Indian Healthcare System

5.
Review
A Comprehensive Survey on Data

Utility and Privacy: Taking Indian
Healthcare System as a Potential
Case Study
Prathamesh Churi, Ambika Pawar and Antonio-José Moreno-Guerrero
Special Issue
Privacy-Preserving Computing for Analytics and Mining
Edited by
Dr. Majeed Abdul
https://doi.org/10.3390/inventions6030045
inventions
Review
A Comprehensive Survey on Data Utility and Privacy: Taking
Indian Healthcare System as a Potential Case Study
Prathamesh Churi 1,2 , Ambika Pawar 1 and Antonio-José Moreno-Guerrero 3, *
1 Symbiosis Institute of Technology, Symbiosis International Deemed University, Pune 412115, India;
[email protected] (P.C.); [email protected] (A.P.)
2 School of Technology Management and Engineering, NMIMS University, Mumbai 400056, India
3 Department of Didactics and School Organization, University of Granada, 51001 Ceuta, Spain
* Correspondence: [email protected]
Abstract: Background: According to the renowned and Oscar award-winning American actor and film
director Marlon Brando, “privacy is not something that I am merely entitled to, it is an absolute
prerequisite.” Privacy threats and data breaches occur daily, and countries are mitigating the conse-
quences caused by privacy and data breaches. The Indian healthcare industry is one of the largest and
rapidly developing industry. Overall, healthcare management is changing from disease-centric into
patient-centric systems. Healthcare data analysis also plays a crucial role in healthcare management,
and the privacy of patient records must receive equal attention. Purpose: This paper mainly presents
the utility and privacy factors of the Indian healthcare data and discusses the utility aspect and pri-
vacy problems concerning Indian healthcare systems. It defines policies that reform Indian healthcare
systems. The case study of the NITI Aayog report is presented to explain how reformation occurs
in Indian healthcare systems. Findings: It is found that there have been numerous research studies
Citation: Churi, P.; Pawar, A.; conducted on Indian healthcare data across all dimensions; however, privacy problems in healthcare,
Moreno-Guerrero, A.-J. A specifically in India, are caused by prevalent complacency, culture, politics, budget limitations, large
Comprehensive Survey on Data population, and existing infrastructures. This paper reviews the Indian healthcare system and the
Utility and Privacy: Taking Indian applications that drive it. Additionally, the paper also maps that how privacy issues are happening
Healthcare System as a Potential Case in every healthcare sector in India. Originality/Value: To understand these factors and gain insights,
Study. Inventions 2021, 6, 45. https://
understanding Indian healthcare systems first is crucial. To the best of our knowledge, we found
doi.org/10.3390/inventions6030045
no recent papers that thoroughly reviewed the Indian healthcare system and its privacy issues.
The paper is original in terms of its overview of the healthcare system and privacy issues. Social
Academic Editors: Majeed Abdul and
Implications: Privacy has been the most ignored part of the Indian healthcare system. With India
Chien-Hung Liu
being a country with a population of 130 billion, much healthcare data are generated every day. The
Received: 13 May 2021 chances of data breaches and other privacy violations on such sensitive data cannot be avoided as
Accepted: 17 June 2021 they cause severe concerns for individuals. This paper segregates the healthcare system’s advances
Published: 23 June 2021 and lists the privacy that needs to be addressed first.
Publisher’s Note: MDPI stays neutral Keywords: healthcare; utility; privacy; Indian healthcare; hospitals; EHR; KPI; PDP bill; data
with regard to jurisdictional claims in breach; attacks
published maps and institutional affil-
iations.
1. Introduction
The healthcare industry is an emerging industry. In recent years, the healthcare
Copyright: © 2021 by the authors. industry in developing countries has grown rapidly. In the last few decades, considerable
Licensee MDPI, Basel, Switzerland. efforts have been taken to integrate information and communication technologies (ICT)
This article is an open access article into healthcare practices [1,2]. In E-healthcare, the latest technologies are integrated with
distributed under the terms and medical infrastructures, including continuous monitoring and transfer of health-related
conditions of the Creative Commons problems from the patient-centric environment to respective services providers [2–4]. The
Attribution (CC BY) license (https:// volume of the data generated in the healthcare industry is rapidly escalating. In healthcare,
creativecommons.org/licenses/by/
for highly accurate prediction and early diagnosis of diseases, we must increase healthcare
4.0/).
Inventions 2021, 6, 45. https://doi.org/10.3390/inventions6030045 https://www.mdpi.com/journal/inventions

Inventions 2021, 6, 45 2 of 30
data utility with the help of various technologies such as machine learning, artificial
intelligence (AI), and data analysis.
According to IBM global business services’ executive report in 2012, the entire health-
care system is being moved from a disease-centric to a patient-centric environment [4,5].
Disease-centric healthcare systems have the following features (Figure 1):
1. The health data are centrally stored according to diseases (type, symptoms, and
remedial medicines).
2. Electronic health records (EHRs) are assessments and analyses conducted according
to diseases. For example, we can analyze the patient data of the past ten years in a
hospital with diabetes, malaria, or another joint disease.
3. Disease-centric databases present less scope for data analysis because they do not
focus on individual traits and symptoms. Some diseases are related to a person’s
behavior, lifestyle, and geographical location. For example, suppose a person is
treated for two or three similar diseases from different hospitals in the past ten years.
In that case, we must analyze his treatment records, family records, and habits, which
are unavailable in the disease-centric database or may be available in heterogeneous
databases, wherein a combined analysis is complex. Some data values are spread
across multiple datasets maintained separately by hospitals or may have incomplete
values, resulting in inappropriate/wrong prediction. The data quality is questionable
to be used for analysis.
Figure 1. Disease- and patient-centric healthcare systems.
By contrast, patient-centric databases have the following features:

1. The data volume generated is considerably larger and stored according to the individ-
ual patient; hence, the data quality and utility are highly satisfactory in appropriate
decision making.
2. In E-healthcare, the latest technologies are integrated with medical infrastructures,
including continuous monitoring and transfer of health-related problems from the
patient-centric environment to respective service providers [2,3,6–9].
3. Because an individual’s data are collected from multiple devices and sensors or
through sources, maintaining the individual’s privacy is challenging.
Security and privacy concerns regarding any type of data are significant problems
in the current technology-driven world. With substantial healthcare data for analyses
and studies, maintaining privacy is another field that requires further improvement. The
data are kept anonymous from users or servers to prevent its misuse. Such health data
are processed and stored dynamically at different dynamic locations with various trans-
parencies in the distributed environment. In such a scenario, maintaining data privacy is
crucial. Some privacy techniques, namely anonymization, generalization, perturbation,
role-based access control, and encryption, are used to hide data. According to [4], data
undergo different phases during its lifecycle: Data storage, transition, transfer, and process-
ing. Existing privacy-preserving techniques remain in the developing stages, and strong
privacy protection is still an open study topic.
With the advent of the technologies mentioned above presenting the problems of
maintaining data privacy, central questions that remain unaddressed in the healthcare
industry field are as follows [10]:
1. Can one pursue high data utility while maintaining acceptable privacy?
2. Because privacy concerns are different for different healthcare organizations, how is
the trade-off between privacy protection and data utility balanced for computing?
Figure 2 illustrates the trade-off between data utility and privacy. In the past years, the
focus was on maintaining patient privacy and maximizing utility by considering patient
privacy [11–13].
Figure 2. Trade-off between privacy and utility.
With the advent of technology, the number of healthcare markets and assets in India
has been increasing every year. India will have a potential healthcare market shortly. Many
medical institutes are emerging because of a change in government policies. The Indian
government is motivating and encouraging medical colleges to be equipped. Because the
Indian healthcare structure is complex and interdependent, technology implementation and
addressing privacy problems has always been a big question. Therefore, the contributions
of this paper are as follows:
• Provide insights into Indian healthcare systems with applications, trends, and advantages.
• Describe policies that drive Indian healthcare systems
• Specify technological inventions used in Indian healthcare systems.
• List the various privacy issues concerning the Indian healthcare system that needs to
be addressed first.
Structure of Paper
The paper mainly presents the utility and privacy of the healthcare data and discusses
the utility aspect and privacy problems of Indian healthcare systems (Figure 3). To un-
derstand these factors and gain insights, understanding Indian healthcare systems first is
crucial. Section 2 presents overall Indian healthcare systems and world health organization
(WHO) indicators that classify sound healthcare systems. Section 3 defines policies that
reform Indian healthcare systems. The case study of the NITI Aayog report is presented to
explain how reformation occurs in Indian healthcare systems. Section 4 describes health-
care applications in India, wherein the advantages of the healthcare system, trends in
healthcare systems, and healthcare startups originated in India are explained. Section 5
presents technologies available for healthcare analytics and Indian papers based on new
machine learning and AI strategies. Section 6 addresses the various privacy problems
discussed in the literature. Section 7 concludes the study.
Figure 3. Structure and contribution of the paper.
2. Indian Healthcare Systems: Overview

Indian healthcare systems are divided into two sectors: Public and private. The public
sector healthcare is handled by the government and opens for all people. This sector
includes super-specialty hospitals equipped with medicines and instruments, which are
majorly located in tier I and tier II cities. Additionally, district- and taluka-level hospitals
provide healthcare services to the people [11–13]. Primary healthcare centers and village
hospitals with low costs are available, which provide affordable services to the people.
The private sector has a similar structure and is generally used by the upper-middle
class and upper-class population. The overall cost of healthcare services included in the
private sector is higher than that in the public sector. Technological interventions are
also more diverse in the private sector than in the public sector. Figure 4 illustrates the
detailed structure of the Indian healthcare system. Table 1 presents the difference between
the public and private sectors [14]. The differentiation factor is adopted from the WHO
health system themes [14]. WHO presents some descriptive indicators to define a suitable
healthcare system.
Figure 4. Indian healthcare system.
Table 1. WHO indicators for suitable healthcare systems and Indian context.
The Public The Private

Category Sub-Category Description and Indicators
Sector in India Sector in India
24 × seven healthcare service availability
Availability Moderate Good
to people without any hesitation
Less waiting time to initial screening and
Access and response Timeliness of service subsequent testing, providing results, Moderate Excellent
and follow-up
Highly responsive feedback system, facility,
Hospitality Moderate Good
and maintenance of healthcare system
The comprehensiveness of Availability of all the components of WHO
Poor Good
healthcare services service packages
Diagnostic Accurate diagnosis of retrospective review Moderate Excellent
Quality Rate of conformity to international
Management standards Poor Good
disease-specific management standards
Rate of failure to follow-up or rate of
Client retention Moderate Moderate
appropriate patient return
Rate of therapy success, controlling of
Treatment success rates population characteristics, Moderate Good
and delayed presentation
The proportion of the catchment
Population coverage population reached through dedicated Excellent Moderate
Outcomes campaigns (e.g., vaccination rates)
Rate of disability to patients and
Morbidity Moderate Less
controlling of population characteristics
Rate of patient death and controlling of
Mortality Moderate Less
population characteristics
Table 1. Cont.
The Public The Private

Category Sub-Category Description and Indicators
Sector in India Sector in India
Data accessibility Availability of data and appropriate use of
Poor Good
and quality indicators and statistics
Contribution of healthcare systems to core
Accountability, transparency, public health system functions
Public health functions Good Good
and regulation. (e.g., reporting of critical diseases and
preventative care)
Reform capacity Results of quality improvement initiatives Poor Good
Financial barriers to care User fees, bribes, and pharmaceutical costs Very less High
Fairness and equity Healthcare availability commensurate
Distributive justice Moderate Good
with requirements
Absolute dollars spent for
Cost Very less High
a given indication
Repetition of diagnostic time, testing,
Redundancy Moderate Good
supply chains, and therapy delivery
Efficiency
Separation of core healthcare system
Fragmentation functions and generating Poor Poor
sluggish management
The time between the ordering of tests or
Delays Poor Good
therapies and their execution
3. Healthcare in India: Reformation in Policies

Case Study: Healthcare Sector in India: NITI Aayog Report
The Indian government is highly proactive in the healthcare sector and encourages
outside investors to invest in the Indian healthcare industry. According to the NITI Aayog
statistics [1], the Indian government will increase the public expenditure of Healthcare from
1.1% to 2.5% GDP in the next four years. This finding shows that India is set on the path
of progressive Healthcare for each individual. The Indian (union and states) government
spends 1.13% of the total asset from its current GDP [1]. According to the NITI Aayog
report, India has inadequate and fragmented delivery of healthcare services, perhaps
because of cultural and religious diversity or inadequate implementation of health policies.
According to a previous report [1], NITI Aayog has reported the following reasons for
challenges, opportunities, benefits, and options for improving India’s health sectors:
√
Strong economic foundation and policy implementation for transforming the
healthcare industry, which is currently underperforming.
The Indian economy is growing at a high rate. For a decade, India has controlled
inflation, increased its GDP, and encouraged states to become policy-driven. The health
factor of Indians has increased in the decade because of a solid economic background.
The use of EHRs, medical health analysis, competent and expert health advice through
machines, and data analysis through wearable devices is adopted in India. The “make in
India” [2] policy helped investors invest more assets in the healthcare industry, resulting
from the quality improvisation of health and healthcare industries in India.
Table 2 [3] summarizes Indian health systems with key performance indicators such
as GDP, PPP, and global healthcare rank. The source was obtained from the Lancet journal.
Table 2. Key performance indicators and source: Lancet Journal.
India China Sri Lanka Indonesia Egypt Philippines

Total health expenditures as % GDP 4.0% 5.5% 4% 3% 5% 4%
Fiscal health expenditures as % GDP 0.9% 3.2% 2% 1% 1% 1.3%
Per-capita health expenditures (PPP) 239 761 491 363 516 342
Level of out-of-pocket
64% 36% 50% 60% 62% 54%
(% Total health expenditures)
Neo-natal mortality 1980 60 65 24 41 53 27
Neo-natal mortality 2016 25 5 7 13 12 13
Global healthcare rank 145 92 71 138 111 124
The burden of disease
34,000 26,300 24,000 28,900 28,000 31,000
(DALYs per 100,000 population)
√
Healthcare system improvisation can decrease mortality and poverty rates and ac-
celerate economic growth.
Implementing critical, intelligent, and automated health systems can help Indian
people improve health and reduce mortality and poverty rates. The use of AI and machine
learning algorithms in digital Indian healthcare data can enable the early prediction of
diseases and provide remote-level advice from medical experts. Centralization of medical
healthcare records can help rapidly access patient information and increase healthcare
record utility.
√
Unnecessary and non-uniform health sector fragmentation is the main problem of
healthcare industries in India.
Data fragmentation at any level and its granularity are the significant reasons for the
underperformance of India’s healthcare systems. Fragmentation, a myriad of organizations,
institutions (formal and informal rules), management, and administrative arrangements
and entitlements that do not coordinate harmoniously and are often subjected to contradic-
tory incentives, severely hampers the continuity of care and portability benefits [1]. In other
countries, healthcare system fragmentation occurs with uniform policies and rules and has
the same set of roles to access it. Uniform and limited fragmentation of the healthcare data
and users helps:
• Protect the healthcare data from a third-party unauthorized entity;
• Have uniformity in centralized health systems.
Indian healthcare policies are growing and are adaptive and structured. Several
problems of healthcare systems required to secure the systems are addressed.
4. Healthcare Industry and Applications in India

India is emerging in terms of revenue and employment in the healthcare field. The
advances of ICT help the healthcare sector streamline data structure, access, and health
analytics [14–16]. The healthcare sector in India is growing relatively slower due to its
extensive coverage, strengthening services, and increasing expenditure by public and pri-
vate players. In India, the healthcare industry is divided into public and private industries.
The public healthcare industry (operated by the Indian government) is responsible for
providing primary health services and treatments primarily to people in rural areas. The
private sector provides amenities and services to the middle-class and upper-class people
in India.
4.1. Segments of Indian Healthcare Industry

The Indian healthcare system is divided into six major segments: Hospitals, pharma-
ceuticals, diagnostics, medical equipment and supplies, medical insurance, and telemedicine,
according to the IBEF report [15]. The Infographics (Figure 5) describe each segment in-
volved in the Indian healthcare system.
Figure 5. Segments of the Indian healthcare industry [15].
4.2. Advantages of the New Indian Healthcare Industry

Make in India is the fundamental initiative taken by the Indian government. Under
this flagship campaign, the healthcare sector comprising hospitals, diagnostic centers, drugs
and pharmaceuticals, and medical devices is identified as a part of the initiative [17,18].
Because of this initiative, the healthcare industry is transforming, and Figure 6 presents its
benefits as infographics.
Figure 6. Advantages of the Indian healthcare industry [18].

4.3. Rise in Healthcare Infrastructure in India

With the advent of technology, the number of healthcare markets and assets in India
has been increasing each year. India will have potential healthcare markets shortly. Many
medical institutes are emerging because of the changes in government policies. The Indian
government is motivating and encouraging medical colleges to be equipped. According
to the national health profile in 2018–19 [17], the number of medical educational infras-
tructures in India has increased rapidly in the past 26 years. The total number of medical
colleges in FY 2019 was 529, with 1,154,686 doctors with recognized medical qualifica-
tions. The presented demographics indicate increased medical colleges and doctors with
recognized medical degrees in India (Figures 7 and 8).
Figure 7. Number of doctors in India [17].
Figure 8. Number of medical colleges in India [17].

Inventions 2021, 6, 45 10 of 30
4.4. Trends in Indian Healthcare System

According to the article published in the Journal of Ayurveda and Integrative medicine [19]
as well as the IRDA, CII, Grant Thornton, Gartner, and Technopunk [20], the notable trends
observed in the Indian healthcare system are presented in Table 3. Each trend also has
some privacy concerns and implications, which are listed in the same table (Table 3).
Table 3. Comprehensive overview of ‘trends and privacy implications in the Indian healthcare system.
Trends Description Privacy Implications

Due to urbanization and technology use In general, diseases are less harmful and
in our daily lives, specific lifestyle-related can be treated by a local doctor or
diseases have led to community diseases. healthcare professionals. The record of
These diseases include cholesterol, blood such diseases and treatment is stored by
Community disease to personal- and
pressure, diabetes, liver problems caused individual hospitals in digital form. Local
lifestyle-related diseases
by overconsumption of products such as hospitals are not trustworthy enough to
alcohol. This trend requires customized store such sensitive information, and
medicines and treatment with personal hence it may invite data breaching issues
health and self-care. due to insecure storage of EHR [20–22].
The privatization of Healthcare by the
Hospitals built in rural areas mostly use
government helped expand Healthcare to
paper-based prescription records; using
tier II and III cities. Hospitals are also
these records lacks electricity and the
built-in villages and rural areas to
Internet to run digital equipment.
Healthcare expansion to Indian cities provide Healthcare to middle and
Paper-based records can be easily stolen
lower-class people. The government is
and are most vulnerable to stealing
reducing taxes for the first five years for
personal information than digitally
such businesses to encourage healthcare
stored information.
expansion in the private sector.
Research says that protection against
privacy concerns is more in telemedicine,
Many healthcare startups such as Apollo
Which requires a multi-disciplinary and
and AIIMS are adopting telemedicine
multi-stakeholder approach. Most of the
services. Telemedicine can bridge the
employees working in the telemedicine
rural-urban gap to provide medical
Telemedicine industry are either very busy with
facilities, low-cost consultation, and
workload or are less trained about
diagnosis facilities to the remotest of
security and privacy violations. This
areas through the high-speed Internet
invites data breaching attacks, phishing
and telecommunication.
attacks, unauthorized access,
and so on [23].
AI ensures that the disease prediction is
The adoption and use of AI-based way faster than an actual spread of
healthcare applications are rapidly disease due to prediction technology.
AI in Healthcare growing. AI helps solve the problems of However, with the massive use of data
patients, doctors, hospitals, and the for training purpose (which contains
overall healthcare industry. sensitive data), privacy issues of
identifying individual rises [24].
Home healthcare provides Healthcare at
affordable prices at patients’ homes. It
saves the traveling costs of
Home healthcare [24] -
doctors/patients, and treatment is
provided with minimum
logistic interventions.
Inventions 2021, 6, 45 11 of 30
Table 3. Cont.
Trends Description Privacy Implications

There are massive amounts of data
generated in the health insurance and
needs to be protected. The sensitive
Health insurance is gaining momentum
information such as personal details,
in India. The trust of people in India in
disease details, past health history is
health insurance and the assurance by
being recorded and shared with the third
Growth of health insurance health insurance has increased in past
party by insurance companies without
years. Many companies such as Aditya
individual consent. Most of the data
Birla and LIC provide health insurance
shared with the third party are
to people.
non-anonymous; it is straightforward to
predict the identity of individual
human beings.
The mobile solid technology
infrastructure and the launch of 4G can
drive mobile-based health initiatives in
Mobile-based health delivery -
the country. It enables fast health-related
services with reduced costs and superior
reach [21,22].
Technological intervention is increasing in
India. According to [21], India’s medical
technology sector can reach US $9.60
billion by 2022. Various advent
technologies are used in the healthcare
Technology for health -
domain, such as machine learning
algorithms for prediction of specific health
parameters/data/diseases/behavior and
the Internet of things-based healthcare
systems [22]
Luxurious services, including pick and
drop facilities, doctor visits at homes,
Luxurious living and health -
online prescriptions, have become a part
of the Indian healthcare industry.
4.5. Popular Healthcare Hubs/Startups in India

The competitive value of the Indian healthcare system provided well-trained medical
professionals, well-equipped instruments, ubiquitous healthcare applications, and suitable
patient-centric health hubs. Table 4 presents some healthcare hubs.
Table 4. Healthcare hubs in India.
Health Care Providers Statistics Description

9844 beds Apollo healthcare has hospitals and pharmacies
70 hospitals across India. Moreover, the company provides
8500+ doctors project consultancy services, health insurance
Apollo Hospitals
Total income was Rs 9648.88 crore services, education and training programs, and
(US $1.38 billion) in FY 19 and Rs 8347.39 crore research services. It also operates birthing centers,
(US $1.19 billion) during 20 day surgery centers, and dental clinics.
Over 1200 employees
Thyrocare is the first completely automated
571 cities
diagnostics laboratory. The company offers cancer
Thyrocare Technologies Limited Consolidated total income of Rs 412.86 crore
and HIV diagnostics centers, chemotherapy, and
(US $59.07 million) in FY 19 and Rs 337.43 crore
dialysis centers across India.
(US $48.28 million) in 9 MFY 20
Inventions 2021, 6, 45 12 of 30
Table 4. Cont.
Health Care Providers Statistics Description

36 healthcare facilities Fortis healthcare is considered an integrated
Approximately 9000 beds healthcare delivery service provider in India. Fortis
415 diagnostic centers memorial research institute (FMRI) ranked second in
Fortis Healthcare
Total consolidated revenue of Rs 4469.35 crore a study of 30 most technologically advanced
(US $639.48 million) in FY 19 and Rs 2379.79 crore hospitals in the world conducted by
(US $340.51 million) in H1FY 20. topmastersinhealthcare.com. 19 August 2020
Netmeds is an online platform for the pharmacy
14 logistic centers across the country
industry. It offers significant pharmacy products
24 × seven online portal and mobile application
through online shipments. It is also called “India ki
Net meds Three million downloads (till 2018) with more than
pharmacy.” The mobile application is well-equipped
$512 million profit; it is projected to earn
with voice chats, e-mailing services, and 24 × seven
$3.645 billion by 2022.
customer care services.
Practo is the world’s leading healthcare platform and
works as an independent medical portal, connecting
doctors and hospitals across India and the globe.
Although the reach of Practo is global, it was
Free services for doctors and patients founded in 2008 in Bangalore. Practo provides its
Practo
Focused website and 1 lac doctor profiles in India users with diagnostic search features on its
web-based platform through high-quality
photographs and filter options. Practo is suitable for
private doctors who independently run hospitals in
rural and urban areas.
5. Healthcare Data Utility: Context of India

In recent years, healthcare analytics has become a broad research topic in India. Au-
tomation in healthcare processes is crucial because the healthcare system has transformed
from diseases- to a patient-centric system. Many people suffer from diseases related to their
lifestyle, eating habits, and work profiles. Such diseases include diabetes. India’s overall
healthcare data system is being transferred from offline to online, wherein digitization
of the health data such as EHR, healthcare applications, digital X-rays, and reports is
being used for diagnosis and treatments. A large amount of data is generated on server-
side platforms. Such healthcare data must be analyzed for suitable treatments and early
disease predictions. In the healthcare industry, technologies such as data analysis, ma-
chine learning, AI, and blockchain [23,24] play a vital role because they enable healthcare
systems to systematically use and analyze the data to identify inefficiencies by keeping
them secure and provide optimal practices that improve care and reduce costs. Doctors,
clinicians, healthcare researchers, and medical industry professionals are the beneficiaries
of healthcare analytics. This section answers the following questions [24]:
• What are the different data sources of the Indian healthcare industry?
• How are the Indian healthcare data classified?
• What are the different intelligent platforms used for healthcare data analysis?
• Which technologies drive the Indian healthcare system?
5.1. Sources of Indian Healthcare Data

The comprehensive data can be divided into three types in India, namely clinical,
exogenous, and genomic data.
• Clinical Data
The clinical data include electronic health records such as magnetic resonance imaging,
X-rays, blood and urine record, molecular imaging, ultrasound, photoacoustic imaging, and
fluoroscopy data. Moreover, it comprises pharmaceutical records and sociodemographic
details of patients or populations. The clinical data are collected from health institutes,
hospitals, or health insurance companies through interviews, surveys, or patient treatment.
Such data contain compassionate information, including the diseases, medicine prescribed,
patient deficiency, address, and other personally identifiable information. Such data can be
structured or unstructured, depending on the type of data collected from patients.
Inventions 2021, 6, 45 13 of 30
• Exogenous Data
The data obtained from medical and wearable devices such as pacemakers, fitness
bands, and intelligent watches are categorized as exogenous data. Because data are col-
lected from devices and sensors, they are stored in the cloud and are considered to have
sensitive information such as heart rates and blood-related information; such data are
breaches to privacy issues [25,26]; the details are presented in the next section of the paper.
• Genomic Data
The data relating to people’s genes and genetic structures are classified as genomic
data. The data are susceptible but simultaneously highly complex to understand as far
as their analysis is concerned. The genomic data analysis helps scientists and medical
practitioners to predict remedies accurately and preventive methodologies for patients
with a particular lifestyle, that have similar genetic make-up, or are exposed to similar
environmental conditions [27,28].
5.2. Types of Healthcare Data

The main three types of data [29] are structured, unstructured, and semi-structured
data. Table 5 presents the details of these data types.
Table 5. Type of healthcare data.
Type Description Examples Clinical Data Exogenous Data Genetic Data

The data arranged in a structured
format are considered structured
Blood reports, sugar reports,
data. Such data are primarily
billing information of patients,
arranged in rows and columns.
Structured and Indian census information. Yes No Yes
The structured data are mostly
Primarily clinical data can be
easy for analysis but have
categorized as structured data.
considerable sensitive
information and direct identifiers.
The data that is minimally
structured and requires scripts for
XML-, JSON-extracted reports
extraction ate classified as
are considered semi-structured.
semi-structured data. Such data
Semi-structured The exogenous data are No Yes Yes
are generally captured from
generally considered
wearable devices, which monitor
semi-structured data.
a person’s response to particular
medicine and activity.
The data with no uniform format The doctor’s written
or structure are classified as prescription on a notepad,
Unstructured unstructured data. Human images, videos, or time series Yes Yes Yes
written prescriptions and reports reports is considered
are considered unstructured data. unstructured.
5.3. Key Data Sources of Health Information of India

In India, health is a state subject; the constitution places the responsibility of health
on both central and state Governments. In various data sources, the health information
of patients is preserved. The central government is responsible for provisions listed in
the union list, and the state government is responsible for providing medical services and
amenities such as hospitals and dispensaries [30]. The data sources are divided into direct
and indirect sources. Table 6 presents the features, advantages, and limitations of these
critical sources of health information.
Inventions 2021, 6, 45 14 of 30
Table 6. Sources of the Indian healthcare system.
Data type Direct/Indirect Description Strengths Limitations

Population census is about storing It covers small information for Population census is conducted
information on the population of people across India. In terms of every ten years by the government
India. The vast database analysis, the data are most helpful of India. The health-related
Population census Indirect
comprises social, geographical, with proper predictions of literacy information is considerably low.
and demographic information of rates, social-cultural activities, and Providing health analytics on census
people collected every ten years. food consumption habits. datasets is challenging.
Death-related information is
documented correctly. For example,
minor details such as the cause of
death (crime, health issue, and
The count and details of the aging), city information, the place of
population are obtained in certain death (can be different from the
Primarily the data related to time
Civil registration system Indirect situations, such as the birth and place of living) are not correctly
and location are recorded.
death of a person and from lost stored, and hence the data are not
and found records. productive for analysis. Inadequate
information or columns are generally
filled by some random values, which
cause wrong/improper prediction of
specific facts.
The data are primarily structured The irregular and impure data are
The data generated by companies, for a particular party collecting obtained most of the time. Mostly,
work organizations, health data. The data are collected the data are not accurate because not
Public surveys Direct insurance companies, and third through digital mediums, all people provide correct
parties are considered the including online forms, SAP information. The data quality is low.
survey data. systems, web portals, The data remain
and social media. moderately analytical.
The data captured directly from
people about their health, work,
and other demographic aspect.
Work organizations generally This is exclusively used for service
capture the data, and data use is management. The data quality is Mainly, data duplication and
limited to organization scopes and excellent and reliable. The data inconsistency problems arise
Service records Direct
limits. The organization must can be captured in limited time because the data are not always at
acquire consent from its intervals of months or days the centralized place.
employees for sharing, using, and (depending on data captured).
publishing such data on a public
platform or with a third-party
service provider.
The data are captured as a single The privacy problems and data
It contains information regarding data source and generally are in a breaching probability are maximum.
Administrative records Direct family details, financial planning, suitable quality format. These The data require uniform and secure
personality, and emotional details. data are highly analytical but are policies to access, use, share
generally substantially private. and publish.
5.4. Technologies Used in Healthcare Data: Indian Perspective

5.4.1. Data Mining/Analysis of Indian Health Data
Data mining is an essential and promising technique used in most countries for
healthcare data analysis. Most data are decentralized and maintained by laboratories,
medical centers, and hospitals in public and private forms in India. Data mining techniques
such as association, classification, and clustering are used by healthcare [31–34]. The details
of data mining techniques are as follows:
• Clustering: Clustering is a type of unsupervised learning and is slightly different
from classification. In clustering, many datasets are divided into small chunks (clus-
ters) based on some similarity. The Euclidian distance is used to calculate the rela-
tion/distance between two data values. K-means clustering is a prevalent method of
clustering; however, it is time-consuming and slow.
• Classification: Classification comprises training and testing data. Training is required
as it helps create classification rules. For high accuracy, providing maximum data for
training is an optimal practice. The accuracy of a classification model depends on the
degree of classifying rules being true, which is estimated using the test data.
• Association: Association is an exciting mining method in which frequent and usual
patterns in a dataset are determined. It is also known as the market basket analysis
because it can identify the association among purchased items or unknown customer
sales patterns in a transaction database. Association rule mining is widely used
Inventions 2021, 6, 45 15 of 30
for identifying the relationships among various symptoms with similar causes of
particular diseases.
• Regression: Regression is used to find the correlation among various attributes de-
fined over a particular function. For regression, a mathematical model is constructed
with the training data with dependent and independent variables. Regression can be
linear and nonlinear. Linear regression identifies the relationship between a depen-
dent variable and one or more independent variables. Logistic regression, a nonlinear
regression type, can accept the categorical data and predict the probability through
the logit function.
5.4.2. Artificial Intelligence, Machine Learning, and Deep Learning in Indian Health Data
Big data plays a vital role in Healthcare, bioinformatics, and health informatics in
recent years [35–38]. The comprehensive data generated in healthcare in 2009 are 44 times
higher than that generated now, and sometimes, processing the data for analytics, predic-
tion, and accurate visualization is difficult. AI has gradually been evolving in healthcare.
According to an article in Wired, in India’s Aravind eye care system, ophthalmologists
and computer researchers work together to test and deploy an automated image classifi-
cation system to screen millions of retinal photographs of diabetic patients [39–41]. The
technologies including AI and deep learning have potential applications in the healthcare
industry such as medical imaging, radiology, cancer prediction, diabetes and heart disease
prediction, pathology, genome interpretation, and patient monitoring.
Moreover, AI is used in fraud detection in the healthcare field. Fraud can be committed
by service providers or healthcare insurance companies in billing and treatment or other
report generation [42].
5.4.3. Data Visualization of Indian Health Data

Interactive data visualization helps understand many data, particularly in decision
support systems [43–45]. The volume of the data collected in the healthcare domain is
large and unstructured and increases rapidly. The high-dimensional data are sensitive and
meaningful for health analytics and prediction. Some healthcare information (particularly
about diseases such as COVID 19 and swine flu) varies with time; hence, their effect can be
analyzed with a time parameter. Regarding visualization, empirical experiments show that
visualizations facilitate an understanding of clinical data; however, a consistent method
to assess its effectiveness remains unavailable. Focusing on the Indian data collected
manually and digitally, representing the data on a large platform (e.g., dashboard and data
publishing platforms) is considerably complex. Many datasets have privacy concerns, and
hence their visualization is affected and distorted from actual outcomes.
5.4.4. Augmented and Virtual Reality in Indian Health Data

For addressing the big data present in the healthcare industry, visualizing the complex
data more simply is crucial. The optimal visualization facilitates the understanding of
health problems for accurate diagnosis and early predictions. The human perception of
visualization is limited and requires high cost and time on the screen. Virtual reality is
used in healthcare in many fields, such as psychological theory, cancer detection, and
maxillofacial surgery.
Table 7 presents the details of studies and innovations based on various technologies
in the Indian healthcare industry and the studies conducted on the Indian healthcare data,
mainly from 2016. Over three years, 31 research papers have been published on disease
prediction/diagnosis, which uses the Indian health data in principle.
Inventions 2021, 6, 45 16 of 30
Table 7. Existing research in the Indian healthcare industry.
Types of Disease Type of Data Data Mining Technique References

Data Mining of Indian Health Data
Conventional pathology data Structured Support vector machine classification [32–34]
Heart disease Structured and unstructured Naïve Bayes, decision tree, and K-nearest neighbor [35]
Lymphoma disease and lung cancer Unstructured (image dataset) Support vector machine [36,37]
Random forest, support vector machine (SVM),
Psychiatric diseases Structured and semi-structured [38,39]
K-nearest neighbor
k-means (KM) clustering algorithm, agglomerative
nesting (AGNES), clustering algorithm,
density-based spatial clustering of applications with
Liver diseases Structured a noise clustering algorithm, ordering points to [40–42]
identify the clustering structure, clustering
algorithm, and exception maximization
clustering algorithm
Skin disease No paper found on the Indian dataset [43]
Diabetes Structured Improved K-means algorithm and logistic regression [44]
Risk factor identification through correlation-based
feature subset selection with particle swarm
optimization search method and K-means clustering
Chest disease Unstructured (image dataset) algorithms. Supervised learning algorithms such as [45]
multilayer perceptron, multinomial logistic
regression, fuzzy unordered rule induction
algorithm, and C4.5 classification algorithm
Chronic disease Structured Naïve Bayes, K-nearest neighbor, and decision tree [46,47]
Breast cancer No paper found on the Indian dataset [48]
Cardiovascular diseases No paper found on the Indian dataset [49]
Parkinson disease No paper found on the Indian dataset [50]
AI/machine learning/deep learning in the Indian health data
Convolutional neural network on pathological
myopia disease for vision blindness.
Conventional pathology data Unstructured (image data) [51–56]
Classification-based glottal closure instants
detection from pathological acoustic speech signals
Heart disease Structured Naïve Bayes. Decision tree and random forest [57]
Lymphoma disease and lung cancer No paper found on the Indian dataset
Psychiatric diseases No paper was found on the Indian dataset.
Multilayer perceptron neural network algorithm
based on various decision trees algorithms such as
Liver diseases Structured See5 (C5.0), chi-square automatic interaction [58]
detector, and classification and regression tree with
boosting technique
Deep learning algorithms: (inception_ v3,
Skin disease Unstructured (image dataset) [59]
MobileNet, resnet, exception
Linear kernel SVM, radial basis function kernel
Diabetes Structured SVM, k-nearest neighbor, artificial neural network, [60]
and multifactor dimensionality reduction
Chest disease Unstructured (image dataset) Random forest [61]
Chronic disease No paper found on the Indian dataset
Breast cancer Unstructured Thermolytic risk score framework [62–64]
Cardiovascular diseases No paper found on the Indian dataset -
Parkinson disease No paper was found on the Indian dataset. -
Data visualization of the Indian health data
Covid 19 dataset (open research
Structured - [65–67]
dataset of India)
Covid 19 dataset (open research
Unstructured (X-ray image dataset) - [68–70]
dataset of India)
Tuberculosis screening Unstructured (X-ray image dataset) - [71–73]
Augmented and virtual reality in Indian Healthcare
Automated data capturing from
Unstructured - [74]
medical devices
Inventions 2021, 6, 45 17 of 30
6. Healthcare Data Privacy in India

Patient privacy is the most crucial aspect and jurisdiction of all countries worldwide,
and all countries have accepted that the privacy of the people must be respected under
any consequences. Privacy is a fundamental right of humans [75–77]. Some countries
(primarily Europe and the USA) strictly prioritize privacy policies. Famous laws such as
HIPPA [78] and GDPR [79] provide strength to people about their privacy concerns and
help them build trust. However, to date, no universal definition of privacy is available.
Some definitions are perception-centric and change with countries [80]. Various definitions
of privacy are as follows.
Definition 1. “The state of being alone or the right to keep one’s matters and relationships secret”—
definition obtained from the Cambridge dictionary [81].
Definition 2. “No one shall be subjected to arbitrary interference of their privacy, family, home, or
correspondence or attacks upon their honor and reputation. Everyone has the right to the protection
of the law against such interference or attacks”—article 12 universal declaration of human rights.
Definition 3. “privacy can be divided into several separate, but related, concepts:”
- Information privacy involves establishing rules governing collecting and handling personal
data such as credit information and medical and government records. It is also known as
data protection;
- Bodily privacy concerns the protection of people’s physical selves against invasive procedures
such as genetic tests, drug testing, and cavity searches;
- Privacy of communications covers the security and privacy of mail, telephones, e-mails, and
other forms of communication; and
- Territorial privacy concerns the setting of limits on intrusion into the domestic and other
environments such as the workplace or public space. This includes searches, video surveillance,
and ID checks—Australian law reform commission.
Definition 4. “Privacy is the right to be let alone or freedom from interference or intrusion.
Information privacy is the right to have some control over how your personal information is collected
and used”—the international association of privacy professionals.
Privacy plays a vital role in the healthcare field because healthcare data contain
sensitive information about patients and related stakeholders. As stated in the introduction,
most healthcare fields have changed their operations from disease to patient-centric. The
records of people are stored according to their characteristics, personal and emotional
behavior, and geographic information. Central storage of electronic medical data across
highly configured servers is one of the most suitable options for data analysis [82,83].
It prevents the use of duplicated or redundant data because of its central storage and
maintenance. The amount of healthcare data is significant, and in India, the data are also
unstructured. Furthermore, this can lead to privacy and data breaching because of its
storage- and transformation-related concerns.
In India, Privacy is not treated as a serious concern. Privacy issues in healthcare,
specific to India, are caused by prevalent complacency, culture, politics, budget limitations,
large population, and infrastructures. Due to these factors, data security requires a backseat
that allows easy access to confidential information. Furthermore, the prevalent culture
affects healthcare disclosure in India. In many cultures, disclosing sensitive personal
healthcare data is considered ill-mannered. This leads to discrepancies in the recorded
healthcare data and a decrease in the level of treatment meted out. The results and statistics
of treatments given do not match the records due to inaccurate data reporting.
India is a democratic country with a large population, and maintaining a standard
infrastructure is a problem for implementing privacy models in India. The cost required
to implement a privacy model is substantial and requires funding from the government
Inventions 2021, 6, 45 18 of 30
and people. Making the privacy model a success involves the work of specialists in the
Privacy and healthcare fields. Budget constraints may cause an ineffective model to be
implemented, which cannot be secure and safe from attacks.
According to the recent news, the Indian health ministry has proposed a law to govern
data security (personal data protection bill) that would provide people complete ownership
of their data. People can access, share, and deny sharing the records available at the
server. The health ministry proposed digital information security in the healthcare act
on March 11, 2018. The committee suggested the following key points and developed a
privacy framework:
• The law must be flexible and adhere to changing technologies.
• Law must be applied to public and private sector entities.
• Entities controlling the data should be accountable for data processing.
• Consent must be structured and genuine.
• Data processing and analysis must be minimal.
• A high-powered statutory authority should enforce the data protection framework.
The Indian healthcare data are considerably diverse and collected from different
heterogeneous sources (public and private sector hospitals and health insurance). No
regulations are enforced over the health data authorship, due to which any third party
can access the sensitive data and misuse the data for its benefit. The proposed law has
guidelines and technological aspects for preserving healthcare data privacy.
Privacy Issues in the Indian Healthcare System

From the literature survey, this paper presents 14 privacy issues (10 Primary issues)
specific to the Indian healthcare system. Figure 9 illustrates the privacy problems. Each
privacy issue is described with an appropriate example obtained from the available re-
sources [84].
Figure 9. Privacy issues in the Indian Healthcare system.

Inventions 2021, 6, 45 19 of 30
A. Lack of Technology and Infrastructure

Healthcare technology is changing, and the paper-based records of the patient are
not used anymore. The records are being converted into EHRs for easy digital access
through the Internet [85]. The use of wearable technologies, patient monitoring through
sensor networks, and data analysis of patient records for early disease prediction are being
implemented to ease and improve the lifestyle. Despite numerous advancements in this
field, India has not successfully implemented technologies at the ground level of the health-
care system. According to the Indian healthcare system (Figure 4), the village/taluka and
district hospitals still lack technologies. Another viewpoint is that patient records are pri-
marily stored using paper-based technology rather than centralized electronic technology.
In India, >60% of the area are villages, which indicates that the healthcare sector is majorly
based in villages. Currently, rural areas face problems such as lack of electricity, high-speed
Internet, and high-technology medical equipment facilities in hospitals and dispensaries.
The lack of technological interventions directly affects patient privacy. Most villagers
must physically visit healthcare centers and hospitals for their treatment with prescriptions,
and health advice is provided on papers. Because records are paper-based, there is no
control over who is having access at what level. Consent management, storage guidelines,
and access control are no longer applicable to paper-based medical records.
B. Doctor–Patient Relationship
Another threat to Privacy in India is the trust between doctors and patients. Most
people from tier II and III cities do not trust their doctors and hospital staff for their
data security. Most hospitals share data with a third party without acquiring patient
consent [85,86]. No law covers such actions because no uniform policy regarding such
fraud is defined in the constitution. According to the literature, many factors lead to the
doctor–patient relationship being compromised.
1. Poor government health systems.
2. A poor ratio of doctors to patients.
3. Easy accessibility of information and privacy concerns [86].
4. Lack of a role of the patient in the decision-making process.
5. Corruption [87].
C. Data Storage and Management
With the large population of India, storing electronic medical records in the cloud is
crucial. A survey [88] revealed that most Indians store their health records on the cloud for
easy access; however, considerably few are concerned about their privacy. Most Indians
store sensitive data on the cloud, relying on the fact that the cloud provides security.
Additionally, data management makes design most optimal for information, centralized or
distributed storage, and data confidentiality and demand.
D. Cyber Attacks and Hacking
A dynamic EHR is maintained and regulated by a third party for suitable data storage
and management. When such data are shared either for analysis, research, or marketing
purposes, maintaining patient privacy is the responsibility of the third party. Moreover, the
third party is responsible for providing sufficient mechanism security for data storage to
prevent cyberattacks. Most Indian healthcare data are either stored in outdated systems, or
no security mechanism is applied to the data. A suitable and secure system must not allow
access to the data to unauthorized users. Table 8 presents cyberattacks presented in the
Indian data [89].
Inventions 2021, 6, 45 20 of 30
Table 8. Cyberattacks presented in the Indian healthcare data.
Cyber Attacks on Data Gathering Phase Cyber Attacks at Network Phase Cyber Attacks at Storage Phase
Phishing attack Eavesdropping of health record Cross-site scripting attack
Log access attack Man-in-the-middle attack Weak authentication attack
Social engineering attack Data tampering
Denial of the service attack
SQL injection attack.
Brute force attack (on passwords) Data interception
Spoofing and sniffing attack
E. Data Sharing Trust in the Third Party

Most Indian healthcare systems lack consent; no consent is acquired while sharing
data with a third party. Most private organizations share the data of their employees with
a third party without applying any rules or policies to it. Sharing data for research and
analysis purposes presents no harm; however, such information is shared with personal
identification information. Alternatively, the information is the responsibility of organi-
zations, which are not regulated by any statutory body for misuse. Most public sector
hospitals share their data without patient consent [90].
Sharing data with a third party always presents doubts in the trust parameter. The
privacy model is divided into two types: Trusted and untrusted models. In the trusted
model, the data owner trusts the third party and shares the health data, and an untrusted
party does not gain the owner’s trust. The use of a third party questions the confidentiality
and integrity of the data and makes dealing with the party during the development of a
highly reliable health architecture a vital issue.
F. Lack of Policy and Constitutional Limitations
Privacy is always ignored; private organizations especially give less importance to
privacy. In Indian healthcare systems, privacy policies remain inadequate. Several case
studies on the Indian healthcare domain have indicated that we are far from privacy
implementation and applying privacy rules through design principles. A cohesive privacy
policy must be implemented in India. The following questions remain unanswered and
must be addressed when the data are used, shared, and published by a third party or
organization [91]:
1. Who owns and accesses patient records and why?
2. What type of data with what granularity level must be collected?
3. Where must the data be stored (central warehouse or hospital)?
4. Who can view medical records?
5. Who is responsible for disclosing medical records?
6. Which consent must be acquired while deleting patient records?
G. Data Breaching
Despite taking data security measures, data breaching is one of the significant privacy
problems in India. In healthcare, the main reasons behind data breaching are as follows [90]:
1. Brocken access and authentication.
2. Flawed service level agreements by organizations.
3. Poor backup and recovery plans in case of data loss.
4. Reverse engineering methods.
A cross-sectional data sharing system is the most suitable technique for low- and
middle-income countries like India. India’s Aadhaar personal identification program is
promising. It is responsible for generating and monitoring health and social data, including
EHRs, through a unique identification number. A unique card is distributed to all Indian
citizens for identification. In 2017, the supreme court of India addressed privacy concerns,
Inventions 2021, 6, 45 21 of 30
including breaching the Indian health data stating that because the Aadhaar card contains
sensitive information, it cannot be used as a mandatory document in fields such as banking,
the insurance sector, and mobile servicing [92].
H. Culture
Cultural interventions are other challenges faced by the Indian healthcare industry.
Most cultural communities do not allow people to share or disclose their personal informa-
tion due to predefined cultural restrictions, resulting in the recording of false information.
The discrepancy in health records results in inaccurate analyses and an inaccurate treatment
that is meted out [93].
I. Prevalent Complacency
Complacency is widespread in Indian healthcare. A large amount of work, planning,
cooperation, and communication among multiple departments is required to make the
privacy and security of healthcare in India a success. However, due to slackness, the
probability of the privacy model implemented in India is poor [94].
J. Cost
Implementation of the privacy model with suitable infrastructure is costly. The Indian
government faces other problems such as poverty and corruption that are given high
priority, and privacy model implementation is given the least priority. Small organizations
do not have enough assets to protect their employees.
Table 9 presents the privacy problems of the healthcare system of India as mentioned
above. Table 10 explains how each privacy problem is being addressed in different health-
care structures in India.
Table 9. Privacy issues stated in the Indian healthcare system.
Privacy Issues Stated in the Indian Healthcare System.

Type of Healthcare Type of Lack of Doctor-Patient Data Storage and Trust in the
Cyberattacks Data Sharing
Sector Technology Relationship Management Third Party
Drafted Policies
Super specialty hospital Public Very good Trustworthy Very good Minimal risk Strict
for consent
Medical
Public Adequate Trustworthy Good Minimal risk With good consent Easy
institutes/colleges
District and
Public Adequate Bit trustworthy Adequate High risk Minimal consent Easy
taluka hospitals
Primary healthcare centers Public Poor Bit trustworthy Poor High risk Without consent Easy
Village hospitals Public Poor Not trustworthy Poor High risk Without consent Easy
Super and multispecialty Drafted Policies
Private Excellent Most Trustworthy Very good Minimal risk Strict
hospitals for consent
Tier II and III Drafted Policies
Private Very good Most Trustworthy Very good Minimal risk Strict
city hospitals for consent
Drafted Policies
Private clinics Private Very good Trustworthy Very good Minimal risk Strict
for consent
Non-profit organizations Private good Trustworthy Very good Minimal risk Minimal consent Strict
Drafted Policies
Pharmaceutical industry Private Excellent - Very good Minimal risk Strict
for consent
Health insurance Drafted Policies
Private Excellent - Excellent Minimal risk Strict
company for consent
Private organizations Private Excellent - Excellent Minimal risk Minimal Consent Easy
Inventions 2021, 6, 45 22 of 30
Table 10. Privacy issues stated in the Indian healthcare system (continued).
Privacy Issues Stated in the Indian Healthcare System.

Type of
Healthcare Privacy Cultural
Type Infrastructure Data Breaching Hacking Accountability Cost
Policies Interventions
Super specialty Well defined
Public Excellent Less probability Less probability Yes No Average
hospital and followed
Medical insti- Well defined Adequate Adequate
Public Adequate Yes No Low
tutes/colleges and followed probability probability
Well defined
District and considerably
Public Poor but not High probability High probability No Yes
taluka hospitals low/no cost
followed
Primary Well defined
Considerably considerably
healthcare Public but not High probability High probability No Yes
poor low/no cost
centers followed
Considerably
Village hospitals Public Not defined High probability High probability No Yes No cost
poor
Super and
Well defined
multispecialty Private Excellent Less probability Less probability Yes No Very high
and followed
hospitals
Tier II and III city Well defined High/considerably
Private Excellent Less probability Less probability Yes No
hospitals and followed high
Well defined
Private clinics Private Excellent Less probability Less probability Yes No High
and followed
Non-profit Well defined
Private Excellent Less probability Less probability Yes No Low
organizations and followed
Pharmaceutical Well defined
Private Excellent Less probability Less probability Yes No NA
industry and followed
Health insurance Well defined
company and followed
Private Well defined
organizations and followed
7. Open Issues and Further Discussions

With the emerging healthcare sector from a revolutionary perspective, India is growing
in healthcare analytics rapidly [95–98]. Healthcare 3.0 was patient-centric from a disease-
centric approach. However, healthcare 4.0 uses various technologies like IoT, Blockchain,
Machine learning, and AI to identify and predict disease, analyze historical health data, and
other intelligent healthcare applications. Such newer technologies require extensive data
and fastest accessing resources, which ultimately need equivalent security techniques to
protect them [99]. In India, the security and privacy of healthcare data are always complex
and challenging tasks. The reasons are already discussed in the previous sections. Based
on the detailed overview of the Indian healthcare system and its privacy issues, there are
some open issues and further discussions elaborated in this section.
Privacy issues in healthcare-specific to India are due to prevalent complacency, culture,
politics, budget limitations, huge population, and infrastructure. Due to these factors, data
security takes a backseat allowing for easy access to confidential information.
The prevalent culture also affects healthcare disclosure in India. In many cultures,
the disclosure of sensitive personal healthcare data is looked down upon. This leads to
discrepancies in the healthcare data recorded and a decrease in the level of treatment
meted out. Research and statistics of treatment given then do not match the records due to
inaccurate reporting of data.
India is a country of large democracy and large populations; maintaining standard
infrastructure is another issue of implementing privacy models. The cost required to
implement a privacy model is substantial and requires funding from the government and
individuals. To ensure the privacy model is a success, it involves specialists in privacy
and the field of healthcare. Budget constraints may lead to an ineffective model being
implemented, which will not be secure and safe from attacks.
Inventions 2021, 6, 45 23 of 30
7.1. Key Performance Indicators in the Context of Privacy in the Indian Healthcare System
Key Performance Indicators (henceforth termed as a KPI) are very important as they
measure privacy concerns that need to be addressed first. According to the research done
in [100,101], the following KPI is related to privacy issues; however, they are applicable for
social media photos and video sharing in the existing research. Since privacy issues exist
everywhere, in every field, KPI is applicable in the Indian healthcare context as well. The
list of KPIs and their details are given below:
• Forced Trust vs. Control: A forced trust is a trust in which an individual has no
choice but to trust any healthcare system. On the other hand, control is a systematic
view of obtaining trust and assuring each individual that their sensitive personal data
will not be shared with the third party without any consent. In the Indian healthcare
context, the ratio of forced trust to control is high. People tend to have less trust in any
healthcare system because of constitutional limitations. This is one of the significant
KPIs in the context of Indian Healthcare privacy.
• Content Viewed by Whom: Though there is limited access to any EHR and only
authenticated people can view or access the sensitive data, there is still the possibility
that unauthorized entities may access health records. Weak passwords, inappropriate
security policies, conflict in access controls, and sharing passwords to untrusted
persons are the possible reasons sensitive data may be misused. In India, the healthcare
system is not very structured and centralized. Local hospitals keep their records on
local servers, which are highly vulnerable to various attacks. Data breaching primarily
happens in tier 2 and tier 3 cities and village hospitals.
• Tacit Knowledge: Even if the healthcare system ensures maximum protection against
data breaches for healthcare data, the metadata or tacit information may reveal more
information than basic health information. Using reverse engineering techniques
or social media analysis, it is easy to gain personal information. In India, there
are many cases reported against criminals who seek sensitive information through
social media accounts. Unfortunately, there is no control over the protection against
such information.
• Laws and Regulation: Limited regulation and law in the constitution are essential
KPI in the Indian healthcare field. As per the latest data of 2019, Indian healthcare
generates 1021 gigabytes of data per year. Managing such a massive amount of data
by protecting sensitive content must prioritize the Indian government.
• Use of new Data Protection Technologies: The newer technologies like blockchain,
two-factor authentication, machine learning, AI, and attribute-based anonymization
is only implemented in high-end industries or healthcare organizations. Small sector
health organizations, village, or tier 3 hospitals do not have funds to support the
protection of such data, and hence newer technologies cannot be used.
• Researcher’s Satisfaction: Since there is a massive generation of healthcare data, it
is an excellent opportunity to analyze the data for research purposes. Healthcare
analytics is the emerging field of computing and is rising exponentially in India. More
restricted and policy-imposed data are not suitable for analytics purposes, and data
quality gets degraded.
• Industry-academia collaboration exists for privacy preservation mechanisms: There
is a huge gap between industry and academia in India. Despite having good re-
searchers in the privacy field, their work is not reaching the industry.
It is also noted that all these KPI are not treated with the same priority. In order to
priorities KPIs, the different stakeholders are taken into consideration. This paper’s contri-
bution is to summarize the ratings given by stakeholders directly or indirectly involved in
managing or accessing healthcare data.
The following stakeholders are chosen:
Inventions 2021, 6, 45 24 of 30
• Doctors and Healthcare Professionals/practitioners (DH): Five doctors are selected

from all tier cities and villages who manage patient records through the digital and
paper-based modes.
• Hospital administrative staff (HA): Five administrative staff are taken from var-
ious hospitals from all tier cities and villages, maintaining patient records for
future communication.
• Researchers and Scientist (RS): Five Researchers from healthcare data analytics and
data privacy are selected to work in a new development in healthcare data science
and data privacy.
• Academicians in the computer science field (AC): Five Academicians in the Com-
puter Science field are selected to either teach data analytics courses or security courses
in their curriculum.
The rating obtained from a 1 to 5 Likert scale where one represents strongly agree
and 5 represents strongly disagree. Table 11 gives the consolidated ratings about KPIs
defined over privacy issues in the Indian healthcare context. It can be seen that almost all
the stakeholders are in favor of considering privacy issues.
Table 11. Ratings of KPIs defined over privacy issues by healthcare stakeholders.
Doctors and Healthcare Hospital Administrative Researchers and Academicians in the

KPI
Professionals/Practitioners Staff Scientist Computer Science Field
Mean
Samples DH1 DH2 DH3 DH4 DH5 HA1 HA2 HA3 HA4 HA5 RS1 RS2 RS3 RS4 RS5 AC1 AC2 AC3 AC4 AC5
Forced Trust
1 2 2 3 3 2 2 2 2 4 1 1 1 2 1 2 2 1 1 2 1.85
Vs. Control
Content Viewed
3 3 4 2 1 3 2 4 1 2 1 1 1 1 1 2 1 3 1 2 1.95
by Whom
Tacit Knowledge 3 3 3 4 2 2 2 2 3 1 1 1 1 3 2 2 3 2 3 1 2.2
Laws and
1 1 2 1 2 1 2 1 1 1 1 1 1 1 2 1 3 1 1 3 1.4
Regulation
Use of new Data
Protection 3 3 3 3 1 3 2 2 3 4 2 2 2 1 1 1 1 1 1 1 2
Technologies
Researcher’s
4 4 4 4 2 5 5 4 4 4 2 2 2 3 1 1 1 1 1 2 2.8
Satisfaction
Industry-academia
collaboration
exists for privacy 3 3 3 3 3 3 3 3 3 3 2 2 2 1 1 1 2 1 2 2 2.3
preservation
mechanisms
7.2. Future of Data Privacy in India

The government of India took significant steps to address the privacy issues and pro-
tect sensitive data from unauthorized access. According to the recent news, the government
proposed a law to govern data security in all emerging sectors like healthcare, finance and
banking, education, and retail that would give individuals complete ownership of their
data. Individuals can access, share, and deny the records associated with them. The Per-
sonal Data Protection Bill (PDP) draft was proposed in 2019, which is similar to GDPR [102].
The committee suggested the following key points and developed a privacy framework:
• The law must be flexible and must be adhered to changing technologies.
• Law must be applied to public and private sector entities.
• Entities controlling the data should be accountable for any data processing.
• Consent must be structured and genuine.
• Processing and analysis of data must be minimal.
• Enforcement of the data protection framework should be carried out by a high-
powered statutory authority.
Indian published health data are very diverse and collected from different hetero-
geneous sources, moving towards the healthcare sector and the proposed bill. There are
Inventions 2021, 6, 45 25 of 30
no regulations over the authorship of the health data, due to which any third party can
gain access to the sensitive data and misuse the data. The reidentification attack is the
most common attack of health data wherein, with the help of a group of some identifiable
entities (called quasi-identifiers), individuals’ identities can be easily determined. The
proposed law mentioned in the above section has guidelines and technological aspects
of preserving healthcare data privacy. The proposed research will be the outcome of the
privacy framework developed by the Indian government in the PDP bill. The primary
constituents of the PDP bill are drawn in Figure 10.
Figure 10. Personal Data Protection bill entities adopted from [101].
Figure 10 presents the essential elements of the data protection bill adopted in India.
The data owner is called a data principle in GDPR; they are also called a data custodian.
The data fiduciary can be any company, organization, group of people, or individual who
determine the purpose of the data use and dissemination. They can be a data holder in the
context of GDPR. A data processor is a third-party entity that is involved in the processing
of data. In some situations, the data fiduciary and data processor roles can be the same,
and the whole depends upon a particular situation. The Data Protection Authority of India
(DPAI) is the statutory body that can define rules and regulations about data protection.
7.3. Data Utility-Privacy Trade-Off in Personal Data Protection Bill

Recalling Section 1 of the paper, there is a thin border between data utility and privacy.
Privacy is subjective and cannot be fully addressed; data breaches can occur not only due to
data publishing but also data pre-processing, data sharing, as well as due to inappropriate
policies. Privacy also varies from nation to nation. The newly created PDP bill is enhanced
by maintaining the proper balance of data utility and privacy. Recall that Indian healthcare
data generated from heterogeneous sources are very unstructured. The user (termed
as role) also restricts the access to a particular level of data according to the bill. To
provide a different and enhanced level of protection, the data fiduciary can implement
data anonymization, randomization, and similar data hiding techniques to ensure that
data are protected from various privacy attacks such as background knowledge, linkage,
Inventions 2021, 6, 45 26 of 30
reidentification, and many more. As per the framework (Figure 10), the data fiduciary and
the data processor shall implement the necessary methods such as anonymization and
de-identification during data processing to implement appropriate security and safeguard
in the system. They also can define what level the privacy can be maintained by keeping
the utility of the data. Privacy by Design (PbD) is one of the solutions suggested by DPAI
in the PDP bill.
8. Conclusions and Future Work

India is an emerging country in terms of revenue and employment in the healthcare
field. The advances of ICT help the healthcare sector streamline data structure and access
and health analytics. The healthcare sector in India is growing, although relatively slowly,
due to its extensive coverage, strengthening services, and increasing expenditure by public
and private investors. This paper covers the overview of the Indian healthcare system with
a focus on veracious trends and technologies in healthcare, sectors in healthcare, policies
that are driving healthcare systems, and various technologies used in the Indian healthcare
system. It is observed that there have been many advances in healthcare in the past year;
however, due to unstructured planning, political interventions, and socio-cultural issues,
the healthcare system is yet to reach the middle class and poor people in India. The other
part of this paper also covered the privacy issues in India. From the existing literature, it
is found that major privacy concerns that arise in the Indian healthcare system are due to
the doctor–patient relationship, trust management, consent management, lack of security
policies, constitutional and political issues, and many more. It can also be deduced that
most of the privacy issues in the Indian healthcare system are because of socio-cultural and
legal aspects and not because of a lack of technological advancements. In future, more care
needs to be taken to improve the attitude of understanding privacy issues for individuals,
healthcare professionals, healthcare management, and government rather than improving
technological advancements.
Author Contributions: The author P.C. and A.P. wrote the initial draft of the manuscript. A.-J.M.-G.
proofread and gave constructive comments towards improving the quality of the paper. He also
handled the major revisions in the paper. All authors have read and agreed to the published version
of the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement: This research work is an extensive review of past published papers,
and hence no specific data/dataset applies to this research work.
Acknowledgments: The authors would like to thank the anonymous reviewers and editors who
have been involved in examining this manuscript.
Conflicts of Interest: The author declares no conflict of interest associated with this research work.
References
1. Healthcare System for New India: Building Blocks—Potential Pathway to Reform. November 2019. Available online: https:
//niti.gov.in/sites/default/files/2019-11/NitiAayogBook_compressed.pdf (accessed on 1 August 2020).
2. Fullman, N.; Yearwood, J.; Abay, S.M.; Abbafati, C.; Abd-Allah, F.; Abdela, J.; Abdelalim, A.; Abebe, Z.; Abebo, T.A.;
Aboyans, V.; et al. Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and
selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016. Lancet 2018, 391, 2236–2271.
[CrossRef]
3. Klecun, E. Transforming healthcare: Policy discourses of IT and patient-centred care. Eur. J. Inf. Syst. 2016, 25, 64–76. [CrossRef]
4. Top 40 Medical and Healthcare Startups in India. February 2020. Available online: https://www.medicalstartups.org/country/
India/ (accessed on 1 August 2020).
5. Liu, X.; Deng, R.H.; Choo, K.-K.R.; Yang, Y. Privacy-Preserving Reinforcement Learning Design for Patient-Centric Dynamic
Treatment Regimes. IEEE Trans. Emerg. Top. Comput. 2021, 9, 456–470. [CrossRef]
Inventions 2021, 6, 45 27 of 30
6. Vora, J.; Devmurari, P.; Tanwar, S.; Tyagi, S.; Kumar, N.; Obaidat, M.S. Blind Signatures Based Secured E-Healthcare System. In
Proceedings of the 2018 International Conference on Computer, Information and Telecommunication Systems (CITS), Alsace,
Colmar, France, 11–13 July 2018; pp. 1–5.
7. Pussewalage, H.S.G.; Oleshchuk, V.A. Privacy preserving mechanisms for enforcing security and privacy requirements in E-health
solutions. Int. J. Inf. Manag. 2016, 36, 1161–1173. [CrossRef]
8. Dey, N.; Hassanien, A.E.; Bhatt, C.; Ashour, A.; Satapathy, S.C. (Eds.) Internet of Things and Big Data Analytics toward Next-Generation
Intelligence; Springer: Berlin, Germany, 2018; pp. 3–549.
9. Kaur, G.; Tomar, P.; Singh, P. Design of Cloud-Based Green IoT Architecture for Smart Cities. In Internet of Things and Big Data
Analytics toward Next-Generation Intelligence; Springer: Cham, Switzerland, 2018; pp. 315–333.
10. Valdez, A.C.; Ziefle, M. The users’ perspective on the privacy-utility trade-offs in health recommender systems. Int. J. Hum.
Comput. Stud. 2019, 121, 108–121. [CrossRef]
11. Churi, P.P.; Pawar, A.V. Jestr r. J. Eng. Sci. Technol. Rev. 2019, 12, 17–25. [CrossRef]
12. Sánchez, D.; Batet, M.; Viejo, A. Utility-preserving privacy protection of textual healthcare documents. J. Biomed. Inform. 2014, 52,
189–198. [CrossRef]
13. Rastogi, V.; Suciu, D.; Hong, S. The boundary between privacy and utility in data publishing. In Proceedings of the 33rd
International Conference on Very Large Data Bases, Vienna, Austria, 23–28 September 2007; pp. 531–542.
14. Talib, F.; Rahman, Z. Current Health of Indian Healthcare and Hospitality Industries: A Demographic Study. Int. J. Bus. Res. Dev.
2013, 2, 1–17. [CrossRef]
15. Available online: https://www.ibef.org/industry/healthcare-india.aspx (accessed on 13 June 2020).
16. Sachdeva, S.; Batra, S.; Bhalla, S. Evolving large scale healthcare applications using open standards. Health Policy Technol. 2017, 6,
17. Available online: http://www.cbhidghs.nic.in/Ebook/National%20Health%20Profile-2018%20(e-Book)/files/assets/common/
downloads/files/NHP%202018.pdf (accessed on 14 June 2020).
18. Ganesan, L.; Veena, S.R. ‘Make In India’ For Healthcare Sector in India: A SWOT Analysis on Current Status and Future Prospects.
Int. J. Health Sci. Res. 2018, 8, 258–265.
19. Shankar, D. Health sector reforms for 21st century healthcare. J. Ayurveda Integr. Med. 2015, 6, 4. [CrossRef]
20. IRDA, CII, Grant Thornton, Gartner, Technopak, TechSci Research. Available online: https://www.ibef.org/download/
Healthcare-July-2019.pdf (accessed on 14 June 2020).
21. Available online: https://mea.gov.in/images/pdf/22899_India_in_Business.pdf (accessed on 14 June 2020).
22. Basu, S.; Andrews, J.; Kishore, S.; Panjabi, R.; Stuckler, D. Comparative performance of private and public healthcare systems in
low-and middle-income countries: A systematic review. PLoS Med. 2012, 9, e1001244. [CrossRef]
23. Gupta, Y.; Joshi, A.; Kale, G. Healthcare Analytics Systems: An Overview. Int. J. Eng. Sci. 2018, 8, 18898.
24. Boric-Lubecke, O.; Gao, X.; Yavari, E.; Baboli, M.; Singh, A.; Lubecke, V.M. E-healthcare: Remote monitoring, privacy, and security.
In Proceedings of the 2014 IEEE MTT-S International Microwave Symposium (IMS2014), Tampa, FL, USA, 1–6 June 2014; pp. 1–3.
25. Morilla, M.D.R.; Sans, M.; Casasa, A.; Giménez, N. Implementing technology in healthcare: Insights from physicians. BMC Med.
Inform. Decis. Mak. 2017, 17, 92. [CrossRef] [PubMed]
26. Kapoor, V.; Singh, R.; Reddy, R.; Churi, P. Privacy Issues in Wearable Technology: An Intrinsic Review. 2020. SSRN 3566918.
Available online: https://ssrn.com/abstract=3566918 (accessed on 20 June 2021). [CrossRef]
27. Vassy, J.L.; Korf, B.R.; Green, R.C. How to know when physicians are ready for genomic medicine. Sci. Transl. Med. 2015, 7,
287fs19. [CrossRef] [PubMed]
28. Chen, X.; Ishwaran, H. Random forests for genomic data analysis. Genomics 2012, 99, 323–329. [CrossRef]
29. Das, A.K.; Kedia, A.; Sinha, L.; Goswami, S.; Chakrabarti, T.; Chakrabarti, A. Data mining techniques in Indian healthcare: A
short review. In Proceedings of the 2015 International Conference on Man and Machine Interfacing (MAMI), Bhubaneswar, India,
17–19 December 2015; pp. 1–7.
30. Pandey, A.; Roy, N.; Bhawsar, R.; Mishra, R.M. Health Information System in India: Issues of data availability and quality. Demogr.
India 2010, 39, 111–128.
31. Patel, S.; Patel, H. Survey of Data Mining Techniques used in Healthcare Domain. Int. J. Inf. 2016, 6, 53–60. [CrossRef]
32. Rojas, E.; Munoz-Gama, J.; Sepúlveda, M.; Capurro, D. Process mining in healthcare: A literature review. J. Biomed. Inform. 2016,
61, 224–236. [CrossRef]
33. Tomar, D.; Agarwal, S. A survey on Data Mining approaches for Healthcare. Int. J. Bio-Sci. Bio-Technol. 2013, 5, 241–266. [CrossRef]
34. Kalaiselvi, C. Diagnosing of heart diseases using average k-nearest neighbor algorithm of data mining. In Proceedings of the 2016
3rd International Conference on Computing for Sustainable Global Development (INDIACom), New Delhi, India, 16–18 March
2016; pp. 3099–3103.
35. Kala, V.C.; Kiran, L.V.; Prasad, P.S. Prediction of diseases with pathological characteristics classification using data mining. In
Proceedings of the 2019 International Conference on Vision Towards Emerging Trends in Communication and Networking
(ViTECoN), Vellore, India, 30–31 March 2019; pp. 1–5.
36. Chauhan, D.; Jaiswal, V. An efficient data mining classification approach for detecting lung cancer disease. In Proceedings
of the 2016 International Conference on Communication and Electronics Systems (ICCES), Coimbatore, India, 21–22 October
2016; pp. 1–8.
Inventions 2021, 6, 45 28 of 30
37. Khan, S.I.; Islam, A.; Hossen, A.; Zahangir, T.I.; Hoque, A.S.M.L. Supporting the Treatment of Mental Diseases using Data Mining.
In Proceedings of the 2018 International Conference on Innovations in Science, Engineering and Technology (ICISET), Chittagong,
Bangladesh, 27–28 October 2018; pp. 339–344.
38. Alonso, S.G.; De La Torre-Díez, I.; Hamrioui, S.; López-Coronado, M.; Barreno, D.C.; Nozaleda, L.M.; Franco, M. Data Mining
Algorithms and Techniques in Mental Health: A Systematic Review. J. Med. Syst. 2018, 42, 161. [CrossRef]
39. Dubey, A.K.; Gupta, U.; Jain, S. Epidemiology of lung cancer and approaches for its prediction: A systematic review and analysis.
Chin. J. Cancer 2016, 35, 71. [CrossRef]
40. Swapna, K.; Babu, M.S.P. A Critical Study on Cluster Analysis Methods to Extract Liver Disease Patterns in Indian Liver Patient
Data. Int. J. Comput. Intell. Res. 2017, 13, 2379–2390.
41. Pasha, M.; Fatima, M. Comparative Analysis of Meta Learning Algorithms for Liver Disease Detection. J. Softw. 2017, 12, 923–933.
[CrossRef]
42. Abdar, M.; Zomorodi-Moghadam, M.; Das, R.; Ting, I.-H. Performance analysis of classification algorithms on early detection of
liver disease. Expert Syst. Appl. 2017, 67, 239–251. [CrossRef]
43. Wu, H.; Yang, S.; Huang, Z.; He, J.; Wang, X. Type 2 diabetes mellitus prediction model based on data mining. Inform. Med.
Unlocked 2018, 10, 100–107. [CrossRef]
44. Verma, L.; Srivastava, S.; Negi, P.C. A Hybrid Data Mining Model to Predict Coronary Artery Disease Cases Using Non-Invasive
Clinical Data. J. Med. Syst. 2016, 40, 178. [CrossRef] [PubMed]
45. Goswami, T.; Dabhi, V.K.; Prajapati, H.B. Skin Disease Classification from Image—A Survey. In Proceedings of the 2020 6th
International Conference on Advanced Computing and Communication Systems (ICACCS), Coimbatore, India, 6–7 March 2020;
pp. 599–605.
46. Induja, S.; Raji, C. Computational Methods for Predicting Chronic Disease in Healthcare Communities. In Proceedings of the
2019 International Conference on Data Science and Communication (IconDSC), Bangalore, India, 1–2 March 2019; pp. 1–6.
47. Jain, D.; Singh, V. Feature selection and classification systems for chronic disease prediction: A review. Egypt. Inform. J. 2018, 19,
48. Chaurasia, V.; Pal, S. A novel approach for breast cancer detection using data mining techniques. Int. J. Innov. Res. Comput.
Commun. Eng. 2017, 2.
49. Kadam, K.; Kamat, P.V.; Malav, A.P. Cardiovascular Disease Prediction Using Data Mining Techniques: A Proposed Framework
Using Big Data Approach. In Coronary and Cardiothoracic Critical Care: Breakthroughs in Research and Practice; IGI Global: Hershey,
PA, USA, 2019; pp. 246–264.
50. Miljkovic, D.; Aleksovski, D.; Podpečan, V.; Lavrač, N.; Malle, B.; Holzinger, A. Machine Learning and Data Mining Methods for
Managing Parkinson’s disease. In Machine Learning for Health Informatics; Springer: Cham, Switzerland, 2016; pp. 209–220.
51. Manogaran, G.; Lopez, D. A survey of big data architectures and machine learning algorithms in Healthcare. Int. J. Biomed. Eng.
Technol. 2017, 25, 182–211. [CrossRef]
52. Yu, K.-H.; Beam, A.L.; Kohane, I.S. Artificial intelligence in healthcare. Nat. Biomed. Eng. 2018, 2, 719–731. [CrossRef] [PubMed]
53. Simonite, T. Google’s AI Eye Doctor Gets Ready to Go to Work in India. WIRED. Available online: https://www.wired.com/20
17/06/googles-ai-eye-doctor-gets-ready-go-work-india/ (accessed on 18 June 2020).
54. Waghade, S.S.; Karandikar, A.M. A comprehensive study of healthcare fraud detection based on machine learning. Int. J. Appl.
Eng. Res. 2018, 13, 4175–4178.
55. Baid, U.; Baheti, B.; Dutande, P.; Talbar, S. Detection of Pathological Myopia and Optic Disc Segmentation with Deep Convolutional
Neural Networks. In Proceedings of the TENCON 2019-2019 IEEE Region 10 Conference (TENCON), Kochi, India, 17–20 October
2019; pp. 1345–1350.
56. Mandal, T.; Rao, K.S. Glottal Closure Instants Detection From Pathological Acoustic Speech Signal Using Deep Learning. arXiv
2018, arXiv:1811.09956.
57. Gupta, N.; Ahuja, N.; Malhotra, S.; Bala, A.; Kaur, G. Intelligent heart disease prediction in cloud environment through ensembling.
Expert Syst. 2017, 34, e12207. [CrossRef]
58. Abdar, M.; Yen, N.Y.; Hung, J.C.-S. Improving the Diagnosis of Liver Disease Using Multilayer Perceptron Neural Network and
Boosted Decision Trees. J. Med. Biol. Eng. 2018, 38, 953–965. [CrossRef]
59. Patnaik, S.K.; Sidhu, M.S.; Gehlot, Y.; Sharma, B.; Muthu, P. Automated Skin Disease Identification using Deep Learning
Algorithm. Biomed. Pharmacol. J. 2018, 11, 1429–1437. [CrossRef]
60. Kaur, H.; Kumari, V. Predictive modelling and analytics for diabetes using a machine learning approach. Appl. Comput. Inform.
2020. [CrossRef]
61. Kumar, R.; Arora, R.; Bansal, V.; Sahayasheela, V.J.; Buckchash, H.; Imran, J.; Narayanan, N.; Pandian, G.N.; Raman, B. Accurate
Prediction of COVID-19 using Chest X-Ray Images through Deep Feature Learning model with SMOTE and Machine Learning
Classifiers. medRxiv 2020. [CrossRef]
62. Kakileti, S.T.; Madhu, H.J.; Manjunath, G.; Wee, L.; Dekker, A.; Sampangi, S. Personalized risk prediction for breast cancer
pre-screening using artificial intelligence and thermal radiomics. Artif. Intell. Med. 2020, 105, 101854. [CrossRef]
63. Ko, I.; Chang, H. Interactive data visualization based on conventional statistical findings for antihypertensive prescriptions using
National Health Insurance claims data. Int. J. Med. Inform. 2018, 116, 1–8. [CrossRef]
Inventions 2021, 6, 45 29 of 30
64. Ledesma, A.; Bidargaddi, N.; Strobel, J.; Schrader, G.; Nieminen, H.; Korhonen, I.; Ermes, M. Health timeline: An insight-based
study of a timeline visualization of clinical data. BMC Med. Inform. Decis. Mak. 2019, 19, 170. [CrossRef]
65. Ulahannan, J.P.; Narayanan, N.; Thalhath, N.; Prabhakaran, P.; Chaliyeduth, S.; Suresh, S.P.; Mohammed, M.; Rajeevan, E.; Joseph,
S.; Balakrishnan, A.; et al. A citizen science initiative for open data and visualization of COVID-19 outbreak in Kerala, India. J.
Am. Med. Inform. Assoc. 2020, 27, 1913–1920. [CrossRef]
66. Tandon, H.; Ranjan, P.; Chakraborty, T.; Suhag, V. Coronavirus (COVID-19): ARIMA based time-series analysis to forecast near
future. arXiv 2020, arXiv:2004.07859.
67. Gupta, S.; Raghuwanshi, G.S.; Chanda, A. Effect of weather on COVID-19 spread in the US: A prediction model for India in 2020.
Sci. Total Environ. 2020, 728, 138860. [CrossRef]
68. Basu, S.; Mitra, S.; Saha, N. Deep Learning for Screening COVID-19 using Chest X-Ray Images. In Proceedings of the 2020 IEEE
Symposium Series on Computational Intelligence (SSCI), Canberra, ACT, Australia, 1–4 December 2020; pp. 2521–2527.
69. Pasa, F.; Golkov, V.; Pfeiffer, F.; Cremers, D. Efficient Deep Network Architectures for Fast Chest X-Ray Tuberculosis Screening
and Visualization. Sci. Rep. 2019, 9, 1–9. [CrossRef]
70. Olshannikova, E.; Ometov, A.; Koucheryavy, Y.; Olsson, T. Visualizing Big Data with augmented and virtual reality: Challenges
and research agenda. J. Big Data 2015, 2, 22. [CrossRef]
71. Schuemie, M.J.; Van Der Straaten, P.; Krijn, M.; Van Der Mast, C.A. Research on Presence in Virtual Reality: A Survey. Cyberpsychol.
Behav. 2001, 4, 183–201. [CrossRef] [PubMed]
72. Prakaash, D.; Kodagahally, R.R.; Honnaiah, M. Virtual reality: A railroad for structural bioinformatics towards advanced cancer
research. PeerJ Prepr. 2017, 5, e2960v1.
73. Ayoub, A.; Pulijala, Y. The application of virtual reality and augmented reality in Oral & Maxillofacial Surgery. BMC Oral Health
2019, 19, 238. [CrossRef]
74. Chamberlain, D.; Jimenez-Galindo, A.; Fletcher, R.R.; Kodgule, R. Applying Augmented Reality to Enable Automated and
Low-Cost Data Capture from Medical Devices. In Proceedings of the Eighth International Conference on Information and
Communication Technologies and Development; ACM: New York, NY, USA, 2016; pp. 1–4.
75. Bhatti, R.; Grandison, T. Towards Improved Privacy Policy Coverage in Healthcare Using Policy Refinement. In Workshop on
Secure Data Management; Springer: Berlin/Heidelberg, Germany, 2007; pp. 158–173.
76. Parker, R.B. A definition of privacy. Rutgers L. Rev. 1973, 27, 275.
77. Mireku, K.K.; Zhang, F.; Komlan, G.; Kingsford, K.M.; FengLi, Z. Patient knowledge and data privacy in healthcare records
system. In Proceedings of the 2017 2nd International Conference on Communication Systems, Computing and IT Applications
(CSCITA), Mumbai, India, 7–April 2017; pp. 154–159.
78. Cheng, V.S.; Hung, P.C. Health Insurance Portability and Accountability Act (HIPPA) Compliant access control model for web
services. Int. J. Healthc. Inf. Syst. Inform. 2006, 1, 22–39. [CrossRef]
79. Cho, S. A Study on Privacy Protection in the EU’s GDPR and Korea’s Personal Information Protection Act. Law J. 2018, 61, 117–148.
80. Akpojivi, U. Rethinking information privacy in a “connected” world. In Censorship, Surveillance, and Privacy: Concepts, Methodolo-
gies, Tools, and Applications; IGI Global: Hershey, PA, USA, 2019; pp. 1–18.
81. Churi, P.P.; Pawar, A.V. A Systematic Review on Privacy Preserving Data Publishing Techniques. J. Eng. Sci. Technol. Rev. 2019, 12,
17–25. [CrossRef]
82. Srinivas, N.; Biswas, A. Protecting patient information in India: Data privacy law and its challenges. NUJS L. Rev. 2012, 5, 411.
83. Jalali, M.S.; Landman, A.; Gordon, W.J. Telemedicine, privacy, and information security in the age of COVID-19. J. Am. Med.
Inform. Assoc. 2021, 28, 671–672. [CrossRef]
84. Kagalwalla, N.; Garg, T.; Churi, P.; Pawar, A. A survey on implementing Privacy in Healthcare: An indian perspective. Int. J. Adv.
Trends Comput. Sci. Eng. 2019, 8, 963–982. [CrossRef]
85. Meingast, M.; Roosta, T.; Sastry, S. Security and privacy issues with health care information technology. In Proceedings of the 2006
International Conference of the IEEE Engineering in Medicine and Biology Society, New York, NY, USA, 30 August–3 September
2006; pp. 5453–5458.
86. Mishra, N.N.; Parker, L.S.; Nimgaonkar, V.L.; Deshpande, S.N. Privacy and the Right to Information Act, 2005. Indian J. Med.
Ethics 2008, 5, 158–161. [CrossRef] [PubMed]
87. Berger, D. Corruption ruins the doctor-patient relationship in India. BMJ 2014, 348, g3169. [CrossRef] [PubMed]
88. Ion, I.; Sachdeva, N.; Kumaraguru, P.; Čapkun, S. Home is safer than the cloud! Privacy concerns for consumer cloud storage. In
Proceedings of the Seventh Symposium on Usable Privacy and Security; 2011; pp. 1–20. [CrossRef]
89. Priya, R.; Sivasankaran, S.; Ravisasthiri, P.; Sivachandiran, S. A survey on security attacks in electronic healthcare systems. In
Proceedings of the 2017 International Conference on Communication and Signal Processing (ICCSP), Chennai, India, 6–8 April
2017; pp. 0691–0694.
90. Kumar, P.R.; Raj, P.H.; Jelciana, P. Exploring Data Security Issues and Solutions in Cloud Computing. Procedia Comput. Sci. 2018,
125, 691–697. [CrossRef]
91. Carol, Y.; Cheung, Y. Data without borders. Lancet 2019, 393, 1331–1384.
92. Bartoletti, I. AI in Healthcare: Ethical and Privacy Challenges. In Conference on Artificial Intelligence in Medicine in Europe; Springer:
Cham, Switzerland, 2019; pp. 7–10.
Inventions 2021, 6, 45 30 of 30
93. Bhattacharya, P.; Tanwar, S.; Bodke, U.; Tyagi, S.; Kumar, N. BinDaaS: Blockchain-Based Deep-Learning as-a-Service in Healthcare
4.0 Applications. IEEE Trans. Netw. Sci. Eng. 2019, 1. [CrossRef]
94. Hathaliya, J.J.; Tanwar, S.; Tyagi, S.; Kumar, N. Securing electronics healthcare records in Healthcare 4.0: A biometric-based
approach. Comput. Electr. Eng. 2019, 76, 398–410. [CrossRef]
95. Kumari, A.; Tanwar, S.; Tyagi, S.; Kumar, N. Fog computing for Healthcare 4.0 environment: Opportunities and challenges.
Comput. Electr. Eng. 2018, 72, 1–13. [CrossRef]
96. Vora, J.; Nayyar, A.; Tanwar, S.; Tyagi, S.; Kumar, N.; Obaidat, M.S.; Rodrigues, J.J.P.C. BHEEM: A Blockchain-Based Framework
for Securing Electronic Health Records. In Proceedings of the 2018 IEEE Globecom Workshops (GC Wkshps), Abu Dhabi, United
Arab Emirates, 9–13 December 2018; pp. 1–6.
97. Vora, J.; Tanwar, S.; Tyagi, S.; Kumar, N.; Rodrigues, J.J.P.C. FAAL: Fog computing-based patient monitoring system for ambient
assisted living. In Proceedings of the 2017 IEEE 19th International Conference on e-Health Networking, Applications and Services
(Healthcom), Dalian, China, 12–15 October 2017; pp. 1–6.
98. Vora, J.; Tanwar, S.; Tyagi, S.; Kumar, N.; Rodrigues, J.J.P.C. Home-based exercise system for patients using IoT enabled smart
speaker. In Proceedings of the 2017 IEEE 19th International Conference on e-Health Networking, Applications and Services
(Healthcom), Dalian, China, 12–15 October 2017; pp. 1–6.
99. Hathaliya, J.J.; Tanwar, S. An exhaustive survey on security and privacy issues in Healthcare 4. Comput. Commun. 2020, 153,
100. Hathaliya, J.J.; Tanwar, S.; Evans, R. Securing electronic healthcare records: A mobile-based biometric authentication approach. J.
Inf. Secur. Appl. 2020, 53, 102528. [CrossRef]
101. Madhisetty, S.; Williams, M.-A. Managing Privacy Through Key Performance Indicators When Photos and Videos Are Shared via
Social Media. In Science and Information Conference; Springer: Cham, Switzerland, 2018; pp. 1103–1117.
102. Singh, R.G.; Ruj, S. A Technical Look at the Indian Personal Data Protection Bill. arXiv 2020, arXiv:2005.13812.

Indian Healthcare System

Uploaded by

Copyright:

Available Formats

Indian Healthcare System

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Indian Healthcare System

Uploaded by

Copyright:

Available Formats

5.

A Comprehensive Survey on Data

Prathamesh Churi, Ambika Pawar and Antonio-José Moreno-Guerrero

Inventions 2021, 6, 45. https://doi.org/10.3390/inventions6030045 https://www.mdpi.com/journal/inventions

Figure 1. Disease- and patient-centric healthcare systems.

By contrast, patient-centric databases have the following features:

Figure 2. Trade-off between privacy and utility.

Figure 3. Structure and contribution of the paper.

2. Indian Healthcare Systems: Overview

Figure 4. Indian healthcare system.

The Public The Private

The Public The Private

3. Healthcare in India: Reformation in Policies

Table 2. Key performance indicators and source: Lancet Journal.

India China Sri Lanka Indonesia Egypt Philippines

4. Healthcare Industry and Applications in India

4.1. Segments of Indian Healthcare Industry

Figure 5. Segments of the Indian healthcare industry [15].

4.2. Advantages of the New Indian Healthcare Industry

Figure 6. Advantages of the Indian healthcare industry [18].

4.3. Rise in Healthcare Infrastructure in India

Figure 7. Number of doctors in India [17].

Figure 8. Number of medical colleges in India [17].

4.4. Trends in Indian Healthcare System

Trends Description Privacy Implications

Trends Description Privacy Implications

4.5. Popular Healthcare Hubs/Startups in India

Table 4. Healthcare hubs in India.

Health Care Providers Statistics Description

Health Care Providers Statistics Description

5. Healthcare Data Utility: Context of India

5.1. Sources of Indian Healthcare Data

5.2. Types of Healthcare Data

Table 5. Type of healthcare data.

Type Description Examples Clinical Data Exogenous Data Genetic Data

5.3. Key Data Sources of Health Information of India

Table 6. Sources of the Indian healthcare system.

Data type Direct/Indirect Description Strengths Limitations

5.4. Technologies Used in Healthcare Data: Indian Perspective

5.4.3. Data Visualization of Indian Health Data

5.4.4. Augmented and Virtual Reality in Indian Health Data

Table 7. Existing research in the Indian healthcare industry.

Types of Disease Type of Data Data Mining Technique References

6. Healthcare Data Privacy in India

Privacy Issues in the Indian Healthcare System

Figure 9. Privacy issues in the Indian Healthcare system.

A. Lack of Technology and Infrastructure

Table 8. Cyberattacks presented in the Indian healthcare data.

E. Data Sharing Trust in the Third Party

Table 9. Privacy issues stated in the Indian healthcare system.

Privacy Issues Stated in the Indian Healthcare System.

Privacy Issues Stated in the Indian Healthcare System.

7. Open Issues and Further Discussions

• Doctors and Healthcare Professionals/practitioners (DH): Five doctors are selected

Doctors and Healthcare Hospital Administrative Researchers and Academicians in the

7.2. Future of Data Privacy in India

7.3. Data Utility-Privacy Trade-Off in Personal Data Protection Bill

8. Conclusions and Future Work

You might also like