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Telehealth, pandemic, and privacy

Telehealth concept. Doctor with a stethoscope on the computer laptop screen
Image credit: gjerome69 / 123rf

In the era of the coronavirus pandemic, telehealth has become a valuable tool for healthcare providers and patients alike – allowing consultations to be had even during a period of stringent lockdown. India is no exception – as if to underscore this point, the Delhi government announced earlier this week free online consultations for the capital’s denizens.

The announcement came from Delhi health minister Satyender Jain, who announced that the state government would collaborate with the healthcare startup CallDoc “to bring 24×7 online medical consultations for free to the people of Delhi. This will save the trouble of physical travel for regular OPD [outpatient department] visits, especially for senior citizens.” More than 100 doctors have been enlisted for the initiative, which will allow consumers to interact via video, audio, or messaging. 

Delhi is not alone in embracing telehealth in the age of coronavirus. Numerous Indian startups have witnessed increased traffic and uptake amidst the coronavirus pandemic for online health checkups. 

Nor is India alone in embracing telehealth. Online health startups are seeing increased use by consumers in numerous countries. Commentators suggest that the coronavirus pandemic could act as a catalyst for greater adoption of telehealth on the road ahead. 

In the United States, restrictions on telehealth were loosened due to coronavirus in what President Donald Trump called “a historic breakthrough — this has not been done before.” The U.S. government – in its US$8 billion Coronavirus Preparedness and Response Supplemental Appropriations Act – included US$500 million to expand coverage for telehealth services under the US government’s federal health insurer Medicare.

The United Kingdom, meanwhile, has seen demand for and usage of telehealth services spike during coronavirus. Doctors increasingly are using digital health platforms to interact with patients who are adhering to physical distancing measures at home.

However, telehealth is far from free from issues. Perhaps foremost among them is privacy and security. As a 2017 paper published in The International Journal of Technology pointed out “when the healthcare practice is moved to the Internet, as in the case with telehealth, and all information is electronic, the situation becomes more complex. Most healthcare providers are not trained in protecting security and patient privacy in cyberspace. In cyberspace, there are many methods that can be used to break into the electronic system and gain unauthorized access to a large amount of protected health information (PHI). Therefore, the information security and patient privacy in telehealth is at a higher risk for breaches of PHI.” 

Data security and privacy is a must in telehealth. Image credit: Galina / 123rf

Attorney Emily Wein noted out in a 2017 interview for Information Security Media Group that “it’s not just your telehealth physician who has access to or is storing your personal health information; it’s the software company that the physician has contracted with to maintain that electronic information that you’re sharing via a telehealth visit…there’s more people touching your information.” 

An article in SC Media observes that “the shift to online medicine” the world is seeing during the pandemic “has resulted in the dissemination of a massive amount of personal health information (PHI), a treasured target of cybercriminals, a trend that’s likely to persist until health officials get the virus in hand.” For a country like India, where concerns are regularly raised surrounding the security of health information and the vulnerability of health data to cybercriminals, such apprehensions are not to be taken lightly. 

In March, India’s Union Ministry of Health and Family Welfare released guidelines in partnership with the government think tank Niti Aayog and the Medical Council of India’s Board of Governors concerning telehealth and telemedicine. The guidelines (accessible here) state that “there has been concern on the practice of telemedicine. Lack of clear guidelines has created significant ambiguity for registered medical professionals, raising doubts on the practice of telemedicine.” It noted a 2018 judgement by the Bombay High Court “created uncertainty about the place and legitimacy of telemedicine because an appropriate framework does not exist.”

The guidelines’ issuance was welcomed by start-up Practo’s co-founder and chief executive officer Shashank N. D., who said “clarity in regulations around telemedicine and digital healthcare was the need of the hour, especially in the light of COVID-19. The guidelines call out the specifics clearly, leaving little room for speculation.”

In the context of privacy, the guidelines state that 

“Principles of medical ethics, including professional norms for protecting patient privacy and confidentiality as per [Indian Medical Council Act] shall be binding and must be upheld and practiced…registered Medical Practitioner would be required to fully abide by Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002 and with the relevant provisions of the IT Act, Data protection and privacy laws or any applicable rules notified from time to time for protecting patient privacy and confidentiality and regarding the handling and transfer of such personal information regarding the patient. This shall be binding and must be upheld and practiced.” 

It goes on to state that “while using telemedicine all actions that wilfully compromise patient care or privacy and confidentiality, or violate any prevailing law are explicitly not permissible.”

Privacy, in the context of telehealth, is vital. This is amplified by the growing uptake of telehealth services in India and the potential for continued growth. Hitherto, the telehealth infrastructure in India has been hampered by a lack of clarity. Stakeholders, including medical practitioners, have called on clear-cut regulations to be implemented. In the form of the Health Ministry guidelines, a framework is in place.

Telehealth services can have manifold benefits. The potential for healthcare delivery through telehealth services to those populations in settings with limited access to resources – thereby reducing the burden on India’s public health system – are significant advantages. A 2019 paper said “even though telemedicine cannot be a solution to all the problems, it can surely help decrease the burden of the healthcare system to a large extent.” But its success will be undercut if security is not a prime concern. Cybersecurity in the context of healthcare has encountered numerous issues in India. If telehealth is to experience a surge, cybersecurity must be robust and fortified to ensure patients’ privacy is preserved and that telehealth can be a boon, not a bane. 

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