The inaugural session was addressed by Dr. V K Singh, Managing Director, InnovatioCuris Pvt. Ltd., who set the tone for the conference by raising the genuine questions as how one can create healthcare delivery at optimum costs. He emphasized on working with grassroot innovators. In his speech, he also warned the young innovators to trust the technology only up to a limit.

Our guest of honor, Lt General (Dr.) Rajesh Pant, National Cyber Security Coordinator,Prime Minister’s Office, Government of India, in his special address quoted Mark Twain’s quote, “Gutenberg’s invention created heaven, and along with it a new hell”. He related this saying by how it applies equally to technology. As the technology has given us new horizons and ways to live, it has alongside created problems too.

Dr. Yasmin Ali Haque, UNICEF India Representative in her introductory address, gave a brief overview on the how unmet needs, especially in health sector become the mother of innovations and how technology can be a solution to address those innovations. She insisted on the use of scalable technology as to how it can be made accessible to millions of people. Referring to this, she talked about the 2030 agenda for sustainable development. The world has resolved to leave no one behind in fighting extreme poverty and preventable child deaths.

Mr. Karnal Singh, Ex-Enforcement Director, India raised during his speech Narayana Murthy’s concern that there have been no recent innovations from India. “Are we so bad?” He said we would have to think differently for finding solutions. The education which we receive in our country is more competitive than collaborative.There are many unmet needs in health sector, for example, for majority of injections, cold chain is not maintained. It’s been a long time that we could have insulin tablets rather having the existing insulin injections. India, prominently being an agricultural land faces a major unmet need of water requirement, which is only 50% against the 80% requirement. He acknowledged that 2010-2020 has been the decade of innovations for India. To everybody’s pride, the ranking of India in the global innovation index has improved by five places to 52nd in 2019 from 57th position last year.

Sachin Gaur, Director Operations, InnovatioCuris, took the opportunity to drive everybody’s attention towards the trust deficit which persists in medical community and equity of stakeholders. He insisted on developing a common language within the medical fraternity to which Artificial Intelligence (AI) can be a probable answer.

The forum manifested remarkable heterogeneity with its speakers from various realms across the globe. The second session on “Innovations for hospitals and insurance companies” was very interestingly structured as a free-style discussion.

Mr. Mohan Krishnan introduced the discussion with a brief presentation on the global trends in healthcare and their affordability. He particularly emphasized on access to healthcare resources and quantity shortage in India. He highlighted how lifestyle associated diseases have taken over the communicable diseases. He discussed the key trends in supply dynamics, their relationship to healthcare sector, and the challenges and opportunities for their future implementation. The functional and central aspect of this session was majorly about healthcare which is accessible and affordable to the masses. Other key points that emerged during the session are outlined as:

• switching of communicable to non-communicable lifestyle associated diseases
• lack of medical care in rural areas
• Ayushman Bharat Yojana or Pradhan Mantri Jan Arogya Yojana or National Health Protection Scheme: one of the largest and promising healthcare initiatives which aims to address healthcare holistically
• patient feedback must be a pre-requisite while thinking of the innovations which can fulfill the unmet needs
• biggest challenge in healthcare is information symmetry
• one of the most remarkable point that came up was that the healthcare provider should be “paid to prevent”, and not paid to cure
• 5 P’s should be prioritized: People, Plant (equipment in hospitals), Processes, Premises, Patient care

This enlightening session focused on four most important factors, viz., better health outcome, better patient experience, better staff experience and better costs.

The tone of the next session on “Innovations in medical devices and diagnostics” was set by majority of doctors. The diagnostics could be done by the help of paramedics or people other than doctors and then they could be replaced by automated systems or AI. There are schemes such as Ayushman Bharat, which give accessibility to each one. The innovations could be patient centric, healthcare centric or in terms of sustainability. The focus was on trends impacting medical devices and diagnostics, for example, lab-on-chip, wearable health monitoring devices, AI, 3D printing, etc.

The tone of the next session on “Innovations in medical devices and diagnostics” was set by the majority of doctors. The diagnostics could be done by the help of paramedics or people other than doctors and then they could be replaced by automated systems or AI. There are schemes such as Ayushman Bharat, which give accessibility to each one. The innovations could be patient-centric, healthcare centric or in terms of sustainability. The focus was on trends impacting medical devices and diagnostics, for example.

The brainstorming session provided meaningful insights into the remedies which innovations can bring to the unmet needs in healthcare. Prime Minister’s health and wellness program were much talked about. Challenges in the not-much-explored area of management of blood banks were discussed. The lack of a centralized system of blood banking is a major concern.

The role of medical robotics, which is a type of disruptive technology, is very fascinating. The thought of switching from open surgery to key-hole-surgery to no-hole surgery is in fact very intruding. Another major concern across the globe is diabetes and how the diabetologists across the nation are ignorant in not examining the feet of their diabetic patients as 30% of the diabetics suffer from severe foot diseases. There are ample cases of diabetic amputation, which must raise an alarm within the diabetologists.e lab-on-chip, wearable health monitoring devices, AI, 3D printing, etc.

The fourth session was a very inspirational one wherein the dais had seven women innovators, each one unique in their own fields. As Prime Minister Modi once said, “The progress of humanity is incomplete without the empowerment of women.
”InnovateHER gave a common platform to few wonderful women where they shared their stories of inspiration, falls, and experience. This session was indeed a beautiful stretch of one hour where these women from varied backgrounds and aspirations showcased their expertise and their words gave hope, path and motivation to everybody present in the auditorium. They were an epitome of women empowerment and proved it greatly “Komal Hai Kamzor Nahi Tu, Shakti Ka Naam Hi Naari Hai, Jag Ko Jeevan Dene Wali, Maut Bhi Tujhse Haari Hai”.

Ms. Shriya Sethi, presented detailed statistical data on women entrepreneurs, about emerging trends in healthcare innovations, the existing lacunae and the current scenario of general well-being of people.

Ms. Priya Prakash, Founder & CEO, HealthSetGo, was one of the youngest innovators, who herself realized at a very tender age, the importance of good health. This drove her to initiate her existing foundation, which focuses on the wellness of children. “If the kids are healthy in the first place, the coming young generation would be disease-free”, was her take on the evolution of her organization.

Another eminent panelist Ms. Preeti Rao, Founder & CEO, Weljii, inspired everybody around to focus on being healthy. Instead of talking about the illness, she emphasized more on how people must take care of their wellness which includes both physical and mental health.

Ms. Veena Sehgal, a pharmacist and entrepreneur mentioned the gap in the availability of medicines which the doctor prescribes. They are most of the times available on area-specific basis which makes it difficult and time consuming for the patients. There should be an emphasis on generic medicines, rather than brands.

Amidst such tech gathering which had brought together so many thought leaders and experts alike; we had between us few young innovators. These innovators with their priceless ideas and vision delivered their pitches to make their candidature remarkable in its unique way.

The candidates included Priya Prakash (HealthSetGo), Yogesh M (Hybrid effluent water system technology), Saiprasad Poyarekar (spray-on skin tissue), Ashish Sharma (Drip monitoring system) and Vijay Kumar Kumawat (Microporous implants). With their unique set of products/services, the candidates made it difficult for the jury to decide on the winners. Saiprasad with his technological advancement of spray-on skin tissues to get rid of minor-to-severe burns grabbed him the award for best innovator pitch. He was followed by Vijay Kumar, as 1st runner-up and Priya Prakash as 2nd runner-up.

The next session was a special one dedicated to diabetes, one of the most worrisome chronic diseases across the globe. The speakers talked about how to monitor, control and manage the disease.

Dr. Arjun Dang, CEO, Dr. Dangs Lab, who was chairing the session referred India as the “diabetic capital of the world”, referring to the alarming scenario of the affected Indians wherein around 16 million Indians are affected with Type 2 diabetes, and this number is expected to rise to more than 100 million in the next ten years. He also insisted not to commoditize healthcare, rather consider it as a service which requires a lot of compassion and empathy.

One very relevant question that came up was that “Why Indians are most prone to diabetes?”. Probably it is because of the harmful oils and highly processed foods available in the Indian markets. Stress is a huge component in diabetes management. Exercise and breath-management (pranayama, etc.) have a major impact on diabetes management. One of the major contributors of diabetes is non-nutritional food. Sleep which is often understated has a direct impact on blood sugar level which increases due to lack of proper sleep. Diabetic patients can improve only to fall back again into the same pit and destroy their health, hence it is of utmost importance to rescue them.

Among the highlights of the next session, “India Global Collaboration in Health Sector: Start-up Opportunities and Challenges” were the long-term Australia-India collaboration goals in the field of Science and Technology. To seek the answer to the question, “What can India offer to countries in the panel and what do the countries have to offer for India?”, let’s read next.

Dr. Jukka Holappa, Commercial Counselor, Country Manager India at Business Finland, shared the current status of healthcare in Finland. He spoke about the excellent condition of R&D in Finland, among which ten large companies are Indian.

Dr. Shiban Ganju, shared that he has come to India because India is “where all the action is happening right now”. He talked about traditional medicines in India, differential pricing of products across various countries. The innovators must focus on “frugal innovation”, for providing the best of healthcare.

Ms. Sharda Balaji, a lawyer by profession highlighted the importance of mobile penetration which is the largest in the world in India. There have been tectonic shifts happening in technology. She discussed how India is all about affordability and value consciousness. The concept of “jugaad” or making things doable work well in India. This is where a lawyer is needed to license the product(s). The major challenge she mentioned in India is lack of connectivity with deep science and research across geographical locations within the country due to its enormous size.

Much was talked on the existence and emergence of the digital health in the intriguing session on “Digital Health: Giving Birth to New Delivery Models through Mobile, IoT, Blockchain and Artificial Intelligence”.

Mr. Jacky Ovadia, General Manager, IDEA (International Innovation & Business Development expert), Israel shared with the audience his viewpoint on advancement in telemedicine. There must be portable medicine devices which can effectively check pulse and nerves very easily. He mentioned about remote monitoring for ultrasound, pregnancy, pulse checking, and clinically approved digital urinalysis. He said that a concept which uses GPS to monitor patients’ activities and habits can have varied impact on people’s lives.

Way forward

With such inspirational, informative and interactive sessions, the two-day conference came to an end, raising too many new questions and challenges that may impact healthcare, especially in India. It also gave answers to many existing issues through the numerous innovations that were presented. The generic thought which probably each one had was on the affordability and accessibility of good healthcare. If the innovations are not scalable, easily accessible and cost-effective to the masses, they cannot persist for long.

Of utmost importance were the views on how AI can save lives, and the importance of end-to-end affordable healthcare. IoT can connect to anyone, anytime, anywhere in rural and urban areas where reach is low, and how AI helps in diagnosis and innovation. Early intervention can resolve health problems and there is a huge scope in the use of the apps which can enable timely and real time intervention. With highly potential schemes like Ayushman Bharat, we can create value chain in affordable and accessible healthcare for everyone.

The healthcare sector sees immense opportunities with the innovations happening across the globe. Innovation pitches from global and Indian companies that were conducted wherein organizations from various sectors came forward to present their portfolio of services and products.

Innovators and researchers are working on various aspects wherein they can target various chronic as well as lifestyle associated diseases. For example, the Nano 4 TB kit helps detect TB easily. There are various state-of-art laboratories across the nation which are deployed and use high-end technology, for example next generation sequencing is used to perform operations to detect aneuploidy or any kind of anomaly which is responsible for spontaneous miscarriages and mental retardation in live born babies. In the light of technology, innovation and healthcare, we must look at technology with a business view; how technologies work in society, sustainability of the model with traditional delivery, and about new models in healthcare.

Read past InnoHEALTH conference press release:
InnoHEALTH 2017
InnoHEALTH 2018
Also Read: Press Release: The International Medical Travel Show Dubai 2020

About the author

Dr. Jasmeet Chhabra is a Doctorate in Immunology and whenever she gets free time from the full-time job she loves to read and write about imperative issues in healthcare.

Ransomware today accounts for 85 per cent of the malware in the healthcare industry. As the IoT ecosystem expands, so does the attack surface for cyber criminals.

In other words, the more hospitals rely on connected technology in our day-to-day lives, the more vulnerable these become to the cyber threats that are increasingly tailored to exploit vulnerabilities and security design flaws in IoT devices at healthcare facilities.

In a recent blog post, Salwa Rafee, IBM Security Industry Leader (Public Sector) says that new cybersecurity threats are emerging in healthcare almost daily.

“Today, hackers target medical and IoT devices that provide, transmit, and access confidential data because they can exploit the fact that most manufacturers did not consider cybersecurity when designing those devices,” she writes.

All of this increases vulnerability to ransomware. Many healthcare providers are forced into paying to get their data back.

Attackers are getting more sophisticated, organized and less obvious as they attempt to snare staff and administrators with rapidly changing tools.

Therefore, security training and guidance is critical to minimize staff exposure to phishing attacks and malware intrusion, as is reasserting policy and penalties for staff with bad intentions.

Tech giant Microsoft which aims to transform the healthcare sector through effective use of analytics- driven insights decoding the complex data available, is very seriously looking at securing the data.

For David Houlding, Principal Healthcare Programme Manager, Industry Experiences at Microsoft, healthcare is drowning in data. “Every patient brings a record that could span decades, with x-rays, MRIs, and other data that can affect every decision. Providers and payers bring their own collateral to the table. Skills, policies, and certifications are just the start,” he said in a blog post recently.

Global cyber security leader Sophos has also found that the healthcare industry in India is the most vulnerable and weak while implementing cyber security solutions for protecting IT infrastructure.

“The ‘State of Endpoint Security’ in Indian hospital needs more attention and preparedness for handling cyber threats like ransomware and malware attacks,” emphasizes Sunil Sharma, Managing Director Sales at Sophos India and SAARC, adding that more and more advanced cyber threat actors are turning their attention to attacks against the healthcare sector.

The attacks are growing exponentially across the world. In July last year, the personal health data of 1.5 million people, almost a quarter of the Singapore’s population, including the details of the city-state’s Prime Minister Lee Hsien Loong, was hacked. The hackers broke into the government health database in a deliberate, targeted and well-planned attack. The hack compromised patients’ names, identity card (NRIC) number, address, gender, race and dates of birth.

Following the hack, SingHealth temporarily banned staff from accessing the Internet on all 28,000 of its work computers. According to IBM’s Rafee, finding the right security staff also poses many challenges to a healthcare organization. “Security is a competitive field and attracting the right talent with limited resources has proven to be difficult. Expanding your applicant pool to people with more diverse backgrounds is effective,” she advises.

Not just Singapore, Hong Kong’s Department of Health became the next big victim of a cyber attack after its computers were hit by ransomware which left data inaccessible. In the meantime, the fifth annual Healthcare Breach Report published by Bitglass has found that total number of records exposed in the healthcare sector globally rose to 11.5 million in 2018. On average, nearly 40,000 people were affected per breach, which is more than double the average number affected in 2017.

Is there any full-proof remedy against such malicious activities?

Sophos says that healthcare business needs to move from traditional security software like antivirus and deploy sophisticated security solutions. “Given the speed at which IT threats are evolving and becoming more persistent and coordinated, it is a deep concern to see the adoption of the next- generation predictive technologies. While we all do our best to assure the integrity and confidentiality of sensitive data, the methods we use leave us with a staggering number of false positives and logs to manage.

“It is important for organizations to keep up in this dynamic world of IT threats. Organizations need effective anti-ransomware, anti-exploit, and deep learning technology to stay secure,” Sharma emphasizes. Transparency is key. Reporting details of a breach to the public quickly and efficiently is now a requirement. “No organization wants the perception that they don’t disclose information that should be reported timely. I believe the public, and your patients, understand the risk that any organization is likely to be hacked or attacked at some level,” says Rafee.

Healthcare firms have made progress in bolstering their security and reducing the number of breaches over the last few years. “However, the growth in hacking and IT incidents does deserve special attention. As such, healthcare organizations must employ the appropriate technologies and cybersecurity best practices if they want to secure the patient data within their IT systems,” said Rich Campagna, CMO of Bitglass. As you read this, an unauthorized user accessed a “limited number” of employee email accounts at UConn Health (branch of the University of Connecticut), compromising personal data of more than 326,000 patients.

The US Department of Health and Human Services (HHS) reported that organisations paid out more than $28 million in settlement fees in 2018 – an all-time high in healthcare breach enforcement activity. “In October, the US health insurance provider agreed to pay a whopping $16 million and introduce “substantial corrective action” following a series of cyber-attacks that led to the largest US health data breach in history,” said HHS. The Cloud environment has changed the way companies manage, store and share their data, applications and workloads. Along with a wide range of benefits, though, the Cloud infrastructure also introduces a new, fertile and attractive environment for attackers who crave the enormous amount of available computing resources and sensitive data it holds.“

While we consider the cloud to be an organization’s weakest link, threats posed to them via their employee’s mobile and IoT devices are also to be taken seriously as one of many attack vectors from which sensitive data can be stolen or leveraged to launch an attack,” informs Check Point. As cyber attacks grow and hackers aim patients’ data to make quick money, what patients are carefully watching is how well the healthcare providers are prepared to respond, mitigate future threats and move forward.

About the author

Meenakshi Iyer is a New Delhi-based freelance journalist covering health, technology and latest innovations. With more than 15 years of experience, she has worked with top media publications in the country.

Q. Given your important assignments for the Government of India in the past, share with us the big picture. What are the trends you see in terms of cybercrime and threats for 2019?

The world is getting more connected and technology has seeped into every aspect of our lives. On one hand, these advancements make our lives easier and on the other bring a lot of vulnerabilities with them if security isn’t strong enough to tackle cyber criminals. Hackers today are well-educated and have the capabilities to develop new methods and tools to exploit the vulnerabilities on the computer systems and networks. Few do it for their academic interest and thrill and inform the person concerned about the vulnerabilities so that the same can be plugged. They are known as white hat hackers. While the others do it with malice and self-gain and are known as Black hat hackers.

To gain access to the computer systems, the cybercriminals and hackers will continue to deploy already existing tools (called as exploits) with enhanced capabilities. More advanced tools will be also be developed in the coming years. Some of the important ones are enumerated below:

1. Chatbots: There will be extensive use of machine learning techniques (Artificial intelligence) in the near future. A Chatbot can be injected into the important website (for example, a banking site). Chatbot in the form of a man or woman would pop up on the screen and will start interacting with the user (like what we see the google assistant doing). Then it may misdirect the customer to a nefarious link similar to an actual banking site, thereby fetching important information from the customer and compromising his banking information.

2. Bot and botnet: The hackers have been successful in remotely taking control of the hacked computer systems. Such a system is known as a bot. The hacker can remotely misuse a machine (using computing time or other resources) without the actual user being aware of it. If there is more than one compromised device, then it is called a botnet. Botnets can be put to perform some distributed function viz, crypto jacking (mining bitcoins) or distributed denial of service attack.

3. Discover and target organizations outside the firewall: Most of the commercial organizations deploy firewalls, intrusion detection systems, and intrusion protection systems; thereby making hacking difficult. But they use the third-party software, which may be having vulnerabilities. Hackers can attack the third-party systems used by commercial websites.

4. Injection Attack: Protective systems installed on computers look for malicious files to detect cyber-attack. The injection attack is filed less; the hacker directly inserts the malicious code in the memory, thereby compromising the machine, without ever dropping a file onto the infected system. One such example is British Airways site hack in 2018, resulting in identity theft of around 3,80,000 users.

5. Biometric Hacking: Cybercriminals use brute force attack, dictionary attack or social engineering, etc., to crack the passwords. Many people have shifted to biometrics. The academic research suggests that a number of officers print authentication systems could be spoofed, even highly sophisticated facial recognition system has been proven vulnerable to more advanced hacking efforts.

6. Application of artificial intelligence: Artificial intelligence techniques will be used more and more to avoid detection by intrusion detection tools. For example, Waterminer, a cryptocurrency mining tool injected as malware, stops mining when task manager or antimalware scan is run.

Also Read:
Social Isolation in a Digitally Connected World
Sweden-India Collaboration in Health Sector

7. Rouge AP(access point) and Evil Twin: Rouge AP is an access point installed on the network without the knowledge of the administrator, while the evil twin is identical network.

The above-mentioned techniques will be sharpened to attack numerous utility services (some of which are listed below) by the black hat hackers for malicious purposes:

A. Internet of things(IoT): the Considerable number of smart gadgets (such as TV, plugs, IP cameras, smartphones, tablets, network video recorders, heaters, refrigerators) are used at homes and industries. When these gadgets are connected to the Internet, they are termed as the Internet of Things. The hackers will increase their attacks on IoT using a vulnerability in cloud infrastructure and hardware to threaten the users physically or mentally.

B. Attack on identity platforms: Identity platforms offer centralized secure authentication of users, devices, and services across the IT environment. It could be a database of banks, hospitals, social media sites, etc. Identities of a large number of persons would be attempted to be stolen for extortion, impersonation or proving the inadequacy of the commercial organization in securing the important data (so as to blackmail).

C. Real world damages: There will be more and more attacks on services providing community services viz, municipality, health sector, electricity supply, water supply, and sewer systems. Besides the cybercriminals, who would use such hacking for ransom, terrorists and even nations can use it against public or adversaries.

D. Social media content compromise: There will be increased use of Botnets to compromise social media to influence public opinion.

Q. Being a healthcare publication, our readers would be interested in healthcare-specific cyber threats. What is your opinion on the health sector threats?
The health sector offers life critical services. It maintains the identity and clinical records of a large number of patients. The following factors make the health sector more vulnerable as compared to the other sectors.

• IoT (Internet of Things) devices are used extensively for the treatment of the patients viz. smart continuous glucose monitoring, connected inhalers for asthma, apple watch Identity platforms offer centralized secure authentication of users, devices and services across IT environment. It could be a database of banks, hospitals, social media sites, etc. PERSONA THEME TRENDS WELL-BEING ISSUES RESEARCH NEWSCOPE app that monitors depression, etc.
• The doctors and patients can connect external storage devices and even mobile phones to the hospital database system.
• Third-party software and hardware are deployed which makes it vulnerable to supply chain poisoning.
• Most of the services provided by the hospital are connected through the Internet or the cloud services.

Clinical data is of immense use for cybercriminals and cyber terrorists. They can use vulnerabilities in cybersecurity in the following ways:

1. Identity theft: Medical identity record is very useful for the cybercriminals as it can be used to impersonate people in the digital world and gain access to financial systems as well as to commit fraud by claiming treatment or insurance at the cost of insurance agencies and the patients. Therefore, this data is sold at a higher rate in the darknet as compared to identity records of other sectors.
2. The clinical records of the patients may sometimes contain their psychological disorders or conditions, or a person may be suffering from concealed diseases (sexually transmitted disease, etc). The hacker may make use of such information by blackmailing or harassing the patients. It would cause hardship to the patients and would put the reputation of the healthcare service provider/hospital at stake which failed to protect the patients’ identity and clinical records.
3. Ransomware attacks on hospitals will be on rising. The information of the patients is mostly time critical. If the cybercriminal denies the access of data to the hospital even for a short span of time, it may lead to lack of timely treatment to critical patients and therefore, hospital administration is not in a position to delay the ransom payment.
4. Prescription change: In India, the majority of renowned hospitals in metro cities are computerized. Doctors give online prescriptions which immediately become available to the concerned medical staff, such as a nurse who administers the drug to the patient. Cybercriminal scan tampers the prescription which may harm or even cause the death of the patient. They can cause an obstruction in the oxygen supply line or failure of electricity. They would be able to change the medical records of the patients, which will lead to wrong diagnosis and treatment. Not only cybercriminals but the terrorists can adopt the above techniques and threaten the nations or can even cause large scale fatalities.

Therefore, it becomes extremely important to adequately secure the health sector databases.

Q. The health sector has seen major attacks of ransomware; part of the equation is ‘money aka cryptocurrency’ in organized crime. How do we handle this?

Being proactive about cybersecurity is perhaps the best approach to tackle cyber-attacks. The health sector should form cybersecurity forum for cybersecurity policy formulations and mutually evaluate hospitals’ preparedness against the cyberattacks ensuring adherence to the cybersecurity policies. Additionally, each hospital network should have a dedicated team of IT security professionals to guide the management and proactively check for any cyber invasion. The IT team should ensure that the latest patches for all the devices and software are installed and there is protection from supply chain poisoning. The system should be equipped with features firewalls, Intrusion Detection System, Intrusion Protection system and processes analytical tools among others.

The blockchain techniques can also be explored for data management and the patient databases should be encrypted so that they are of no use to the hacker. Further, the hospitals must take data backup with a fast recovery plan. Regular penetration testing of the system should be done to eliminate potential vulnerabilities.

Hospitals should invest in training IT staff in cybersecurity policies and cybersecurity technologies. Regular analysis should be done of employees’ computer usage pattern so that any compromised user is effectively detected and timely removed from using the system. There should also be a secure access control preferably using biometric features.

Q. Today security has become a hot topic and world over we see that regulation is leading change and innovation! What is your vision for India in regard? What regulations will make the health sector more secure? Or we don’t need regulation?

The cybercriminals attempt to hack the computer resources of the hospitals by exploiting the vulnerabilities in the computer systems. They manipulate the stored information, steal the same or hold it for ransom. The hospital databases work on the trust reposed by patients in the hospital administration that their data will be guarded with privacy.

Cybercriminals can be prosecuted under various provisions of the Indian Information Technology Act, 2000(ITA). The IT Act creates civil liabilities for the offenses under the Act vide Sections 43 to 45, wherein an amount of compensation can be given to victims; it also creates criminal liabilities vide Sections 65 to 74 of the Act. Cybercriminals are liable to both civil and criminal liabilities.

Hospital administration is responsible for protecting the data and failure to protect can result in civil liability under Section 43A of the IT Act. However, this section can be invoked if the breached data results into wrongful loss to the victim or wrongful gain to a cybercriminal. The victim has to prove that there was a wrongful loss to him/her. The offenses by the intermediaries are criminalized under Section 67C of the IT Act. However, the same gets diluted by the provisions contained in Section 79 of the IT Act. Hence, the IT act doesn’t provide absolute data security laws.

The Government of India appointed Justice BN Srikrishna Committee for effective data protection laws in India. The committee submitted the Draft Data Protection Bill, 2018 to the government in July 2018. It will be introduced in parliament after the forthcoming elections in India. The Government of India is also planning to introduce “The Digital Information Security in Healthcare Bill” in the parliament to secure the healthcare data of patients in India.

Q. As the cyber incidents keep rising and legal regime catches up, what is your opinion on our abilities in investigating cybercrime? As you know attribution and audit trail are not the easiest in the cyber world, any advice for stakeholders so that they are not wrongly prosecuted or get justice on time?

According to Section 78 of the IT Act, 2000, a police officer of the rank of Inspector and above is authorized to investigate the offenses under the IT Act. This is to ensure the quality of the investigation. However, all Inspectors in police are not trained in cybercrime investigation. Further, complexities of computer technology, tools, and methodology used by cybercriminals make it difficult even for a trained person to keep pace with the development in this field. Police organizations don’t employ external cyber experts to aid in the investigation. Each police officer investigating the case seeks help from other expert police officers or cyber experts of his/her choice. Therefore, institutional help is lagging.

There is also the dearth of cyber experts in forensic science laboratories, resulting in delays of months and years in getting reports from them which can compromise the further evidence leading from forensic analysis of seized electronic material. During my tenure in the Enforcement Directorate, I found this delay to be of 1 to 3 years, therefore, I initiated six in-house cyber forensic labs. This led to the cyber forensic analysis done at a quicker pace also improving the quality of investigation.

The next hurdle is the global spread of evidence into other jurisdictions. A letter rogatory (letter of request) is sent to each foreign jurisdiction for getting the evidence located in that jurisdiction. The process is slow and it may take 3 to 4 years in getting a reply. If that reply further requires evidence from another foreign jurisdiction then another 3-4 years are gone. Therefore, the entire investigation is time-consuming.

The investigation becomes further complicated if Tor or onion routing is employed by cybercriminals. Finding the cybercriminal in this scenario becomes more difficult.

The IP address (internet protocol) and the time of its use, identify uniquely the source of the attack. However, the cybercriminal may commit cyberattack through Bot or botnet. In that case, the IP address will lead the investigation officer to the slave machine, even though the user of this machine would have no knowledge of the misuse of his computer resources. If the investigating officer doesn’t go into the depth of log analysis of such a system, then the innocent people might have to face false prosecution. The stakeholders should ensure all logs are maintained and stored by his computer system so that the audit trail can lead to actual perpetrator of cyber-attack.

In a recent healthcare conference, the people were unaware when I spoke about how on October 21, 2013, the former US Vice President Dick Cheney’s doctors disabled his pacemaker’s wireless capabilities to thwart possible assassination attempts. To this, everyone had an issue on accountability. It remains unanswered that who would be liable, the doctor, hospital, company which provided pacemaker or the insurance company. Amidst all this, nobody was concerned about the patient as none present there questioned it. Maybe we are awaiting a major catastrophe to happen to put our minds to work. It is our endeavor to equip the healthcare community to this aspect of digital health.

Cybersecurity is a major concern for patient safety and healthcare infrastructure. The health records, data, hospital information system and individual medical devices are all targets. The vulnerability is in technology and lack of awareness of staff. There are many examples to quote wherein hospitals have become the victim of attacks. A recent audit of a corporate hospital in Delhi by our team revealed that 80% of equipment is vulnerable to cyber attack, thus, risking the patients. Healthcare providers are not sensitized to issue as required hence this magazine is dedicated to Cybersecurity. We have named it Cyber4Healthcare and even launched a training program in the healthcare domain to update knowledge of this extremely important topic. There is an immediate necessity that we invest in staff and equipment to make our systems robust enough to protect them from cyber-attacks.

We at InnovatioCuris always strive to sensitize the healthcare providers with new technologies and our next issue would focus on IoMT or connected healthcare which is overtaking the segment rapidly. However, we should always keep in mind that we are master of technologies and not the other way around. Can humane touch be replaced by technology? The trend nowadays is that we are leaving human ingenuity behind and are being heavily dependent on technology. There is a need to understand the benefits and challenges of newer devices, technology, and thinking. Let us consider how we can balance traditional to modern approach in today’s world and get the best of both worlds. Let our readers share their experiences by writing for the magazine to benefit all.

In an effort to give a fillip to the ecosystem, the second edition of The Economic Times Hospital Strategic Management Summit 2019 held at The Hyatt Regency brought together government officials, healthcare industry leaders, analysts & service providers under one roof to focus on delivering innovative and world-class hospital planning. While healthcare systems and hospitals are faced with increasing pressure to find operating efficiencies in a time where traditional cost-cutting methodologies are producing diminishing returns, it is imperative to create a sustainable healthcare funding mechanism.

In a panel discussion focusing on Ensuring Profitability Through Optimum Patient Care, Dr. K. Ravindranath, Founder & Chairman, Global Hospitals opined that “Our doctors, staff and everybody needs to be educated in such a way that they become involved partners in patient care. From the beginning, our organization has always focused on delivering patient-centric doctor driven care”.

Dr. Tarang Gianchandani, CEO, Sir HN Reliance Foundation Hospital added, “Clinical outcomes are the key and it’s the future, so not only will it improve patient satisfaction, but it will also help the hospital to ensure that costs are taken care of. We always say; what we don’t measure, you can’t improve. In the same way, if you don’t measure your clinical outcomes how will you improve, and if you don’t improve your clinical outcomes, what satisfaction will you give to the patient?”.

Dr. B.K Rao, Chairman, National Accreditation Board for Hospitals and Healthcare Providers (NABH) made a succinct point when he explained, “Accreditation is a holistic kind of thing, it’s a process, it’s not an event and if you really look at what we are talking about, we are talking of quality and safety of the patient and we agree whatever you may do in the hospital or in the healthcare industry, quality and safety is an integral part of every activity”.

Addressing the topic of Futuristic Models in Home Health Care, Meena Ganesh, Co-Founder, MD & CEO, Portea Medical proclaimed, “The movement towards setting up of quality standards is a very important move that’s happening in the whole hospital care space”.
Ram Natesan, Group COO, SRM Institute of Medical Health Sciences & Research also aired his views, stating that, “Blockchain is going to impact the healthcare sector in a very big way, starting from patient data management, patient medical records, the insurance claim process management and publishing of research papers. Blockchain is going to impact healthcare in every stream of clinical excellence, because this is one technology which can not be erased or duplicated, and this will help long way for maintaining the patient data medical records”.

About Times Strategic Solutions Limited
Times Strategic Solutions Ltd., functional under the brand name ET Edge, is an Economic Times initiative founded to empower multiple industries and segments by sharing critical business knowledge through strategic conferences and summits. Encompassing the Indian business vista, ET Edge strives to bring together visionaries and key leaders on its knowledge platforms to create social and business ecology conducive to the positive changes required by the industry. The main aim of this initiative is to channel global business intelligence through summits and conferences in overarching lectures, hands-on workshops, panels, roundtables, and case studies.

Sumit Puri, in his keynote, addressed the digital innovations in healthcare in three contexts: Industry context, future of healthcare through digitization and used the cases in Max Healthcare – IoT and AI etc.

Today’s patients are informed, savvy and social too. They are looking for: Convenience, reduced cost, improved outcomes, efficient processes, personalized care.

[vc_single_image image=”4854″ img_size=”500×300″ alignment=”center” onclick=”link_image”]

Digital is about user interactions and experience powered by Technology. Digital in Healthcare is empowering us to reduce cost, increase quality and enable wellness! – Sumit Puri. Emphasized on the utilization of Data from multiple sources like customer experience, patient safety, cost, and operational efficiency and growth to provide insights. He shared his plans on leveraging IoT at Max Healthcare through Connected, Coordinated and Integrated ecosystem with the focus on the patient. Proposed a dedicated, 24×7, technology-enabled clinician monitoring cell, digitized remote patient monitoring during emergency ambulance transfer. MAX BIKE RESPONDERTM for immediate medical care during emergencies 13 mins each time, >150 lives saved since June’17.

The learnings from his keynote were
● Standardization of core systems
● An adaptive and iterative culture of Innovation
● Outside in patient-centric design
● Collaborative ecosystem
● Strong governance mechanisms with metrics
● Focus on user (Clinician) adoption

As we know digital has struggled to make a headway into Indian health sector in a big way so far. However, given the enabling building blocks, it seems that we are at the cusp of a new paradigm in the health sector. In this session, panelists discussed the topic of digital in three contexts, as we have representation from policymakers, IT experts, Hospitals to an insurance marketplace.