Digital health IDs in Karnataka: State plans big, but privacy concerns remain

The health department is planning to issue Ayushman Bharat Health Account (ABHA) IDs for the entire population in the next few months.

Though the IDs are optional as of now, the department believes it will become universal soon, and can lead to major changes in disease surveillance and policy making. However, health and data activists are skeptical.

Karnataka has so far created ABHA IDs for 89.4 lakh citizens. Personal health records (PHRs) can be created online for those who have these IDs.

So far, PHRs have been created for 2 per cent (1.96 lakh) of those with the IDs. PHRs can be accessed by healthcare professionals and facilities anywhere, making consultations and telemedicine easier, especially for patients from rural areas.

Currently, there are three mechanisms by which ABHA IDs are created - individuals availing it themselves online, health department issuing it simultaneously during its insurance card distribution campaign and government hospitals creating the IDs for some of their patients. Only a person’s Aaadhar number is required to create the ABHA ID.

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But, under the Ayushman Bharat digital mission, health professionals and facilities would also need to register to access patients’ ABHA IDs and PHRs.

“As of now, among health professionals, registration is open only for doctors and nurses. There are around five lakh doctors and nurses in Karnataka overall, but only around 25,000 have registered so far. Once they all register, enrolment will be opened to others like pharmacists and lab technicians,” said a health department official.

He says patients can decide which professionals they share their ABHA ID with.

If the patient shares it with a pharmacist, for example, the pharmacist will be able to enter the prescription details in the PHR, so that it becomes part of the record.

The patient will also be able to access and modify health records any time.

In the long term, the idea is that all professionals and citizens are registered, which would result in better availability of disease data.

“The number of patients and their illness will be reflected in the doctor’s records. This will help us know the prevalence of certain types of diseases in the state, and accordingly how much we should invest in each programme,” says the health official.

Public health activist Dr Sylvia Karpagam is sceptical. “The government has no control over the private health sector. If a doctor avoids sharing data, will the government take action against him?”

Tejasi Panjiar of Internet Freedom Foundation says the Centre’s Draft Health Data Management Policy, 2022, talks about sharing health data with private companies, but doesn’t have sufficient safeguards to restrict its use.

An insurance company could use the data to profile individuals and increase premiums. Or pharma companies could use it for targeted marketing, she says.

Digital rights activist Srinivas Kodali says, “According to the Supreme Court judgement on Aadhaar and right to privacy, an identity like National Health ID can’t be created without a separate law. So ABHA can be challenged legally. India doesn’t have a data protection law either, to ensure that such data is not misused.”