Experts & Views
By Smitha Krishna Prasad
Medical and health records are increasingly digitised, and ease of access is considered one of the key benefits of this trend. However, patient privacy and security of such records are important concerns that need to be addressed both under the existing legal framework, and in terms of development of new laws.
Earlier this month, news reports suggested that private medical records of over 35000 patients had been made publicly available through the website of a diagnostic laboratory based in Mumbai. Reports indicate that the website of the lab was hacked. However, other reports specify that the lab has disclaimed liability, stating that any requirement for confidentiality is limited in applicability to doctors only. Further, the lab suggested that since they were shortly to be moving to a different system, there was no urgency in remedying the security flaws.
While the above seems to be an internal security issue on the part of the lab, we have seen that health records are a favourite for hackers, across the world. These records are then either held for ransom or sold by such hackers.
The healthcare industry as a whole is seen as one of the least secure industries globally. At the same time, medical and health records of individuals are increasingly being digitised. Individuals and institutions in the healthcare industry are digitising records within their organisations to improve ease of access. The Ministry of Health and Family Welfare, Government of India, is in the process of setting up an Integrated Health Information Platform, and has issued Electronic Health Record Standards (EHR Standards). The EHR Standards are meant to provide for creation and maintenance of health records in a standardised manner that would allow for interoperability across platforms and institutions across the country. There are many pros and cons to undertaking such a digitisation effort – however, this post is limited to examining the legal framework surrounding such digitisation and the protection of privacy of patients.
Current Legal Framework in India
Today, India does not have a comprehensive privacy law, or an industry specific privacy regulation that focuses on the healthcare / medical industry. We do have the Information Technology Act, 2000 (“IT Act”), and the Information Technology (Reasonable security practices and procedures and sensitive personal data or information) Rules, 2011 (“IT Rules”), as well as the Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002 (“MCI Code of Ethics”).
The MCI’s Code of Ethics provides that physicians must maintain medical records pertaining to patients for a period of 3 years from commencement of treatment. Further, physicians must also make such records available to patients, authorised attendants and legal authorities upon request. Physicians are also required to make efforts to computerise such records. While there is no specific provision on maintenance of privacy and security of these medical records, the MCI Code of Ethics does provide that confidences entrusted by patients to physicians must be not be revealed, unless required by law or in public interest. However, the MCI Code of Ethics is applicable to physicians i.e. doctors with MBBS or equivalent qualifications only.
On the other hand, the IT Act and the IT Rules are wider in application. They deal specifically with electronic records and require any person dealing with certain defined types of sensitive information, including medical records, to undertake data protection and security measures.
Any violation of the MCI Code of Ethics calls for disciplinary action against the concerned physician which could include removal of the physician’s name from the register of qualified physicians. The IT Act however, does not provide for any direct action or penalty in the case of non-compliance with the IT Rules, and relies on the person affected by the non-compliance to take action.
In addition to the MCI Code of Ethics and the IT Act, there are a few other laws such as the Medical Termination of Pregnancy Act, 1971 which provide for maintenance of confidentiality of patient information. However, these are largely specific to certain circumstances and are not comprehensive.
In the absence of a comprehensive privacy and data protection law in India, some regulators have taken to establishing basic rules to protect consumers and individuals in their respective industries. For instance, the RBI places certain restrictions on the circumstances in which customer information can be shared by banks. Insurance and telecom companies are restricted from transferring certain customer information outside India.
Given the highly sensitive nature of medical / health related information, and recent trends of commoditisation of such information in the black market, such laws are much needed in the healthcare industry.
The EHR Standards do deal with certain aspects of privacy of patients and security of healthcare records. They prescribe several international standards to be adhered to by members of the healthcare industry while dealing with electronic health records. However, they appear to default back to the IT Act as the legislation that would govern the implementation of any data protection measures in relation to such records.
The Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Bill, 2014 also provides certain safeguards to ensure the privacy of patients, specifically in relation to their HIV status. Some concerns regarding the provisions of this bill have previously been discussed here. However, this proposed bill is again limited in scope, and does not apply across the medical industry.
Reports suggest that recognising the need for a more comprehensive law, the Central Government has taken up the initiative of drafting a healthcare industry specific privacy and data protection law.
Given that this law would be drafted from scratch, we suggest that it should be (a) holistic i.e. be applicable across the entire healthcare / medical industry, and not specifically to doctors / hospitals, and (b) technology agnostic, addressing medical / health information in any format, digitised or not.
The law should also take into account the internationally recognised privacy / fair information principles. These principles provide, among other things, for (a) collection of data by lawful means, and only when required (b) use of data for the purpose it is collected only, (c) adequate security measures to be undertaken to protect data, and (d) accountability and openness about policies in place for use and protection of data.
Further, to the extent that it provides for the digitisation of records, and implementation of EHR Standards, it should be ensured that, the principles of ‘privacy by design’ should be used. The concept of privacy by design stipulates that privacy and data protection measures must be built into any system as a default, taking a preventative approach to data protection rather than a remedial approach.
Another important concern is enforcement – our current laws such as the IT Act, do not provide for proactive enforcement in case of failure to protect privacy / data of individuals, and leave it up to the affected individuals to act. Ideally, a dedicated regulator with the ability to investigate and direct action against defaulters is required. Perhaps the role of the National e-Health Authority proposed by the Government could be expanded to deal with privacy and security of all health records and information.
While the idea of implementing a health privacy and data protection law is a welcome move, it remains to be seen how far this proposed legislation will go towards fully protecting patients’ rights.