Acting on its vision for a National eHealth Authority ("NeHA"), the Ministry of Health and Welfare had introduced a draft bill for Digital Information Security in Healthcare Act ("DISHA" or "Draft Bill").
DISHA's main purpose, as per its preamble 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". Our previous note on the overview of DISHA can be read here https://novojuris.com/2018/08/12/disha-the-future-direction-of-digital-health-information-in-india/). In this blog, we are covering aspects of data ownership, security, consent and others that DISHA proposes.
The Draft Bill defines digital health data as electronic data of an individual containing information about the individual's medical records and health information and such individual would be considered as the owner of the digital health data. DISHA grants rights to owners of digital health data such as:
- The right to privacy, confidentiality and security of their digital health data.
- The right to refuse or give consent for generation and collection of digital health data by Clinical Establishments (a defined term which you can read in our previous blog here...).
- The right to refuse, give or withdraw consent for storage and transmission of digital health data.
- The right to refuse consent thereby restricting access to or disclosure of digital health data. However, it is not clear if the Clinical Establishment can still transmit under "reasonable use", despite refusal by the data owner. It may be noted that reasonable use is used as a wide term.
- The right to ensure that the data collected is specific, relevant and not excessive in relation to the purpose sought.
- The right to know about the Clinical Establishments or entities which may have access to the data, the recipients to whom data has been transmitted or disclosed.
- The right to access the health data including their consent details and access of their data by any Clinical Establishment or any other entity.
- The right to possess the right to seek rectification of data by a Clinical Establishment in the form prescribed by NeHA.
- The right to necessarily mandate express prior permission before transmission or use of data in an identifiable form.
- The right to be notified each time their data is accessed by a Clinical Establishment.
- The right to ensure sharing of data with family members in case of health emergency.
- The right to prevent transmission or disclosure of sensitive data that may cause distress to the owner.
- The right to not be refused health services in case of refusal to give consent for any of the activities or data generation, collection, storage, transmission or disclosure.
- The right to seek compensation for damages cause as a result of breach of data.
DISHA lists down the purposes for which data is to be collected, stored, used which are:
- Advancement of delivery of patient centred medical care.
- Appropriate information for guiding sound medical decisions at time and place of treatment
- Improvement of coordination of care and information among hospitals, laboratories, medical professionals through an effective infrastructure for secure and authorised exchange of data.
- Improvement of public health activities and facilitation of early identification and rapid response to public health threats, such as disease outbreaks and bioterrorism.
- Facilitation of health and clinical research and health care quality
- Promotion of early detection, prevention and management of chronic diseases.
- Carrying out public health research, policy formulation, review and analysis.
- Undertaking of academic research and related purposes.
Under the Draft Bill the usage of personally identifiable information can be undertaken only for advancement of delivery of patient centred medical care, appropriate information for guiding sound medical decisions at time and place of treatment and improvement of coordination of care and information among hospitals, laboratories, medical professionals through an effective infrastructure for secure and authorised exchange of data to extent of ownership rights and in the best interest of the owner. The usage of data for public health related purposes shall be undertaken only after anonymisation and de-identification of data.
No data collected shall be used for any purpose other than what has been prescribed, be provided access to or disclosure of personally identifiable information without express consent of the owner or a statutory or legal requirement. The data collected shall not be used for commercial purpose or disclosed to insurance companies, employers, human resource consultants and pharmaceutical companies, irrespective of such data being identifiable or anonymised. However, the insurance companies may seek consent of the data owner to access such data for the purpose of processing insurance claims.
A Clinical Establishment may, by consent of the owner, collect the health data after informing the owner about the ownership rights, purpose of data collection, identity of data recipients to whom data may be transmitted or disclosed or who may have access to data on a need-to-know basis. A copy of the consent form is to be provided to the owner. Moreover, an entity that engages in collection of health data would be regarded as the custodian of such data and would be responsible for protection of such data. In case the owner is incapacitated or incompetent to provide consent, the same shall be obtained from a nominated representative, one having legal capacity to give consent. In the event the person becomes competent to give consent, the owner would have the right to seek withdrawal of consent given by nominated representative and seek consent of owner for collection of health data as prescribed by NeHA. This option to consent through a nominated representative extends in the case of collection of health data of a minor as well with the minor having the option to seek withdrawal of consent of the nominated representative to give own consent.
DISHA prescribes that the storage of digital health data so collected would be held in trust for the owner and the holder of such data would be considered as the custodian of data thereby making such holder responsible to protect privacy, confidentiality and security of data. The holder of data could be a Clinical Establishment or a Health Information Exchange.
Storage of digital health data shall be stored only by a Clinical Establishment or a Health Information Exchange and shall be held on behalf of NeHA and shall be subjected to such usage as has been prescribed without compromising on the privacy or confidentiality of such data or owner.
The transmission of digital health data is required to be transmitted by a Clinical Establishment to a health information exchange in an encrypted form for reasonable use as per standards prescribed by NeHA keeping in mind the privacy and confidentiality of the owner. A Clinical Establishment or health information exchange would be allowed to transmit the digital health data only after obtaining the prior consent of the owner and giving information to the owner about their ownership rights and the purpose of collection of data. Moreover, a health information exchange is also under an obligation to maintain registers containing information regarding any and all transmissions of digital health data between Clinical Establishments and health information exchanges and between health exchanges.
The digital data collected, stored or transmitted by a Clinical Establishment or a health information exchange may be accessed by a Clinical Establishment on a need-to-know basis. Access to digital health data may be sought by the governmental departments by their secretaries in de-identified or anonymised form by submitting a request to NeHA in furtherance of public usage of health records. Moreover, access may be granted to digital health data for purpose of investigation into cognizable offences or for administration of justice subsequent to order of a competent court. In the case of emergencies, the Clinical Establishments may be granted access to the digital health data of the patient and the relatives of the owner may also be given access to the data for correct treatment of the owner. Moreover, all Clinical Establishments and health information exchanges are required to maintain registers to record purpose and usage of digital health data so accessed in a manner prescribed by NeHA.
Under DISHA, the Clinical Establishments, health information exchanges, SeHA, NeHA are duty bound to protect the privacy, confidentiality and security of digital health data of the owner. Such duty also extends to an entity which has generated and collected digital health data. Such duty is to be given effect to by undertaking necessary measures to ensure that data collected, stored, transmitted is secured and protected against unauthorised access, use or disclosure and against accidental or intentional destruction, loss or damage.
The Clinical Establishments or health information exchanges are required to notify the owners of data in cases of breach or serious breach of digital health data within 3 (three) working days. The Draft Bill does not clarify if the 3 days is to be calculated from the date of breach or from the date of becoming aware of a breach.
- The Draft Bill must identify a competent court that is authorised to pass an order for usage of data.
- The Draft Bill fails to provide for a penalty on Clinical Establishments and health information exchanges for storage of incorrect digital health data.
- The time of 3 working days for intimation of breach, may have to be 3 days and not necessarily "working" days.
- Although the entities have a duty to protect the data of the owner, the duty to notify the owners in cases of breach of information doesn't extend to entities and has been limited only to Clinical Establishments and health information exchanges.
- The Draft Bill must provide for Right to be Forgotten.
- The Draft Bill must provide for a cohesive reading with (Reasonable Security Practices and Procedures and Sensitive Personal Data or Information) Rules 2011, under the Information Technology Act.
- We hope that there will be sufficient Rules under the Draft Bill which can provide for specific consent specifically to certain acts and not a blanket consent.
- The Draft Bill should provide for specific time period for record maintenance.
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.