Policies on Cybersecurity

Co-authored with Parminder Singh

The need for cybersecurity has become apparent with the increasingly important role played by Information Technology and Telecom in India’s growth and the role of internet and telecom backbone in India’s socio-economic activities. Without a robust security infrastructure in place, cyberspace can become a vulnerable nerve-center where any act of sabotage or espionage can comprise India’s financial systems, citizen’s services, and sensitive data to the extent of partial or complete paralysis of India’s critical infrastructure. The reports of nation-led cyber offensives such as the Stuxnet virus attack on Iran’s nuclear reactors and the espionage attempts by hackers based in China against several states put cyber-security at the heart of national security.

Cybersecurity comprises of multiple facets including Network security, Information security, Critical Infrastructure protection, Law enforcement and Disaster recovery. These facets come with their unique and often inter-dependent issues that need to be addressed keeping a holistic perspective in view than following a piecemeal approach. The scope for cybersecurity goes beyond the traditional jurisdictions of ministries and departments as it involves processes and people at the level of each of stakeholder jointly. It is increasingly been observed that Security needs to be incorporated at the design and operations stage rather than as an additional feature to be put on the top of existing systems and processes.

One of the interesting observations for Cybersecurity in India is that although Cybersecurity is a critical component of National security, it is the private sector which controls most of the critical information infrastructure. This intrinsic feature calls for Government of India to look beyond regulatory framework and partner with private organizations for national cybersecurity. The private organizations operating the critical infrastructure would need to look beyond the profit-centric approach for partnership initiatives. This also mandates the use of implementable security solutions that are cost effective. But even before exploring this public-private partnership, an atmosphere of trust and cooperation is imperative between the government and industry. Recent steps by the government in setting up Joint Working Groups on different facets of Cybersecurity are laudable.

Another challenge for India’s Cybersecurity strategy is the need to achieve the fine balance between security through data encryption and the necessity for Law Enforcement Agencies to monitor the information exchange for national security and anti-terrorism operations. The national encryption policy needs to be formulated and rolled out to prevent possible conflicting situations.

Pursuit and conviction of trans-national cyber criminals is a critical condition for maintaining deterrence. This cannot be achieved without international cooperation at multiple levels which reaches beyond national boundaries and jurisdictions. Fresh avenues of dialogue between sovereign nations through existing and new forums are desired to work towards international treaties for law enforcement.

Education, awareness and human resource capacity building is another dimension of a robust Cybersecurity framework. Partnership with Academia will help develop much needed skilled security manpower and fuel research into cyber forensics and analytics. Reports indicate that India will need half a million cyber-security professionals by 2015. A cybersecurity educational eco-system supported by leading technology institutions is essential for such capacity building.

The nation and industry is anticipating a comprehensive and progressive Cybersecurity policy which takes into account the multiple dimensions and challenges that are faced by a diverse nation like India. An institutional framework for managing these dimensions should be responsive, agile and adaptable to cope with this highly dynamic issue. As the government rolls out the national cybersecurity architecture in the coming months, the nation hopes that a resilient mechanism will be put in place that can withstand any future cyber warfare.

Impact of eHealth Centre (eHC)

In the developing world healthcare delivery is constrained by lack of appropriate infrastructure, medical personnel and electronic medical records. In India we created the eHealth Centre (eHC) as an innovative and visionary cloud enabled health care infrastructure that can be rapidly rolled out to provide affordable preliminary healthcare along with tele-health services. It leverages the power of cloud technology to provide high quality healthcare in resource constrained settings. The solution attempts to hide the technical complexities in the backend while creating a robust front-end solution. This solution conceptualized by HP, Government Relations is implemented as cross HP collaboration (HP GR, HP SSI, HP TS) and partnership with external partners- Council for Scientific and Industrial Research (CSIR), O.P. Jindal Sansthan.

 

 Problem statement

About 75% of health care infrastructure, medical manpower and other health resources are concentrated in urban areas where just 27% of the population lives. Most of the poor living in rural areas is isolated from the benefits of formal health care and many of them access untrained local 'private practitioners' incase of any illness.

The basic health care infrastructure in rural areas in India is based on the population norms of having one Primary Healthcare centre (PHC) for every 30,000 people and one Sub-Centre for every 5000 people. However, the existing public health infrastructure, is understaffed and poorly managed and cannot be monitored. PHC and other medical institutes face a challenge and are sub-optimally functional due to staff shortage and poor uptime of essential equipment. They also do not cover the last mile of healthcare as there is no electricity or connectivity in the hinterland.

 

Solution Description

The  eHealth Centre (eHC) has been conceptualized and created to provide affordable healthcare in the remotest of locations, leveraging HP technology. The solution is equipped with built in electricity through power generators, built in connectivity (2 MBPS via leased line with redundant satellite connectivity). This is the first of its kind solution in the world where a rapidly deployable telemedicine solution has been created with all vital diagnostic equipment being integrated directly to the Cloud hosted EMR.

The solution positions HP at an extremely competitive advantage to help government mitigate their issue of providing healthcare to the last mile.

The solution consists of a standard shipping container converted into a Health centre which can be easily transported and even air-lifted. The solution has all vital diagnostics  equipment that are integrated directly to the Cloud hosted Electronic Medical Records (EMR) solution. The video conferencing solution that is built-in can be operated by paramedics to connect with the specialist medical personnel providing medical consultation.  The entire solution is designed to eliminate the need for highly skilled manpower at the remote location where the infrastructure is deployed.

eHC thus provides an   access to healthcare in rural and remote areas. The infrastructure is highly affordable and easily deployable as compared to the Brick and Mortar alternatives. The Cloud hosted EMR aids in disease surveillance by tracking disease patterns and risk factors. It acts as a means of providing efficient collection, storage and analysis of patient health data by means of a centralized health database and thus helps in research and health policy formulation

The solution is being viewed as a source for Big Data analytics on healthcare by Government of India. Government of India has earmarked USD 10 million to experimentally roll out more eHC’s, based on the first prototype that had been rolled out.

Till now, attempts at introducing Telemedicine in infrastructure challenged economies have met with limited success. This is because of non-integration of the vital diagnostic equipment, non-usage of a centrally hosted EMR, lack of monitoring and management systems, poor institutional support and limited integration with the Government’s health delivery system.

The solution in this paper integrates the following vital diagnostic equipment directly to the Cloud hosted EMR (a) Blood analyzer, (b) Spirometer, (c) ECG, (d) Stethoscope

In order to ensure that provider absenteeism is curbed and to ensure monitoring of the solution, a central dashboard has been provided which provides constant data analytics and alerts, including video feed of patients using the facilities of the eHC.

The solution also monitors the uptime of the refrigerator and the power to the eHC using switches. This ensures that alerts are sent out if temperature sensitive medicines such as vaccines are damaged due to power outage.

The concept also has innovations in the institutional structure to support the solution. It has created local governmental structure for the MHC that constitutes the Village head and key people from the village to ensure management and upkeep of the solution.

The solution integrates Cloud offering, HP’s workstations, software offerings, networking offerings, TS offerings and enterprise offerings to create a One HP solution that enables the following (a) Access to Super Specialists, through remote medical consultation at any location in the world, (b) Collection of automated health data directly from equipment can be made available at Health Cloud for diagnosis and remote expert medical consultation, (c) Remote Monitoring of Medical Personnel to mitigate the provider absenteeism, (d) Fingerprint enabled tracking of patient records, (e) SMS based medication reminders for critical diseases and immunization adds to patient assistance and tracking (f) Remote Monitoring of eHC medical equipment makes the solution sustainable and reliable (g) Referral to tertiary healthcare facilities, (h) Monitoring of power outage in medicine refrigeration facility, (i) Ability to do disease surveillance in real time and (j) tracking of patient history and also assists in building a patient database for future reference and policy formulation.

 

Figure 1: Concept of Cloud Enabled Micro Health Centre and Analytics based Medical Dashboard

Evidence the solution works

The first pilot eHealth Centre solution serves a catchment area with population of 20,000 and has had 1054 new patients in the first month of its operation. The solution has been rolled out in a cluster of 5 villages in District Kaithal in the state of Haryana in India. The telemedicine studio has been setup at the Agroha Medical University. All patient data have been captured in EMR and can be a source for patient analytics, disease surveillance.

Figure 2: Actual MHC at a Village in Haryana, India and the transportation of the solution

Competitive approaches

Different models and frameworks have been proposed for implementing cloud computing in healthcare. There are several studies describing the potential of cloud technology to provide quality healthcare in remote, underserved areas of the population. A cloud based rural healthcare information system model has been proposed by Padhy et al [[i]]. Another study explores the cloud computing paradigm to share electronic health records and addresses the related security concerns. However, there is no single solution that  has integration of the vital diagnostic equipment, usage of a centrally hosted EMR, monitoring and management systems, institutional support and integration with the Government’s health delivery system. The current solution developed and deployed in collaboration with CSIR, Government of India, Jindal Sansthan (Civil Society), Maharaja Agrasen Medical College, Agroha, Orion eServices Pvt. Ltd. Centre for Digital Economy Policy Research and 3M, addresses all the above issues.

Current status

The solution has already been deployed and is running for over 2 months now. By May next year, there will be 4 more such solution deployed by the Government.

Next steps

The solution is being examined by the 20 country regional body of Indian Ocean Rim Association of regional Cooperation as a trans-national solution to be adopted by all the member countries. Cross HP Project team plan as well to team up with one of the global leading NGOs to examine opportunities replication and implementation of the solution in developing countries with special focus on Africa.

The immediate next step is to develop a clinical decision support system that would aid in the diagnosis in order to mitigate the severe shortage of trained medical personnel and doctors.

The solution would also need more rigorous Big Data analytic tools to support management, policy making and drug discovery efforts. The plan is to collaborate with HP labs and offer this project as an ideal platform for piloting some of their latest researches and solutions.

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[[i]] http://uniascit.in/files/documents/2012_0207.pdf