DIGITAL HEALTHCARE IN INDIA

Introduction:

The World Health Organization defines Digital health as “a broad umbrella term encompassing eHealth, as
well as emerging areas, such as the use of advanced computing sciences in ‘big data’, genomics and artificial
intelligence. It includes the tools and services that use information and communication technologies (ICTs)
for purposes related to health. Such purposes may include improving the accuracy of diagnostics, monitoring
chronic diseases more closely and better results of treatment for patients.

India is a large nation with socio-economic complex features that are reflected in their medical systems. This
includes insufficient number of primary health care doctors working in rural and semi-urban areas and
continuing or ongoing need to create awareness for those working in rural areas. Thus, despite of this,
healthcare in India is facing several challenges including inadequate access, less insurance penetration and a
growing chronic disease burden. It aims to ensure the quality, accessibility and affordability of health
services. To deliver effective and affordable health services to all, it involves:i

1. Accountability: it represents the proportion of target population (registered as a subset of total

population) in the health system. For instance, civil registration and vital statistical mechanisms,
population census, issuance of national or health identifiers which are important for the different
population denominators of the provisions of health care.
2. Supply: it includes the availability of goods and equipments of human resources and of health
facilities and facilitates the access of qualified health workers in geographically accessible health
services, where and when patients need them. Even where the health services are available, there
may be barriers to accessing them for the target populations.
3. Demand: driving demand and increasing access can ensure that there are gaps in contact coverage ii
do not further undermine the health care system performance. Individuals often need multiple
interactions and healthcare follow up. The system of health interventions to be effective and
continuous coverage defines the extent to which they are effective.
4. Quality: it is related to the effective coverage and can be undermined by the gaps that result from
that coverage. Health interventions are performed in a sub-optimal manner, such as when health
workers do not comply the protocols for treatment.
5. Affordability: the direct and indirect costs to the patient may have catastrophic financial
consequences. Efforts made to ensure that individuals are protected from impoverishment due to
health interventions are reflected as improved financial coverage in the affordability layer.

Due to this, the information and communication technology for e-health has worked on improving these
areas and facilitating and improving the health care facilities and information regarding health. iii Since then,
the world has come a long way with the development of information technology. The culmination of a phase
in which such innovation procedures are becoming increasingly accepted. Healthcare technology is pushing
borders, extending its scope and opportunities every day. Built from monitoring of heart rates into watches
to glucose monitors integrated into contact lenses, the healthcare sector is heading into some interesting and
revolutionary times.

India’s expanding health care industry:

Digital technologyiv can help in becoming a game changer in the improvement of these. The Make in India
initiativev by the Indian Government promotes the domestic manufacture of medical devices and helps in
reducing the rates that patients pay for items such as stents and implants that have been imported in the past.
At the same time, the policy environment and regulators in India need to accommodate technological
developments such as the growth of online pharmacies with the appropriate checks in place. Health care
innovation in India, if given the scale of its unserved communities, could serve as a global model for shifting
from treating the ill to preventive care and wellness. Health care has the ability to contribute to the economic
development and employment but it is also a vital sector for protecting the health and wealth of the nation. It
provides an opportunity to find ways to make medical services more comprehensible, reliable and
accessible. India’s healthcare sector is becoming increasingly attractive to investors, with technology – lead
innovations helping to penetrate second and third tier markets.vi

Does the digitization of healthvii data improve the health results or achieve the “health for all” goal? The
digitization of data (e.g. patient records or healthcare personnel and suppliers’ directories) is a colossal and
complicated task which forms the foundation for open, efficient and reliable healthcare delivery. Adopting
digital solutions across the prevention, diagnosis and cure is the smartest route for India to inch closer to the
“health for all” goalviii. And, on its own, it won’t move any needle significantly or rapidly enough to make
any tangible effect on the market. Therefore, India’s digital health mission’s current scope must extend
beyond mere digitaization of health data, to include various aspects of digital health applied.

The brief proposes the drafting of an NDHB 2.0 ix, in addition to the planned digitization activity, which will
bring a holistic version for a future-oriented digital health environment, including telemedicine, digital
health therapy, and digital diagnostics, within its purview for actionable impacts. It has three main reasons:

1. Blending or mixing digital approaches into traditional healthcare models will create a three-in-one
antidote for tackling the system trio of access, affordability and quality problems at once.
2. A digital health system fits in with India’s overall strategic direction to form its new internal order,
with missions like Ayushmaan Bharatx, Swachh Bharatxi, Digital Indiaxii and Make in India all aiming
to build a stable and prosperous society.
3. Health technologyxiii is a revolutionary development for the fourth industrial revolution with complex
implications both for the industry and the society with a longer average lifespan. As a result, India
has the potential to influence global health policymaking and sharpen its ranking of competitiveness
in technological growth. Unlike space-technology, where India has already entered the top echelons,
the health tech arena is in a germinal stage, with a level playing field for most countries.
Some of the most commonly discussed digital technologies that are used to create healthcare solutions in
India are:

1. Telemedicine:

It is one of the original components of digital health and is listed as an essential objective by the National
Health Policy. However, this has yet to be properly nurtured in India. Since then the ISRO’s modest
beginning in 2001 with the telemedicine pilot project has progressed gradually. It has only linked 45 remote
and rural hospitals and 15 super-speciality hospitals in last 20 years. Such facilities efficiency and uptake
was dismal due to limited infrastructure and lack of regulation. It is assumed that the former will be
addressed in the due course of time, because the NDHB defines “inclusivity” to ensure that the unconnected
and digitally illiterate are not left out. The latter requires urgent action. Hence, in order to allow access to
advanced medical consultation services across the country, telemedicine must be put under immediate policy
deliberation as a solution to alleviate doctors shortages and excessive loads on tertiary care hospitals in Tier-
1 and Tier-2 cities.

2. Digital Therapeutics and Diagnosticsxiv:

The introduction of digital therapeutics and diagnostics has begun to disrupt the health products and services
of 20th century. In this respect, there are four forces of technology and research at play. One is deep tech in
human biology: like genomicsxv, microbiome sciencexvi, tumour immunologyxvii and brain sciencexviii, deep
tech provides a deeper understanding of origin of health and how diseases are caused. Second is genetic
engineeringxix and biotech innovationsxx: like gene-editingxxi, tissue engineeringxxii, and molecular
medicinexxiii, which promotes the production of new-age therapies which are precise and personalized. Third
is ICT developmentsxxiv: like 5G, Internet of Things, cloud computing, and 3D printing, which allow
healthcare services to be accessed in a seamless continuum of care, with a combination of in-clinic and
virtual care. This also enables patients to monitor their health in real time, with applications that actively
relay information and alert them to take urgent corrective action or make healthy lifestyle choices. Fourth is
AL/MLxxv, Blockchainxxvi, and Predictive Analyticsxxvii: This makes clinical and diagnostic decision-making
more robust, i.e. less error prone, quicker, evidence-driven and bias-free. It helps medicine practice to
become more humane whereby the interactions between doctor and patient are emphatic and care-oriented,
rather than time-pressed and transactional.xxviii

India’s ongoing digital revolution in Healthcare:

Digital health has the potential to revolutionize that how people interact with national health services and
reinforce the health systems. India is now embarking on a futuristic journey to bridge the healthcare in
divide haves and haves not of the digital health tools. When it comes to digital health, the ministry of health
& family welfare has taken a range of impactful initiatives. Our Honourable Prime Minister has tried to
optimally exploit the digital media and electronic health to meet the key challenges posed to us in health
sector, such as the shortage of human health resources, accessibility of healthcare facilities and affordability
of healthcare services but the current legal and regulatory framework regarding digital health is ambiguous
and vague.

Key I.T initiatives by ministry include numerous mHealth programs to enhance the quality and efficacy of
public healthcare in the country under the digital India campaign. For example, the mobile application –
Vaccine Tracker helps parents in tracking their child’s immunization status and helps them in ensuring
complete and timely vaccination. The mobile application – India Fights Dengue offers comprehensive
details detecting the symptoms of dengue and connects the users to nearest hospitals and blood banks.
Another mobile application – Swasth Bharat provides extensive or detailed information on healthy lifestyle,
disease conditions and symptoms, treatment options, first aid and public health alerts. Through the mobile
application – Kilkari, it sends audio messages directly to families and parents regarding pregnancy,
childbirth and childcare. A mobile based audio training course to broaden the awareness of village-based
volunteer workforce has been created.xxix

The laws that cover the broad framework of digital health is The Information and Technology Act, 2000
and data protection rules, 2011: it involves an exchange of information between patient and service
provider. The patient’s personal information regarding his medical history is considered as sensitive personal
data or information (SPDI)xxx under the data protection rules, 2011. Further, consent is one of the major
requirements under such rulesxxxi. The patient must be informed about this fact that for what purpose data
would be collected, how it will be used and whether it would be transmitted to third parties or not xxxii.
Secondly, it also mandates the implementation of reasonable security practices and procedures to keep the
SPDI secure. Thirdly, it is required to appoint a grievance officerxxxiii.

The applicability of IT act is slightly different for digital health services which has facilitated the interaction
patient and service providers and are not directly involved in provision of such services. In those cases,
service providers would be considered as an intermediary xxxiv under the intermediary guidelines of the IT act.
Hence, the constitutionality of intermediary guidelines and section 79 xxxv of the IT act was challenged under
Shreya Singhal v Union of Indiaxxxvi in which Supreme Court held that the guidelines are vague and
ambiguous and is violating the article 19 of the Indian Constitution. Further it was argued that section 79 of
the act and the guidelines allow the discretion to decide whether an unlawful material is published or not and
these restrictions have gone beyond the purview of article 19(2)xxxvii.

Conclusion:

Health is no longer an internal matter for any single nation in today’s interconnected world. Digital health is
quickly emerging as one of the most important phenomena of this decade and will have a major impact on
geopolitical and socio-economic realities in the future. India must play a more constructive role in shaping
global policies and guiding principles in order to influence answer new questions and conundrums rising
from this disruptive trend. Hence, policy intervention for next generation digital diagnostics and therapeutics
needs to comply with India’s wider AI agenda. The current version of India’s AI policy lists “healthcare” as
one of the most promising areas but classifies it among the most challenging in terms of defining the next
steps.

The future of healthcare in India will be driven entirely by the technology. The development of a digital
healthcare ecosystem will bring a complete gamut of healthcare goods and services under one roof.
Integrated and personalized health systems will bring together various service providers such as hospitals, e-
pharmacies, insurance companies and more; as the need for care will continue from the pre-diagnosis stage
all the way to chronic disease management and treatment. The pace at which India is adapting itself to digital
solutions can, however, be seen as a strong marker for growth in the health-tech industry. The use of a
digital strategy is the convergence of multiple applications to disrupt business processes and ensure
enhanced and sustainable access to services for all. Technology isn’t the solution itself; instead, it allows the
development of healthcare solutions enhanced patient treatment and provider growth.
i

ii
The gap between the overall availability of services and actual contact that individuals have with each other.
iii
Szymon Jarosławski & Gayatri Saberwal, In eHealth in India today, the nature of work, the challenges and the
finances: an interview-based study, 14 BMC MEDICAL INFORMATICS AND DECISION MAKING (2014)
iv
Digital technology refers to an electronic technology that generates, stores and processes data in terms of both positive
as well as non-positive states.
v
Make in India is a major national programme of the Government of India designed to facilitate investment, foster
innovation, enhance skill development, protect intellectual property and build best in class manufacturing infrastructure
in the country. The primary objective of this initiative is to attract investments from across the globe and strengthen
India’s manufacturing sector. It is being led by the Department for Promotion of Industry and Internal Trade (DPIIT),
Ministry of Commerce and Industry, Government of India. This programme is very important for the economic growth
of India as it aims at utilising the existing Indian talent base, creating additional employment opportunities and
empowering secondary and tertiary sector. The programme also aims at improving India’s rank on the Ease of Doing
Business index by eliminating the unnecessary laws and regulations, making bureaucratic processes easier, making the
government more transparent, responsive and accountable.
vi

vii
The digitization of health care has given birth to numerous tools and resources that improve healthcare services,
including software that makes health information more accessible to patients, and keeps patient data secure in one place.
viii
In 1977, the World Health Assembly decided that the major social goal of governments and WHO should be the
attainment by all people of the world by the year 2000 of a level of health that would permit them to lead a socially and
economically productive life.
ix
National Digital Health Blueprint 2.0
x
Ayushman Bharat Pradhan Mantri Arogya Yojana is a part of Indian government’s national health policy which aims
to provide free health coverage at secondary and tertiary level.
xi
Swachh Bharat Abhiyan is a campaign in India that aims to clean up the streets, roads and infrastructure of India's
cities, smaller towns, and rural areas.
xii
Digital India is a campaign launched by the Government of India in order to ensure the Government's services are
made available to citizens electronically by improved online infrastructure and by increasing Internet connectivity or
making the country digitally empowered in the field of technology.
xiii
Health technology is defined by the World Health Organization as the "application of organized knowledge and skills
in the form of devices, medicines, vaccines, procedures, and systems developed to solve a health problem and improve
quality of lives".
xiv
Digital therapeutics deliver evidence-based therapeutic interventions to patients that are driven by high quality
software programs to prevent, manage, or treat a broad spectrum of physical, mental, and behavioral conditions.
xv
the branch of molecular biology concerned with the structure, function, evolution, and mapping of genomes
xvi
The microbiome comprises all of the genetic material within a microbiota (the entire collection of microorganisms
in a specific niche, such as the human gut). 
xvii
describes the interaction between cells of the immune system with tumour cells.
xviii
the scientific study of the nervous system.
xix
the deliberate modification of the characteristics of an organism by manipulating its genetic material.
xx
It provides an authoritative crystallization of some of the evolving leading-edge biomedical research topics and
developments in the field of biotechnology. 
xxi
the manipulation of the genetic material of a living organism by deleting, replacing, or inserting a DNA sequence,
typically with the aim of improving a crop or farmed animal, or correcting a genetic disorder.
xxii
It is the use of a combination of cells, engineering, and materials methods, and suitable biochemical and
physicochemical factors to improve or replace biological tissues.
xxiii
Molecular medicine is a broad field, where physical, chemical, biological, bioinformatics and medical techniques
are used to describe molecular structures and mechanisms, identify fundamental molecular and genetic errors of
disease, and to develop molecular interventions to correct them.
xxiv
The ICT Development Index is an index published by the United Nations International Telecommunication Union
based on internationally agreed information and communication technologies indicators. This makes it a valuable tool
for benchmarking the most important indicators for measuring the information society.
xxv
Abbreviated as Aritficial Learning/Machine Learning.
xxvi
a system in which a record of transactions made in bitcoin or another cryptocurrency are maintained across several
computers that are linked in a peer-to-peer network.
xxvii
Predictive analytics encompasses a variety of statistical techniques from data mining, predictive modelling, and
machine learning, that analyze current and historical facts to make predictions about future or otherwise unknown
events.
xxviii
References:
1. IBEF. (2015). Healthcare industry in India. Retrieved from http://www.ibef.org/industry/healthcare-india.aspx/
2. DIGITAL HEALTH TECHNOLOGY CAN REVOLUTIONIZE HEALTHCARE IN INDIA, IDENTIFIES PHILIPS' 2019
FUTURE HEALTH INDEX REPORT PHILIPS,
https://www.philips.co.in/a-w/about/news/archive/standard/about/news/press/2019/20190821-digital-health-
technology-can-revolutionize-healthcare-in-india-identifies-philips-of-2019-future-health-index-report.html/
3. Nandita Mathur, Digital Health Technology can revolutionise healthcare in India:
Report, HTTPS://WWW.LIVEMINT.COM/
4. World Bank data: http://databank.worldbank.org/data/home.aspx/
5. HOW TECHNOLOGY IS CHANGING HEALTH CARE IN INDIA KNOWLEDGE@WHARTON,
https://knowledge.wharton.upenn.edu/article/technology-changing-health-care-india/
6. 76% of healthcare professionals in India use digital health records:
Report, HTTPS://HEALTH.ECONOMICTIMES.INDIATIMES.COM/
7. Rajendra Pratap Gupta, India to become the world leader in Digital
Health, HTTPS://HEALTH.ECONOMICTIMES.INDIATIMES.COM/
8. Sheetal Ranganathan, Towards a holistic digital health ecosystem in India, OBSERVER RESEARCH
FOUNDATION (n.d.),
9. https://www.orfonline.org/research/towards-a-holistic-digital-health-ecosystem-in-india-63993/
10. file:///C:/Users/HP%2001/Downloads/9789241550505-eng.pdf
11. http://www.nishithdesai.com/fileadmin/user_upload/pdfs/Research_Papers/Digital_Health_in_India.pdf
xxix

xxx
Rule 3 of the Data Protection Rules defines Sensitive personal data or information of a person to mean such personal
information which consists of information relating to (i) password; (ii) financial information such as Bank account or
credit card or debit card or other payment instrument details; (iii) physical, physiological and mental health condition;
(iv) sexual orientation; (v) medical records and history; (vi) Biometric information.
xxxi
Rule 5(1) of Data Protection Rules
xxxii
Rule 5(3) of Data Protection Rules
xxxiii
Rule 5(9) of Data Protection Rules
xxxiv
Intermediary under the IT Act is defined as any person who on behalf of another person receives, stores or transmits
that record or provides any service with respect to that record and includes telecom service providers, network service
providers, internet service providers, web hosting service providers, search engines, online payment sites, onlineauction
sites, online market places and cyber cafes.
xxxv
Section 79 of the IT Act provides intermediaries with exemption from liability if it meets the requirements laid down
under the section
xxxvi
Writ Petition (Criminal) No.167 Of 2012
xxxvii
Article 19(2) of Constitution of India, 1950