The National Health Authority announced its plan to promote health locker-type apps in an online meeting on February 10. These apps are supposed to allow citizens to view their respective health records that will be digitised by way of the Ayushman Bharat Digital Mission.
The meeting also saw a discussion on issues faced by third-party platforms integrated with the ABDM Sandbox. This sandbox is where private or government entities are able to test their regulatory and technical compliance with the ABDM, before passing assessment(s), and graduating to the ABDM live environment.
The ABDM looks to digitise health data which is sensitive; thus, it may cause discrimination and psychological harm if the data is abused or leaked. Health repositories, which will essentially be private entities who get to store such data, are thus worth tracking insofar as their interaction with the ABDM.
How will such apps link up with the ABDM?
During the meeting, NHA’s IT advisor Kiran Anandampillai outlined the following steps:
- A patient registers with a health facility by providing their phone number, name, date of birth, gender
- The health facility creates a new health record for that individual’s account, based on those details.
- The facility then notifies the ABDM about the new record, providing the patient’s phone number and the facility’s Health Information Provider (HIP) ID, (that will be generated after enrollment in the Health Facility Registry) and linking it with an ABDM-approved repository software.
- The ABDM sends the user a message with a deep link to view their record
- Clicking on the link will display all health locker apps integrated with the ABDM through which the record can be viewed. If a user already has such an app on their phone, it will directly open that app.
- After logging into the app using their mobile number, name, gender, and date of birth they can view the record. The app will pull up the record through ABDM’s health information exchange and consent manager component based on the user details provided.
These health locker apps are already a part of it
Although the NHA released its own Personal Health Records app last year, Anandampillai said that it only has barebone features and that the NHA expects the private sector to come up with more technologically advanced apps. Earlier this week, the NHA revealed that it had received 745 registrations for its sandbox. Over 27 third-party organisations have already been integrated with the ABDM, with the following health locker apps being among them:
- Verraton Health
Under the ABDM, health data is stored in a ‘federated’ manner with data storage software or services to be adopted by a hospital, clinic, laboratory, etc.
What’s the problem with private actors having access to health data?
In September 2021, MediaNama had reported on allegations that health tech platforms were storing health records, creating platform IDs, and ABHAs for users without their consent. In some cases where medicines were ordered online, the prescriptions were shared with doctors without consent from the patient. This had raised concerns about user privacy and the level of autonomy ensured by such apps.
Additionally, researcher Radhika Radhakrishnan, in her paper titled “Health Data as Wealth: Understanding Patient Rights in India within a Digital Ecosystem through a Feminist Approach” found that rapid digitisation of health could limit insurance coverage for the most vulnerable.
Insurance companies could normalise requiring access to data from health trackers, electronic health records, etc., to make decisions about their insurance coverage or premiums. This could take place even in the absence of proof that such practices were effective, she said.
“When individuals become legible to private actors who can access massive amounts of personal data about their lives, it changes how people’s health can have value, and who can benefit from that value.” — Radhika Radhakrishnan.
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