach out to all the people in need of healthcare facilities, the strenuous efforts of the government are focused on the digital healthcare facilities to attenuate the effect of this pandemic. Amidst this chaos, one of the concerns of the government is regarding the suspected cases which can be broadly divided into two groups. Firstly, those people who have the concerned prodromes but the blood test reports are on hold. Secondly, the ones that came in contact with the positive patients but they have not been tested positive yet and are strictly advised to isolate. These people are required to visit the doctor daily until the final diagnosis report is out.
This makes even the doctors more exposed to the virus as on an average, 22% of the healthcare workers get infected by the virus. In several such cases, this complication has been deciphered with the introduction of virtual health care programs that are announced for the suspected people whose situation is not at all critical. An example of such virtual programs is the one developed by an acute care management firm,
Day To day Health, in Mumbai. This program involved an app that provides a virtual care team. In the present scenario of COVID-19, the Government of India has emphasized and actively promoted the use of digital health care as on 14th April, the Prime Minister urged the countrymen to download the Aarogya Setu app.This initiative of developing this application by the Ministry of Electronics and Information Technology along with a team of 20 experts, has been appreciated by the WHO and World Bank. The app has come into existence to link the common man with the essential health services and make them aware of the risks and advisories concerning the restrictions of COVID-19.7 Based on the health status of an individual, this app ‘Aarogya Setu’ executes a form of digital contract tracing.8 Although this app has been criticized on the ground of security by French ethical hacker Robert Baptiste, claiming that the security of 90 million Indians was at stake.9 Justice B.N. Srikrishna, the former Supreme Court judge, also stated that the government cannot make it mandatory for people to download the app as it had no legal backing.
However, this app has become the most downloaded healthcare app as it reached fifty million users in just thirteen days. Analysing the post lockdown scenario in the country, a significant number of hospitals have adopted to telemedicine and the registered medical consultants have opted for teleconsultation that has made the communication between the doctors and patients, safe and easier. The officials of major telehealth platforms like Practo and Apollo have confirmed that the number of queries on such platforms have increased by more than 50%.13 Thus, during this pandemic, mainstreaming the teleconsultation and virtual healthcare has turned out to be a very cathartic and transformative change adopted by the government and hospitals.
LEGAL AND REGULATORY FRAMEWORK
The health sector of the country is witnessing a real digital revolution with the embodiment of technology in all the processes. There is no doubt that the health sector is blooming and blossoming, however, at the same time, it is crucial to assure the citizens that their data is safe, secured and confidential. Currently, in India, the legal framework related to the digital health is regulated by the Information Technology Act, 2000
In the year 2018, the Indian Government proposed a bill for Digital Information Security in Healthcare Act (DISHA) which aimed at the establishment of National eHealth Authority (NeHA) and State e-health Authorities (SeHA) in the country. The purpose of DISHA was also to initiate a health information exchange and ensure data security, confidentiality, collection and transmission of the digital health data. The act defines the rights of the owners of health data and lists down the duties of the collector of the data. The breach of any of the provision of the act will be liable for strict actions.
INDIA’S NEW TELEMEDICINE GUIDELINES
The figures of the coronavirus positive cases in the country are mushrooming incessantly. As a result of which, on 25th March 2020, the Ministry of Health and Family Welfare has issued and approved
Telemedicine Practice Guidelines for allowing Registered Medical Practitioners (RMPs) to provide healthcare using telemedicine.18 These guidelines have been adopted as an amendment in the form of regulation to ‘Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002’ under the Indian Medical Council Act, 1956. These guidelines are needed to be followed by the RMPs while providing e-medicine or any consultation through technology to a patient where distance is a critical factor.
Before this, there was no specific legislation which dealt with the practice of telemedicine in the country. This is the first legislation on telemedicine. There are several acts and statutory guidelines but they primarily focus on the practice of medicine and the data privacy issue concerning digital health. According to the guidelines, RMPs are required to provide healthcare in the interest of people and their communities by using communication technologies and exchanging the required information to facilitate the process of diagnosis, treatment and prevention. These guidelines have been issued keeping in mind several complications that are prone to arise while opting for digital healthcare in place of the traditional ones. RMPs are required to abide by the privacy and protection laws, Informational Technology Act, 2000, Indian Medical Council Regulations, 2002 and other law related to the data privacy and confidentiality of the patients. As per the guidelines, the prescription given by the practitioners is restricted to a certain category of medicines. The consent of the patient is mandatory while treating him and they must not be anonymous to each other. Further, through the usage of these guidelines, the principle of social distancing is also ensured. It will help in dealing with this outbreak and the present crisis by maintaining a safe distance between the patients and the Practitioners. In future, this will make the digital healthcare more approachable, economical and legally protected.
IMPEDIMENTS AND THE SOLUTIONS
The efforts of the government to uplift the digital healthcare from a nascent to a developing one should be applauded and praised. But there are enormous challenges that exist in this initiative of the government. One of the biggest hurdles in the growth of digital healthcare in India is the ever-growing population. With a population of 1312 million people and drastically increasing ageing population, the country is facing tremendous difficulties in the healthcare sector. The rank of the Also, the doctor population ratio in India is 1:1,457 which is extremely low as compared to the recommendation of the WHO i.e. 1:1,000.21 another problem is the lack of digital infrastructure and the lack of training provided to medical practitioners which are the essential requirements for the development of the digital healthcare industry. In India, the number of physicians and the practitioners, bed density, pharmaceutical personnel density is not up to the mark when compared with the standards of the WHO. The healthcare departments and their access are scattered and biased in different states of the country. The healthcare expenditure is also not enough to meet the requirements of all the citizens. With the digitization in the health sector, the expectations of the people are always high, demanding accessibility, connectivity and faster service 24/7. One of the other major issues that are required to be tackled by the government include the detection of the subsets that are at high risk of being infected by COVID-19. For that, the various governments all over the world are relying on Digital DHIS2 based solutions that make it easy to record the data of those travellers that enter their country, coming from at-risk countries. Governments are trying to engage with those agencies that are capable of developing such systems and with this, the process of detecting and reporting the COVID-19 patients would be accelerated.
There exists a dire need of increasing the investment in innovating digital healthcare, by the government. The concern of limited access has to be taken care of by providing internet connectivity in every part of the nation. For digital healthcare to play a catalytic role in perpetuity of safeguarding timely medication, the government needs to focus on increasing the medical practitioners and should urge the major medical companies to adopt virtual healthcare platforms. The Government must encourage such digital healthcare start-ups that possess the objective of innovating the present hospital information management systems through the use of technology.
CONCLUSION
The current global crisis has unravelled the infinite number of opportunities in augmenting the digital healthcare sector in the country. The current scenario of India itself speaks about how digital healthcare is playing an influential role in fighting against this draconian virus. Digitization in India has delineated the relationship between a patient and a physician and has ultimately changed the definition of healthcare. It will certainly guarantee a high grade of healthcare services and will become more accessible to the future generation.
The outbreak poses humongous challenges to the healthcare sector of the country. But the digital healthcare and the technology is successful in warring against COVID-19 by developing a novel diagnostic, a strong surveillance system, telehealth and mobile chatbots for spreading the information about the virus. Digital healthcare is no longer an alternative, but a compulsory requirement. Amidst this pandemic, one can say that health is wealth and technology being its greatest investment.