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Digital Health ID Card – Smart Governance or Good Governance?
Digital Health ID Card – Smart Governance or Good Governance?
By- Aditi Maheshwari
The growing dependence on internet of things in various forms
such as development of smart cities, robotic functions replacing manpower
services, increasing use of drone for security, delivery of medicines and food,
photography or video capturing, etc. highlights the influence of technological
advancements in the current societal framework. Government functions are
naturally falling in the sphere of technological influence which can’t be
criticised completely but in certain aspects this requires serious reflection. Will
digital governance for health be a transformative move in improving the health ecosystem of India? What are the priority determinants in the health sector? In times of
fiscal crisis and shifting demographics, collaboration of public private
partnerships to enable improved health infrastructure as well as better diagnostic
solutions is no doubt a rewarding venture.
The latest example is the Digital Health ID Card programme under
The Ayushman Bharat Digital Mission, which seeks to ease the process of
availing medical treatment in any corner of the country along with safeguarding
the privacy of the citizens. However, a pilot project is being executed to
understand the evidential results for the same.
There are various benefits attached to this digital health id
card like storage of complete health records, reduced number of tests, no need
to carry physical documents, linkage of Aadhar database to this card for
safeguarding identity proof, etc. This is a great example of smart governance allowing
for new business models in the delivery of services but is this also a good
governance practice is what needs serious reflection.
Making health facilities easily available to the rural and
underprivileged people should be our priority more than focusing on providing
digital database. Real drivers of change will be when governments focus on providing
easy and fast access to the life-saving treatments, to ensure the underprivileged
are guaranteed financial protection to meet out expensive treatments, addressing
the changing population needs and health inequities, addressing food crisis, etc.
especially during the time of pandemic and outbreaks of avian influenza when
the governments do not have much bargaining power.
Prima facie this digital health id card facility looks attractive,
but this also makes it a lucrative opportunity to attack the privacy of
individuals whose data would otherwise have been restricted to a few
institutions in the normal course but now their personal data is available
nationally as per the data management policy draft. The stored data is not shared
with anyone without the persons consent with the participating health providers,
but in order to avail the advantage of this digital health ID card such consent
is mandatory. Hospitals and governments agencies will be allowed to collect
sensitive personal data of patients in the normal course of health ecosystem, i.e.,
information relating to physical, mental, physiological health, genetic data,
etc. Also, other sensitive information like bank account details and payment
details will be stored in the database, making it easily prone to cyber-attack.
One cannot also withdraw from the fact that technological and
logistical challenges in implementing this scheme is a matter of concern. Ethical
management needs to be addressed too, which won’t be an easy task because of
the numerous parties involved including cyber security loopholes and hacking
attacks. Cyber criminals will naturally feel more tempted, which makes it essential that all
responsible precautions to safeguard the privacy of the patient must be
ensured.
Diffusion, democratization and shared value, will result in data
fiduciaries scope being broadened, as yoga and wellness centres, local pharmacies
will also be a part of this in addition to doctors, hospitals and diagnostic
centres. The responsibility of getting consent of people and security of data
will be with these institutions. Government will have complete access to this
data, along with the liberty to make anonymised or de-identified data in an aggregated
form making it available for research and development works. It is important to
ensure that the secondary use of health data with appropriate deanonymization
of datasets is implemented with ethically centred systems for testing, validating
and benchmarking artificial intelligence solutions and big data analyses across
various parameters and settings.
It is vital to take care that no compromise in terms of implementing
a strong legal and regulatory framework to
protect privacy, confidentiality, integrity and the processing of personal
health data, along with measures to deal with cybersecurity, accountability and
governance, ethics, equity, capacity building, literacy, trust building, ensuring
that good quality data are collected and eventually with proper approval mechanism
for the use of same is shared to support planning, commissioning and
transformation of services, protection against malign or inappropriate use of
information and the penalty for infringements must be executed transparently and
in a way the layman can understand.
The user must be made aware in detail regarding the
consequences of sharing their private information with various research and
development institutions. The range of influence will be exponential covering
not just clinical research but also academic research, statistical analysis,
archiving, policy formations, research for diagnostic solutions, health reform
measures, etc. Competing agendas will exploit use of personal data of
individuals for practically anything. Even though individual consent will be
taken before sharing their data, yet the fact is that large no. of population
is not sufficiently aware about the consequences of permitting the use of their
private information by these authorities, making them easy targets for
exploitation. All this naturally raises the question whether this is a move of
good governance or merely a move to show off smart governance. Think for
yourself.