India: DISHA – The Future Direction Of Digital Health Information In India

Last Updated: 17 August 2018
Article by Manas Ingle

The Ministry of Health and Welfare in the year 2015 published a note on establishing a National eHealth Authority ("NeHA") to regulate the emerging usage of electronic mediums in healthcare, especially for maintenance of e-Health records and digital health information across India. The goal of NeHA is "to ensure development and promotion of eHealth ecosystem in India for enabling, the organization, management and provision of effective people-centred health services to all in an efficient, cost-effective and transparent manner".

The Ministry Health and Welfare ("Ministry"), eHealth Department has been working on developing international standards for creating, maintaining and storing of eHealth records. There were circulars in 2013 and 2016 providing guidelines and specific standards to be adopted and implemented by hospitals, medical professionals and other stakeholders in the healthcare industry, which were not mandatory, but definitely a step forward in digitising health care records.

Innovations in integrating healthcare and technology is helping a large population to access healthcare. Acting on its vision for NeHA, the Ministry had introduced a draft bill for Digital Information Security in Healthcare Act ("DISHA" or "Draft Bill").

DISHA'S main purpose, as per the pre-amble is to (i) establish NeHA, State eHealth Authorities ("SeHA") and Health Information Exchanges; (ii) standardise and regulate the process related to collection, storing, transmission and use of digital health data; (iii) and to ensure reliability, data privacy, confidentiality and security of digital health data".

DISHA aims to have a national as well state level implication and aims to regulate the digital health data in a federal structure i.e. NeHA being a central and an apex authority under the Bill established by the Central Government as per the provisions of this Bill and SeHA being a state level authority established by the respective State Governments. Further the Central Government shall establish as many Health Information Exchanges as necessary. Further under the act there has to be National level and State level executive committees which will aid and assist NeHA and SeHAs in the performance of their functions under DISHA.

DISHA, is applicable to clinical establishments which includes medical institutions and individuals performing and providing any kind or form of medical and healthcare services excluding hospitals owned and operated by the army, navy and the air force. However, it includes clinical establishments which are owned and operated by government or a department of government.

Further these clinical establishments can only collect digital health information for certain particular purposes which are more or less related to providing medical and healthcare services to owners of the digital health information. DISHA makes clear that digital health in any form i.e. whether identifiable or anonymized, shall not be accessed, used or disclosed to any person for commercial purposes.

The Draft Bill enumerates the functions of NeHA and SeHA ("Authorities") which are to:

  • formulate standards, guidelines and protocols for generation, collection, storage and transmission of the digital health data.
  • define protocols to safeguard the data from any theft or breach and to provide for data security measures at each level of processing of data, which shall at least include access controls, encryption and audit trails.
  • lay down protocols for transmission of digital health data to and receiving it from other countries.
  • provide for standards for establishing necessary norms and standards for certifying digital healthcare data systems and stakeholders.
  • conduct regular checks and investigations to ensure compliance with law.

One of the key aspects of DISHA is to establish Digital Health Exchanges; digital health information exchange ("DHIE") allows doctors, nurses, pharmacists, other health care providers and patients to access and securely share a patient's vital medical information electronically—improving the speed, quality, safety and cost of patient care. Any and all transmission of digital health information will happen through these exchanges. The intention under DISHA is to store and keep all the digital health data in these DHIEs located across India. This can only be possible if the digital health information is standardised i.e. it is maintained in same format by all and therefore the Ministry primarily introduced the eHealth record standards and now through DISHA wants to integrate the eHealth records and provide the whole digital healthcare system a proper structure under these DHIEs. It would be good if the Government can aggressively promote data centres across India.

Under the Draft Bill, DHIEs will be monitored and controlled by their respective Chief Health Information Executive whose duties primarily will be to take care of the DHIEs day to day affairs, to access and further transmit the digital health information appropriately as transmitted by clinical establishments, notify the data breach to a data owner and store the data appropriately.

At the outset this looks like a fairly centralised system of data storage and therefore the same may be vulnerable to cyber threats and data breaches. One of the ideas that can be considered is to store eHealth records using block-chain technology to make the DHIEs more secure.

DISHA elaborates ways to protect the data and has brought in the concept of "data ownership" i.e. digital health data under the Draft Bill is explicitly owned by the person of whose digital health data is generated and processed. Section 31 of the Draft Bill, states that individuals are the owners of the digital health data and clinical establishments and DHIEs are custodians of the digital health information and have a duty of trust to maintain confidentiality and security of such data.

The Draft Bill explicitly describes the roles and responsibilities at the time of collection of data, transmission, anonymisation and de-identification of data. The data owner has to provide explicit consent to various actions that can be taken on the data. The Bill also provides individuals with a right to rectify their digital health data which might be inaccurate and incomplete, a right to have obtain explicit consent in each and every instance of transmission of data, right to be notified, right to prevent disclosure of digital health data under certain circumstances, right to not to be refused of any health services.

A breach under DISHA is of two types, (i) breach of digital health data and (ii) Serious breach of digital health data. Serious breaches are detailed to include cases where a person or an entity or a clinical establishment breaches digital health data intentionally or if digital health data is used for commercial purposes, or breach occurs where the digital health data was not in de-identified or anonymized form.

Punishment for a breach of digital health data is that "A person shall be liable to pay damages by way of compensation to the owner of the digital healthcare data in relation to which the breach took place". Serious breaches are punishable with imprisonment as well.

While DISHA appears to be conceived with the right intent, there are certain aspects which has to be thought through in more depth.

  • The many mobile apps which collects huge amounts of health data in order to provide tracking/monitoring for the users or apps which are aggregators of medical practitioners and providers or apps which are market-places for medical practitioners, pharmacists etc. or apps which connect medical practitioners with patients. These apps are not part of the definition of "Clinical Establishment" to whom the law applies.
  • With India proposing new legislation for data protection and privacy, it has to be seen how this Draft Bill inter-relates.
  • It is believed that block-chain technology might help in keeping the data secure. This is already being used in Estonia.
  • DISHA prohibits the use of digital health information for commercial purpose, whether in anonymized or de-identifiable form. However, operationalizing of collection and transmission should be more robust and India has seen "Aadhar" related mis-use of personal data.
  • Sharing of data on "need to know basis" seems wide and it would be essential to perhaps either through the Rules under the Draft Bill can make it more specific.
  • Compensation for data breaches, including adjudication has to have some specific and strict timelines.

DISHA is definitely a right direction but should have to maintain the fine balance in enabling innovation in health-care, government's requirement of data, protecting the data-owners' rights in a swift and efficient manner, making it easy for the medical practitioners and other stakeholders in the healthcare industry to make this robust.

Over the next blog, we will detail the consent, information that can/ cannot be collected etc.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Authors
Similar Articles
Relevancy Powered by MondaqAI
 
In association with
Related Topics
 
Similar Articles
Relevancy Powered by MondaqAI
Related Articles
 
Up-coming Events Search
Tools
Print
Font Size:
Translation
Channels
Mondaq on Twitter
 
Mondaq Sign Up
Gain free access to lawyers expertise from more than 250 countries.
 
Email Address
Company Name
Password
Confirm Password
Position
Industry
Mondaq Newsalert
Select Topics
Select Regions
Registration (you must scroll down to set your data preferences)

Mondaq Ltd requires you to register and provide information that personally identifies you, including your content preferences, for three primary purposes (full details of Mondaq’s use of your personal data can be found in our Privacy and Cookies Notice):

  • To allow you to personalize the Mondaq websites you are visiting to show content ("Content") relevant to your interests.
  • To enable features such as password reminder, news alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our content providers ("Contributors") who contribute Content for free for your use.

Mondaq hopes that our registered users will support us in maintaining our free to view business model by consenting to our use of your personal data as described below.

Mondaq has a "free to view" business model. Our services are paid for by Contributors in exchange for Mondaq providing them with access to information about who accesses their content. Once personal data is transferred to our Contributors they become a data controller of this personal data. They use it to measure the response that their articles are receiving, as a form of market research. They may also use it to provide Mondaq users with information about their products and services.

Details of each Contributor to which your personal data will be transferred is clearly stated within the Content that you access. For full details of how this Contributor will use your personal data, you should review the Contributor’s own Privacy Notice.

Please indicate your preference below:

Yes, I am happy to support Mondaq in maintaining its free to view business model by agreeing to allow Mondaq to share my personal data with Contributors whose Content I access
No, I do not want Mondaq to share my personal data with Contributors

Also please let us know whether you are happy to receive communications promoting products and services offered by Mondaq:

Yes, I am happy to received promotional communications from Mondaq
No, please do not send me promotional communications from Mondaq
Terms & Conditions

Mondaq.com (the Website) is owned and managed by Mondaq Ltd (Mondaq). Mondaq grants you a non-exclusive, revocable licence to access the Website and associated services, such as the Mondaq News Alerts (Services), subject to and in consideration of your compliance with the following terms and conditions of use (Terms). Your use of the Website and/or Services constitutes your agreement to the Terms. Mondaq may terminate your use of the Website and Services if you are in breach of these Terms or if Mondaq decides to terminate the licence granted hereunder for any reason whatsoever.

Use of www.mondaq.com

To Use Mondaq.com you must be: eighteen (18) years old or over; legally capable of entering into binding contracts; and not in any way prohibited by the applicable law to enter into these Terms in the jurisdiction which you are currently located.

You may use the Website as an unregistered user, however, you are required to register as a user if you wish to read the full text of the Content or to receive the Services.

You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these Terms or with the prior written consent of Mondaq. You may not use electronic or other means to extract details or information from the Content. Nor shall you extract information about users or Contributors in order to offer them any services or products.

In your use of the Website and/or Services you shall: comply with all applicable laws, regulations, directives and legislations which apply to your Use of the Website and/or Services in whatever country you are physically located including without limitation any and all consumer law, export control laws and regulations; provide to us true, correct and accurate information and promptly inform us in the event that any information that you have provided to us changes or becomes inaccurate; notify Mondaq immediately of any circumstances where you have reason to believe that any Intellectual Property Rights or any other rights of any third party may have been infringed; co-operate with reasonable security or other checks or requests for information made by Mondaq from time to time; and at all times be fully liable for the breach of any of these Terms by a third party using your login details to access the Website and/or Services

however, you shall not: do anything likely to impair, interfere with or damage or cause harm or distress to any persons, or the network; do anything that will infringe any Intellectual Property Rights or other rights of Mondaq or any third party; or use the Website, Services and/or Content otherwise than in accordance with these Terms; use any trade marks or service marks of Mondaq or the Contributors, or do anything which may be seen to take unfair advantage of the reputation and goodwill of Mondaq or the Contributors, or the Website, Services and/or Content.

Mondaq reserves the right, in its sole discretion, to take any action that it deems necessary and appropriate in the event it considers that there is a breach or threatened breach of the Terms.

Mondaq’s Rights and Obligations

Unless otherwise expressly set out to the contrary, nothing in these Terms shall serve to transfer from Mondaq to you, any Intellectual Property Rights owned by and/or licensed to Mondaq and all rights, title and interest in and to such Intellectual Property Rights will remain exclusively with Mondaq and/or its licensors.

Mondaq shall use its reasonable endeavours to make the Website and Services available to you at all times, but we cannot guarantee an uninterrupted and fault free service.

Mondaq reserves the right to make changes to the services and/or the Website or part thereof, from time to time, and we may add, remove, modify and/or vary any elements of features and functionalities of the Website or the services.

Mondaq also reserves the right from time to time to monitor your Use of the Website and/or services.

Disclaimer

The Content is general information only. It is not intended to constitute legal advice or seek to be the complete and comprehensive statement of the law, nor is it intended to address your specific requirements or provide advice on which reliance should be placed. Mondaq and/or its Contributors and other suppliers make no representations about the suitability of the information contained in the Content for any purpose. All Content provided "as is" without warranty of any kind. Mondaq and/or its Contributors and other suppliers hereby exclude and disclaim all representations, warranties or guarantees with regard to the Content, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. To the maximum extent permitted by law, Mondaq expressly excludes all representations, warranties, obligations, and liabilities arising out of or in connection with all Content. In no event shall Mondaq and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use of the Content or performance of Mondaq’s Services.

General

Mondaq may alter or amend these Terms by amending them on the Website. By continuing to Use the Services and/or the Website after such amendment, you will be deemed to have accepted any amendment to these Terms.

These Terms shall be governed by and construed in accordance with the laws of England and Wales and you irrevocably submit to the exclusive jurisdiction of the courts of England and Wales to settle any dispute which may arise out of or in connection with these Terms. If you live outside the United Kingdom, English law shall apply only to the extent that English law shall not deprive you of any legal protection accorded in accordance with the law of the place where you are habitually resident ("Local Law"). In the event English law deprives you of any legal protection which is accorded to you under Local Law, then these terms shall be governed by Local Law and any dispute or claim arising out of or in connection with these Terms shall be subject to the non-exclusive jurisdiction of the courts where you are habitually resident.

You may print and keep a copy of these Terms, which form the entire agreement between you and Mondaq and supersede any other communications or advertising in respect of the Service and/or the Website.

No delay in exercising or non-exercise by you and/or Mondaq of any of its rights under or in connection with these Terms shall operate as a waiver or release of each of your or Mondaq’s right. Rather, any such waiver or release must be specifically granted in writing signed by the party granting it.

If any part of these Terms is held unenforceable, that part shall be enforced to the maximum extent permissible so as to give effect to the intent of the parties, and the Terms shall continue in full force and effect.

Mondaq shall not incur any liability to you on account of any loss or damage resulting from any delay or failure to perform all or any part of these Terms if such delay or failure is caused, in whole or in part, by events, occurrences, or causes beyond the control of Mondaq. Such events, occurrences or causes will include, without limitation, acts of God, strikes, lockouts, server and network failure, riots, acts of war, earthquakes, fire and explosions.

By clicking Register you state you have read and agree to our Terms and Conditions