The pros and cons of using ChatGPT in Healthcare

Generative Pre-trained Transformer, often known as GPT, is an innovative kind of #ArtificialIntelligence (#AI) that can produce writing that seems to have been written by a person. OpenAI created this AI language model called ChatGPT. It is built using the GPT architecture and is trained on a large corpus of text data to respond to natural language inquiries that resemble a person’s requirements. 

This technology has lots of applications in #healthcare. This technology has the potential to improve the way #patients interact with healthcare providers and enhance the overall quality of healthcare services. Some people will immediately embrace ChatGPT as a medical resource, while others will avoid it for as long as they can. Both feelings are justified. The man who ignited the home computer revolution, #BillGates, believes ChatGPT will 'change the world,' claiming that AI is just as important as the PC and the internet. The need for accurate and current data is one of the major obstacles to adopting ChatGPT in healthcare. GPT must have access to precise and up-to-date medical data to provide trustworthy suggestions and treatment options.

Pros of including ChatGPT in our health care system

1. ChatGPT can provide real-time information and support, answering patients' questions and offering guidance on health-related topics, including symptoms and treatments.
2. It can help healthcare professionals automate various tasks and provide better treatment.
3. ChatGPT can educate patients on various health topics, such as managing chronic conditions, understanding treatment options, and adopting healthy lifestyles.
4. It can provide information and answer questions about health and wellness so that people can make informed decisions about their health.
5. ChatGPT has the potential to revolutionize healthcare by providing patients and healthcare professionals with access to medical information and clinical decision support.
6. It helps patients access medical information, such as symptoms, diagnoses, and treatment options, before or instead an appointment.
7. ChatGPT can help reduce the workload of healthcare professionals by automating routine tasks such as appointment scheduling.
8. It can help improve patient outcomes by providing personalized care plans based on individual needs.
9. ChatGPT can help reduce healthcare costs by providing more efficient care.
10. It can help improve patient satisfaction by providing a more convenient way to access medical information.

Cons of including ChatGPT in our health care system

1. One critical limitation is the potential for bias in the training data, which can result in biased or inaccurate responses.
2. ChatGPT is a statistical model, lacking the medical expertise and judgment of a healthcare professional. Even if it does score over 60% on a medical test, it cannot diagnose or treat medical conditions.
3. ChatGPT cannot provide hands-on learning experiences. Medical education requires practical training, and ChatGPT cannot replace the importance of hands-on training in medical education.
4. ChatGPT may not be able to understand complex medical terminology or nuances that are important for accurate diagnosis and treatment.
5. It may not be able to provide personalized care plans based on individual needs.
6. ChatGPT may not be able to provide accurate information about rare diseases or conditions that are not well understood.
7. It may not be able to provide accurate information about medications or treatments that are not well understood.
8. ChatGPT may not be able to provide accurate information about alternative therapies or treatments that are not well understood.
9. It may not be able to provide accurate information about mental health conditions or treatments.
10. ChatGPT may not be able to provide accurate information about emergency situations.

Conclusion

ChatGPT is a state-of-the-art language model that has numerous advantages and applications in the healthcare and medical domains. It can assist medical professionals in various tasks, such as research, diagnosis, patient monitoring, and medical education. However, the use of ChatGPT also presents several ethical considerations and limitations such as credibility, plagiarism, copyright infringement, and biases. Therefore, before implementing ChatGPT, the potential limitations and ethical considerations need to be thoroughly assessed and addressed. Future research can focus on developing methods to mitigate these limitations while harnessing the benefits of ChatGPT in the healthcare and medical sectors.

Digital Personal Data Protection Bill 2022 – History & Impact in Healthcare Industry

 

On November 18, 2022, the Ministry of Electronics and Information Technology (MeitY) released the draft of the Digital Personal Data Protection Bill, 2022 (DPDP Bill 2022), inviting suggestions and comments from relevant stakeholders. In its fourth iteration since 2017, the DPDP Bill 2022 attempts a better ‘comprehensive legal framework’. Previous versions of the proposed general data protection legislation drew heavily upon European Union’s General Data Protection Regulation (GDPR) and were dense, voluminous documents, etc. The Bill draws inspiration from Singapore’s Personal Data Protection Act, 2012, and is a condensed and concise document. The new bill is a lot simpler than the previous one as it is having only 24 pages as compared to 70 pages as well as 30 guidelines as compared to 90 in the previous draft bill.

Let’s first understand the status of privacy in the Indian context. As per Part III of the Indian Constitution, we have many fundamental rights like Right to Life & Personal Liberty, Right to Equality, Freedom of Speech & Expression, etc. Fundamental rights provide a high degree of protection from encroachment but the fundamental right to privacy was not guaranteed under the Constitution of India till 2017. Before 2017 in many cases e.g. M. P. Sharma vs. Satish Chandra and Kharak Singh v. State of Uttar Pradesh, the status of Privacy was not recognized as a Fundamental right. In Justice K. S. Puttaswamy v Union of India, the nine Judge Bench unanimously reaffirmed the right to privacy as a fundamental right under the Constitution of India. As per instruction of the Supreme Court of India an expert committee headed by Justice B. N. Srikrishna was created to examine various issues related to data protection in India. The Committee submitted its report and a draft Personal Data Protection Bill, 2018 to the Ministry of Electronics and Information Technology.

Provisions related to Protected Health Information (PHI) are governed by the Information Technology Act, 2000, together with the Information Technology (Reasonable Security Practices and Procedures and Sensitive Personal Data or Information) Rules, 2011. Patient data, including health information, is treated as sensitive personal data or information and under the IT Act offers some degree of protection to the collection, disclosure, and transfer of sensitive personal data. Also long before DPDP Bill 2022, the Government introduced the Digital Information Security in Healthcare Act (DISHA), India’s counterpart of the Health Insurance Portability and Accountability Act (HIPAA), aimed at providing healthcare data privacy, security, confidentiality, and standardization and establishment of the National Electronic Health Authority (NeHA) and Health Information Exchanges. While the purpose of this act is to encourage the pan-India adoption of e-health standards, DISHA has not yet come into force.

Digital Personal Data Protection 2022 Bill operates on a triad - Data Principal, Data Fiduciary, and Grievance Resolver. Unlike the GDPR, the bill boldly defines “harm”, “loss”, and “public interest” in small lists. A first in India’s legislative history, the bill uses “her” and “she” for an individual, irrespective of gender—a welcome populist and inclusive move. The Bill mandates obtaining consent for processing after providing notice in clear and plain language, “describing” the type of personal data sought to be collected and an ‘itemized’ list of the purposes of the processing. PDDP Bill 2022 allows the transfer of personal data outside India to countries notified by the Indian government.

The provisions for penalties in DPDP Bill 2022 Bill fall far short of other data protection legislation around the world, such as GDPR or similar laws in China. In the proposed bill, Healthcare Organizations are subject to penalties of up to ₹500 crores for non-compliance. Other than that, the bill includes a laundry list of penalties: up to ₹250 crores for failing to take adequate precautions against data breaches; ₹200 crores for failing to notify of a breach or complying with provisions related to children; ₹10 crores for violating data localization norms; ₹150 crores when a significant Healthcare Organization fails to carry out their additional obligations under the proposed law. A key ingredient in laws in other countries is the power to impose penalties up to a particular amount as prescribed for offenses or as a percentage of total worldwide turnover, whichever is higher.

A data principal is under an obligation to not register a false or frivolous complaint with a data fiduciary or the Board, not to furnish any false particulars or suppress any material information. DPDP Bill 2022 has introduced a penalty of up to ₹10,000/- (Rupees Ten Thousand) on the data principal for failure to comply with its proposed obligations.

The proposed DPDP Bill 2022 introduces the concept of ‘Deemed Consent’ where the data principal is deemed to have given consent for processing their personal data. Consensual processing of Personal Data may be done in case of medical emergencies involving a threat to life or an immediate threat to the health of the Data Principal. In the context of such processing, a parallel may be drawn with India’s draft Health Data Management Policy by NDHM released in April 2022 which also envisages provisions relating to the processing of Personal Data in case of medical emergencies. Notably, the NDHM contemplates the appointment of a nominee to provide valid consent on behalf of the Data Principal in case such Data Principal becomes seriously ill, or mentally incapacitated, or where the data principal is facing a threat to life or a severe threat to health and is unable to give valid consent. Unlike the DPDP Bill 2022, the NDHM does not propose Deemed Consent in absence of a nominee but rather shifts the right to give valid consent on behalf of the Data Principal to an adult member of the family of the Data Principal.

Despite the recommendation under the JPC Report, the DPDP Bill 2022 has kept the 'Non-Personal Data' of the individuals such as information collected by the Government, NGOs, and other private sector entities, outside its ambit. The usage of phrases 'as it may consider necessary' and 'as may be prescribed' can lead to administrative ambiguities. The autonomy of the Data Protection Board which is entrusted with overseeing the protection of individual's personal data and ensuring compliance with the provisions of the law is not reassuring. Further, the Government and its instrumentalities can retain personal data for an indefinite period irrespective of whether the purpose for which data was processed has been fulfilled.

By 2030 India is projected to be the world’s third-largest economy and will have one of the world’s largest digital personal data footprints in motion and at rest. The DPDP 2022 Bill’s essentiality shines in our strengthening role in the global order. With the G20 Presidency and multiple Free Trade and Regional Trade Agreements in place, we will have to find solutions for Data Free Flow with Trust and cross-border data flows.

Digital Healthcare – Laws & Regulations in India

Digital health is using technologies to help improve individuals' health and wellness. These technologies include both hardware and software solutions and services, including telemedicine, web-based analysis, email, mobile phones and applications, text messages, wearable devices and clinic or remote monitoring sensors. Really it's about applying digital transformation, through disruptive technologies and cultural change, to the healthcare sector. Digital health is a multi-disciplinary domain involving many stakeholders, including clinicians, researchers and scientists with a wide range of expertise in healthcare, engineering, social sciences, public health, health economics and data management.

Digital Healthcare has been around in India since long but COVID-19 pandemic has put it in the spotlight and we are noticing mass adoption as 5 crore Indians accessed healthcare online in the last three months (Practo’s Insights Report, 18 Jun3 2020). In a significant move, the Ministry of Health and Family Welfare (“MoHFW”) on March 25, 2020, has issued the Telemedicine Practice Guidelines to provide healthcare using telemedicine and that is another major reason behind surge in online consultations. Also these Guidelines are one of the best guidelines ever published and the reason that telemedicine practice will stay in India. The Guidelines have made the practice of text/audio/video based medical care legal and regulated and thus have given platforms (mobile apps, web portals & social media) as well as doctors the standards to follow.

The legal and regulatory framework in India is/will be govern by following relevant acts / bills –

• Telemedicine Practice Guidelines by MCI & NITI Aayog, 2020
• Personal Data Protection Bill, 2019
• Information Technology Act, 2000 & Information Technology Rules 2011
• Clinical Establishment Act, 2010
• MCI Act, 1956 & MCI Regulations 2002
• Indian Medical Council Act, 1956 and Indian Medical Council Regulations 2002
• Drugs & Cosmetics Act, 1940 and Rules 1945
• Other Service Providers Regulations under the New Telecom Policy 1999

In September 2013, MoHFW notified the EHR Standards (Electronic Health Record Standards) for India.  Those standards were chosen from the best available & previously used standards applicable to International EHRs, keeping in view their suitability to and applicability in India.  Accordingly the EHR Standards 2016 document is notified and is placed herewith for adoption in IT systems by healthcare institutions and providers across the country.  The MoHFW facilitated its adoption by making available standards such as the Systematized Nomenclature of Medicine Clinical Terminology (SNOMED CT) free-for-use in India, as well as appointing the interim National Release Centre to handle the clinical terminology standard that is gaining widespread acceptance among healthcare IT stakeholder communities worldwide.

In addition, the MoHFW has proposed a new bill named DISHA (Digital Information Security in Healthcare Act) to govern data security in the healthcare sector.  The purpose of this Act will be to provide for electronic health data privacy, confidentiality, security and standardization.  The MoHFW, through the proposed DISHA, plans to set up a statutory body in the form of a national digital health authority for promoting and adopting: e-health standards; enforcing privacy and security measures for electronic health data; and regulating the storage and exchange of electronic health records.

One of the most immediate changes that health tech companies may need to be prepared for is the cost of compliance – with the Personal Data Protection (PDP) Bill 2019. As of the current interpretation of the text of the PDP Bill, 2019 (which effectively can get signed into law at any time) there is no period provided to affected companies to comply with the data protection measures in the Bill. The requirement of having a privacy-by-design system in place means that for a lot of companies the cost of compliance will go up as they would have to upgrade/overhaul their data protection systems and software. This change would be akin to the one experienced by European companies when they needed to comply with the General Data Protection Regulation (GDPR), but at least, in that case, there was a period prescribed within which companies were permitted to overhaul their security systems.

If any IT company or startup into Digital Healthcare plans to offer and add telemedicine/telehealth software to already existing software like healthcare CRMs, clinical software and patient management systems, have to incorporate all the relevant Acts & guidelines. It will not only help their clients but also will help companies because as per Telemedicine Practice Guidelines, technology platforms are obligated to ensure many instructions otherwise can be blacklisted.

Digital Health: Why Digital Health will become the new normal

During COVID-19 pandemic, terms like telehealth, telemedicine, remote-patient monitoring, virtual care and digital health are thrown around very commonly, though these terms have been around for years, but the recent situation is accelerating patient awareness and physician adoption of these technologies.

With a growing need for social isolation, healthcare organizations are actively seeking ways to provide health services to patients with both COVID-19 and other conditions remotely.

Start-up investing is not a new phenomenon in the financial world, but one sector, in particular, has seen a veritable boom in investors since the beginning of the COVID-19 pandemic. While many industries plummeted in the first quarter of the year, digital health companies closed the first quarter of 2020 with unprecedented levels of funding. Private equity and venture capital financing of digital health start-ups reached an all-time high of just over $3 billion in Q1 2020. 

Digital health seeks to enhance administrative tools, clinical tools and patient interaction to make the healthcare experience more effective, efficient, and positive for patients. Healthcare is far behind in technology, and this industry is looking to fill that gap. Those of us who work in the digital health space want to take current healthcare experience, which is something like Blockbuster Video in the early 2000s and turn it into Netflix.

The Board of Governors in supersession of the Medical Council of India (MCI) issued Telemedicine Practice Guidelines on March 25 to strengthen delivery in a post-Covid-19 world, with a focus on Health and Wellness Centres (HWCs) that provide preventive and primary healthcare within a 5 km radius at the grassroots level.

Telemedicine is being used by doctors to connect with patients, and by mid-level provider/health workers to connect patients with doctors without patients having to physically visit a hospital or clinic. Even post lockdown, it will help reduce the burden on the secondary hospitals and improve documentation, data-collection, diagnosis and care without risking the safety of the patients or the health workers. It is already being used with success in some states for reproductive and child health and tuberculosis notification and outreach.

There is a persistent shortage of doctors, health workers and hospital beds in the country, especially in rural areas and densely populated underserved states. India has 1.1 million allopathic doctors registered with the Board of Governors/State Medical Councils in December 2019, according to the National Health Profile 2019.

India’s public health expenditure is just 1.28% of its GDP, with the per capita public health expenditure being Rs 1,657 in 2017-18. The rising cost of treatment has led to inequities in access, with people in under-served rural areas and urban slums among the worst hit. For people living in rural areas completely dependent on government hospitals and clinics, the government allopathic doctor-patient ratio is 1:10,926, shows NHP 2019 data.

For a population of 1.36 billion, this makes the doctor-population ratio 1:1,457, which is lower than the WHO recommended norm of 1:1,000. In addition to doctors, India has a little more than two million registered nurses and midwives, many of whom need infection control training to care for patients with communicable diseases, such as Covid-19 and tuberculosis. The WHO estimates there is a deficit of 6 lakh doctors and 20 lakh nurses in India. Further, doctors often have to perform many routine tasks like data entry, patient management; pharmacy interfacing, ensuring the right gear and equipment are present in the required quantities at the point-of-need, and so on—over and above their medical and caregiving duties.

Before Telemedicine Practice Guidelines, there was no legislation or guidelines on the practice of telemedicine through video, phone, and online platforms, which include the web, apps, chats, etc. The existing provisions under the MCI Act, 1956, MCI Regulations 2002, Drugs & Cosmetics Act, 1940 and Rules 1945, Clinical Establishment Act, 2010, Information Technology Act, 2000 and the Information Technology Rules 2011 primarily governed only the practice of medicine and information technology.

With such a large rural population and insufficient trained medical staff and rural healthcare facilities, India can rapidly adopt telemedicine capabilities to make up for the gap. E-consultations, which took off during the lockdown, can vastly improve access to healthcare in rural areas. Mobile and internet penetration in rural areas is accelerating, and telehealth can piggyback on this trend. A quick e-consultation can determine whether the person has a simple problem or needs to access a facility for a physical check-up. We may find that 50-60% of cases could be diagnosed in this manner, and the remaining might have to travel for a consultation—largely reducing the healthcare burden in the country.