A Glimpse For Ethical Landscape For Digitalisation Of Health Sector In COVID-19

created by Eliel Takunda Chiponya

The surge of COVID-19 pandemic in Indonesia has triggered the great use and inventions of technological advancements in the Health sector, and these advancements have addressed many aspects of the technological spectrum in health and they have a direct impact on supporting COVID-19 management, detection, treatment and response. Despite these advancements seeming to be a blessing to the health sector, they have failed to provide a clear snapshot of the whole management procedures of these technological advancements, perhaps they have raised a lot of ethical questions.

 The ethical landscape lied on the following aspect privacy concerns by the community to the Tracking systems which the health sector used to track the behavioural change of the individual and the compliance with the COVID-19 regulations. The society was concerned about how the data was going to used and who had access to that data since they believed that it could be misused if in wrong hands. The system will not store data, not even geolocation data, and the users’ phone numbers and personal identification data are not exchanged at any point. In Indonesia, at an individual user level, the government has protected the users’ privacy by not storing geolocation data in the local app, in addition to not exchanging any user information and disallowing permission options to access users’ data. In 2020, Indonesia experienced a significant data breach involving the personal information of approximately 230,000 COVID-19 patients. This incident highlighted serious vulnerabilities in the country’s telemedicine systems, particularly concerning their security measures. The personal data of these patients was reportedly stolen and sold on dark web forums, including Raid Forum. This breach involved sensitive information related to health conditions and personal details, putting patient privacy at risk. The question for you is where the following regulations enforced since they are obligated to be enforced;

Law No. 11 of 2008 on Information and Electronic Transactions (ITE Law) Unauthorized Access: The breach involved unauthorized access to sensitive personal data, which is a violation of Article 30 of the ITE Law that prohibits hacking or unauthorized access to electronic systems. Data Misuse: Selling stolen data on the dark web constitutes a misuse of information, violating Article 27, which prohibits the dissemination of information that violates privacy. 2. Law No. 36 of 2009 on Health Confidentiality Violation: This law mandates strict confidentiality regarding patient health information. The breach exposed sensitive health data without patient consent, violating the provisions that protect patient confidentiality and data privacy. Patient Consent: The law emphasizes that personal health data cannot be shared or disclosed without the explicit consent of the patient, which was clearly disregarded in this case. 3. Government Regulation No. 71 of 2019 on the Implementation of Electronic Systems and Transactions Data Protection Obligations: This regulation requires electronic system providers to implement adequate security measures to protect user data. The failure to secure the personal information of patients demonstrates a lack of compliance with these obligations. Accountability: Providers are responsible for ensuring the integrity and security of the data they manage. The breach indicates a failure to fulfill these responsibilities, exposing the system to vulnerabilities.

 Digital literacy become a major barrier in the use of digital systems in the remote parts of Indonesia and this re-imposed ethical questions about the uneven distribution of education and resources which would have made it possible for the people there to be literate digitally in the previous years. Major cities are crowded, do you think they should receive more resources than others?! Some people believe that they should be an even distribution of resources between all the towns and cities of Indonesia, do you think these people are being naïve?!

Even before the pandemic, were the remote parts of Indonesia not modernised and were the schools there not equipped with the modern-day technology so that the people there will be digital literate?! These the some the questions that we have to ask ourselves and evaluate the progress and the concerns of the people.

 Robots and artificial intelligence machines were also invented in the health ecosystem to help treat patients and assist the health workers. The fact that the robots and Al are not human beings and the assumption that they might not be benevolent, raised resurrected the issues of serious doubt about the non-maleficence ability of the machines. Robotic inventions are not humans, there are machines , so in the case of algorithmic fault it would be dangerous to humans. Perhaps people do not even fully trust robots since they are not humans and they rely on a certain code.

SOME OF THE INVENTIONS IN THE HEALTH ECOSYSTEM OF INDONESIA;

Namely, those 11 digital apps are Alodok (PT Sumo Teknologi Solusi), GetWell (PT Telemedika Teknologi Indonesia), Good Doctor (Good Doctor Tech), GrabHealth (PT. Grab Indonesia), Halodoc (PT Media Dokter Investama), KlikDokter (PT Medika Komunika Teknologi), KlinikGo (PT Medika Nuswantara Digital), Link Sehat (PT Link Medis Sehat), Milvik Dokter (PT Milvik Indonesia), ProSehat (PT Atoma Medical), SehatQ (PT SehatQ Harsana Emedika), and YesDok (PT Yes Dok Indonesia).

Additionally, 9 robot innovation products were developed to support health workers treating hospitalized patients. Namely, the 9 robotics innovation products are Robot RAISA TIARA, Robot RAISA BCL, Robot Dekontaminasi (decontamination robot), Smart Syringe Pump, Autonomous UVC Mobile Robot, Robot Violeta, Smart Telemedicine Robot “Win-MTA,” Service Robot, and Doctor Representative Robot. Their intended aims are to prevent within-hospital transmission or to alleviate health care workers’ work burden. In addition, 2 health care data systems were developed assisting patients’ treatment, namely SIRANAP (Sistem Informasi Rawat Inap) and Blood Plasma Donor.

References ;

1. Nur Aisyah, Dewi et al. “The Use of Digital Technology for COVID-19 Detection and Response Management in Indonesia: Mixed Methods Study.” Interactive journal of medical research vol. 12 e41308. 28 Feb. 2023, doi:10.2196/41308

2. Kandun IN. Emerging diseases in Indonesia: control and challenges. Trop Med Health. 2006;34(4):141–147. doi: 10.2149/tmh.34.141

3. Aisyah DN, Mayadewi CA, Diva H, Kozlakidis Z, Siswanto. Adisasmito W. A spatial-temporal description of the SARS-CoV-2 infections in Indonesia during the first six months of outbreak. PLoS One. 2020 Dec 22;15(12):e0243703. doi: 10.1371/journal.pone.0243703. https://dx.plos.org/10.1371/journal.pone.0243703 .PONE-D-20-16853

4. Kozlakidis Z, Catchpoole D. Healthcare innovation: will COVID-19 be a transformative experience? Innov Digit Health Diagn Biomark. 2021;1(2):25–26. doi: 10.36401/IDDB-21-X2. https://meridian.allenpress.com/innovationsjournals-IDDB/article/1/2/25/467575/Healthcare-Innovation-Will-COVID-19-be-a . [DOI] [Google Scholar]