Saturday, May 30, 2020

215. Kerala’s corona electronic medical data deal ends in shambles. P S Remesh Chandran

215

Kerala’s corona electronic medical data deal ends in shambles

P. S. Remesh Chandran

 
Editor, Sahyadri Books & Bloom Books, Trivandrum


Image by Kewl. Graphics: Adobe SP.


1

The first corona virus case in the world was reported in China towards the end of 2019. The first corona virus case in India was reported in Kerala in Trichur in Kerala when a student traveling from Wuhan in China to India reached the native town on 01 January 2020. Soon many people came from foreign countries carrying this disease and people in Kerala began to be affected from them. As the number of cases increased the health data of the people who came to Kerala from abroad and who came to Kerala from other states of India had to be collected and analyzed and a follow-up action charted. In addition to updating data on people either under observation or under treatment, the data on the health staff in the state engaged in disease control and treatment and interacting with them also had to be collected and analyzed to identify who would be next susceptible to be affected. Considering that around 2,00,000 people were under quarantine in Kerala during this period, it was not small data. It was enormous.

This data comprising of complete medical and personal data of the affected and the likely to be affected people of Kerala including their symptoms and health conditions, present and past diseases, their treatments present and past, and geo-positioned satellite tracking of all these people, not to mention details of their insurance coverage if any for treatment, collected at lower levels and sent upwards had to be processed and analyzed and decisions arrived at in each individual case and at the community level for which special tools had to be engaged.

To track patients, digital intelligence on them has to be created which is done by collecting patients’ structured and unstructured data and processing and analyzing them. Government needed software in the form of an App which could be downloaded into and made functional in the various devices including mobile phones, laptops and computers used by personnel from the field staff level to the master controlling centre level. Thus data would be collected by field staff and fed to the control centre and the control centre in its turn would process and analyze this data and inform the field staff what to do in each individual case and at the community level.

When the corona virus spread through Kerala during the months of February-March of 2020, the government had this immense data but ‘according to them’ had no know-how to process and meaningfully use it. The political commission agents in government came up with the name of a foreign data collection and processing service provider who in records agreed to provide this service free of cost under conditions for a few months. They were assigned the job and entrusted with the data which they were expected to receive and store in their server wherever it was. They were soon exposed and proved to have been illegally involved in the American presidential elections. The only justification the government had to offer was this company was founded by an American-resident Keralite and his services were offered free-of-cost.

A government can contract the help of private technology specialists if and only when governmental capabilities are not sufficient and contract foreign private technology specialists only if native private technology specialists are not available there for use. But a government overriding governmental and native capabilities and going after inferior and dubious foreign private ‘capabilities’ who have practically no experience in health care was what the Kerala government did in its Sprinklr deal. Knowing well in advance that the nefarious data transfers in this deal in future may result in legal litigation, to escape Indian courts, the government also agreed to the law governing jurisdiction being fixed as New York. This law-breaking tendency of the people in government was clear indication of the breaking of many laws by its collaborating company itself on their part in future in that they were hoping the government would be functioning as the collector and the company as the seller, an experienced seller, of the data. The mutual benefit would be the people in government- that is the political commission agents associated with or in the ruling party of the government- would be unburdened with the complexities of selling the data and the company would be relieved of the huge expenses of collecting the huge data.

One thing which must be noted here is that though collection and processing of health data by electronic means is what is called e-health, the government, the media and everyone associated with this undercover deal carefully avoided using the name e-health. They called it everything but e-health, keeping the already much publicized and expensive e-health project of Kerala out of the picture and keeping it in reserve for more lucrative other deals in future before the term of government expires in a few months.

Medical data stored in a server can be misused or lost due to a multitude of reasons. Discussing the data outside of the office and business associates breaching privacy, security and data confidentiality are common. Phones, laptops and USB devices attached to using the data can be lost or stolen, hack-wares may invade and mal-wares run. Improper security safeguards and lack of ample access controls may lead to data unauthorizedly accessed, stolen, misused or sold. The security protocols may have purposefully inbuilt loopholes to override administrative, technical and physical safeguards in the system and drain data onto the black market where it will get on average three times more of important and confidential financial data and be used for thousands of purposes by hundreds of companies and individuals including blackmailers and ransom seekers. 

Instead of the minimum data needed for the execution of a given assignment, the bulk of the data in the repository could be made to be exposed to an accessing person who could sell it piecemeal on who-needs what-basis to be used for a wide variety of companies and individuals. Employers of firms may want confidential medical data of staff and will pay handsomely for getting hold of that information. The amount that changes hands will always be many times higher than the legal fine for that information unauthorizedly changing hands if detected.

The National Informatics Centre is India’s prime and paramount institution in the IT sector, far experienced and credible compared to its foreign competitors, and the most ideal IT tool and the biggest data analytics platform in India for the various Indian states to crunch the personal health information of citizens collected by field workers. While this institution’s services were available without the hassle of the data being stolen and misused by foreign agencies when the corona virus threat was becoming a reality in India, the Kerala government ignoring this national institution approached an American-based and controversial- controversial in being illegally involved in the American presidential elections and facing prosecution there- firm to receive, store and process the health data the state was collecting from citizens in connection with the corona defense. When this deal came to public light and the government’s motivation for this deal was questioned, the Chief Minister of the state, Comrade Mr. Pinarayi Vijayan told that this American company was offering its services free, the state had no other companies accessible or available at the time, and the government had proprietary rights over the health data collected electronically which will be protected and will never be misused or monetized by this American company. He also emphasized the fact that this company was run by a Malayali as if all Malayalis are clean!

Many large multinational hospital chains which operate even within India have excellent electronic patient data management systems which already handle very big data collected in real time from patients, analyzes it in no time, and tell doctors and nurses what to do. Their systems manage millions of patients at one time and it is very strange that the Kerala government did not approach any of them for help to handle a large volume of data when an epidemic began to make its sweep in Kerala.

This company was till then only a social media management company providing apps and software for social media management. They were never experienced in managing massive health data from hundred thousands of people. It was their first attempt of this kind and one or two of their software was modified to accommodate the health data collection and processing needs of the Kerala government. They were using Kerala government as a stepping stone in to big health data management. Had this deal originated in any other state in India it would not have ended in controversy. The people of Kerala- the highest literate state in India- are unique in that they view suspiciously any data storage system, especially health data collection and storage, and if it is handed over to and stored by a private company as highly suspicious. The perpetrators of this deal did not consider this mindset of the people in Kerala whose data was what they were going to collect and as a result this deal became controversial and a topic of public debate. As a result the trustworthiness and honesty of this data collection was lost and people of Kerala are now doubly suspicious. Remember that the crowd of IT experts and net investigators and net hackers on the right side of law in India and in the world are a large part Keralites and they are now vigilant enough to detect where and when this data resurfaces and is made use of commercially by parties who were never signatories to this agreement between Kerala government and a foreign company on behalf of Kerala people.

Why should their services be free under conditions of course at least for a time? It is because they are in possession of the data free. Any insurance company would be eager to get hold of this data to learn in advance which of their policy holders had which of the diseases before taking their insurance policy so that they can deny payment of medical expenses saying, and also proving, that the policy holder concealed information on treatments of previous diseases. If they escape payment of 2,00,000 rupees of medical coverage and had to pay 50,000 rupees for getting hold of information on that particular case, still they had made a very handsome profit. Think how elaborate and efficient medical data theft would be and is! Of course the service provider can offer their services to government free. What is most important for them is access to the data which they get free anyway.



2

In government’s opinion manual processes of medical care which were generating thousands of medical records which were dispersed across several different locations were creating problems. The meaning: A person or a company sitting at or situated at Bombay or New York cannot now see the medical records in the General Hospital or the Medical College, Trivandrum. Therefore every medical record should be kept in the electronic form, uploaded in real time to a central data base, and stored there to be available to anyone from anywhere to see.

HP Enterprise Services India officially announced on 27 July 2015 that they were selected as partners in the e-health project of Kerala by the Department of Health and Family Welfare, Government of Kerala, for providing the core technology, applications, various online and real time services, and collect, store, analyze and research medical data. The HP was to be in partnership with JK Technosoft in this deal with the Kerala Government. The e-clinical services they offered included online prescription, online diagnostics and online imaging, the data and images they all generated going to their dynamically updated central universal database in a cloud server and accessible to doctors from anywhere on a need-only-basis. The idea was, once HP takes care of the responsibility of data collection and monitoring of treatment, doctors can access their data repository, get real-time advice and focus on patients better and take care of treatments more efficiently.

How this e-health will be working in hospitals is in more or less this way: All the people above 30 will be invited to screen for hypertension and diabetes, records will be created of those tested positive, their current medications noted, and they will be notified in their mobile phones after three months to go check their blood pressure and sugar levels again, all data fed into the central data bank under unique identification. The concept is these persons using their biometric authentication can go to any hospital and for the doctors there access on the desktops or other devices there their demographic and medical data by the help of the authorized employee in that institution. Other diseases detected will have other similar sub data bases from which other regimens will be advised to the patients through their doctors.

The mobile health world of 32000 apps and 28 billion US dollars as assets!

The m-health or mobile health apps are the new applications for collecting and stealing medical data. Their projected value in 2018 was 28 billion US dollars. More than 200 mobile health apps are added to the worldwide app stores each day and as of now 320,000 of them are available to download and install in websites, tablet computers and mobile phones now. Ninety percent of these are created exclusively for the purpose of stealing medical data of people for various interested companies and nearly all of them are fronts, backs, subsidiaries or associates of ‘interested’ companies. Any government installing them in their health network system and advising people with tablets and mobile phones to comply will never fully know whatever they would be doing with the data passing through them; the government will know only bits and parcels of the operation.

The government suppressed medical data theft and tried to portray the end result as the cause!

So the government of Kerala installed an m-health application- most probably the cheapest one recommended by the greediest of the political cronies in the minister’s office- in their e-health project website. No sooner the e-health project was inaugurated on 26 January 2018 than the data thieves began their operation with the full blessings of the project’s political promoters. By the beginning of March 2018 more than ten million people’s personal and medical data had been collected in their app and successfully leaked out. The end result was a number of tablet computers which stored personal medical data of people becoming damaged or dysfunctional and most people’s data messed up and found to be mixed together or jumbled- the inevitable result of any clumsy hasty operations. The government tried many ways to portray this end result as the cause! Finding no other option the government stopped e-health data collection from 23 March 2018 and removed the m-health app from the e-health project’s website. The government suppressed this data theft but it came out in April 2018. On 10 April 2018 it was reported that the health department, under the direction of the health secretary, initiated an investigation on the irregularities in the e-health project and shared the people’s forewarned anxieties over insurance companies and medical companies acting behind and getting hold of this information for illegally using them.

On 11 April 2018 it was announced by the health secretary of the state that this e-health project which was officially launched on 26 January 2018 has succeeded in securing World Bank assistance as a project for the automation of hospital processes and collection and storage of electronic demographic and health data of the population, it would automate all health care and patient care activities in the state and link all government health institutions through a high bandwidth (reliable!) network, and will have a complete profile of every citizen living in Kerala in the end to enable surveillance of each and everyone’s diseases. He also admitted in not too many words that this project would use the insecure Aadhaar unique identification number of citizens, it would be implemented first in the rural areas where there will be the least resistance, and there could be no guarantee as to the protection of personal identifiable data and privacy in the new massive data repository to be set up.

On 10 January 2019 the health minister announced that 14 million of the 35 million population of Kerala had already been brought to the digital health platform, 79 of the 170 Family Health Centres had been digitized, e-health was being extended to all districts and all government medical colleges, outpatient registration, clinical examination and administration were working on the e-Health software, and that hospitals were going patient-friendly and paperless. Six months later, on 15 may 2019, the health minister announced that 20 million people had been covered under e-health, hard copies of patient records are going extinct, diagnosis and treatment are done from soft copies available in computers and the system, and that patients were being given virtual tokens for doctor consultation with appointment time marked.

If corona data collection had to be assigned to a foreign firm, then what were the HP Enterprises India and the Government E-Health Project doing in Kerala?

The three people in Kerala who most claimed in media that the e-health project of Kerala which was in operation since 2014 is a great success were Mr. Pinarayi Vijayan, the Chief Minister of Kerala, Smt. K K Shylaja, the Health Minister of Kerala, and Mr. Rajiv Sadanandan, the Health Secretary. If what they claimed was true, by 2020 Kerala must have had a vast repository of people’s demographic and medical data covering some 33 million residents in Kerala. Or are they jokers? When the corona virus broke out in the beginning of 2020, the Kerala government was seen engaged in busily setting up data banks of demographic and medical details of all people of Kerala with foreign assistance. Then how was the e-health project of Kerala which has been in operation since 2014 a success? Moreover, these three people separated corona monitoring from e-health to avoid the question why there was not enough data in e-health demographic-wise and medical-wise to cater to the needs of corona monitoring, and if not, why were they claiming the e-health project was a success. In fact the e-health project was a thorough failure in spite of bringing in and assigning the job of setting up the data repository to the famed HP Enterprises in 2015. Even HP Enterprises India’s Vice President & General Manager Marshal Correia on 27 July 2015 publicly announced that ‘they were assigned the job of creating an e-Health IT platform for Kerala, electronically linking 1,000 government health centres, 200 hospitals and 3 medical colleges across the state, to provide healthcare to 33 million citizens, and coordinating all public health programmes, medical inventories, electronic medical records and hospital management information systems in the state.’ In their own admission their duty in this deal was ‘to provide the core technology and mobile applications for capturing all activities and processes of patient care, compile and store and analyze the medical data and report them, provide centralized monitoring and management, e-clinical services and disease surveillance, and do medical research’. If in 2020 corona data collection and care had to be assigned to a foreign American firm then what were the HP Enterprises India and the Government E-Health Project doing in Kerala?

 
(UNDER EDIT. WILL CONTINUE….)  

  

Images Courtesy: Pixabay.
Written and first published in: May 2020


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About the Author P. S. Remesh Chandran:


Author Profile Of P S Remesh Chandran By Sahyadri Archives.


Editor of Sahyadri Books & Bloom Books, Trivandrum. Author of several books in English and in Malayalam. And also author of Swan: The Intelligent Picture Book. Born and brought up in the beautiful village of Nanniyode in the Sahya Mountain Valley in Trivandrum, in Kerala. Father British Council trained English teacher and Mother University educated. Matriculation with distinction and Pre Degree Studies in Science with National Merit Scholarship. Discontinued Diploma studies in Electronics and entered politics. Unmarried and single.

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Post: P. S. Remesh Chandran, Editor, Sahyadri Books, Trivandrum, Padmalayam, Nanniyode, Pacha Post, Trivandrum- 695562, Kerala State, South India.



Thursday, May 28, 2020

214. Kerala’s E-Health In Dark Shadows. P S Remesh Chandran

214

Kerala’s E-Health In Dark Shadows

P. S. Remesh Chandran

 
Editor, Sahyadri Books & Bloom Books, Trivandrum


Image by Free-Photos. Graphics: Adobe SP.

First published in 2014 at https://sites.google.com/site/trivandrumresearchinstitute/kerala-s-e-health-in-dark-shadows as Kerala’s E-Health In Dark Shadows.


Insurance companies and pharmaceutical companies want people’s medical information which they cannot collect officially. The first need it for screening medical insurance claimants to know about undisclosed medical conditions to deny payments. The second need it to geo-target their products and boost sales and profits. So they pay huge amounts as bribe to political commission agents in government to bring about e-health legislation and policies, set up data banks and collect people’s health information in them for them to steal freely. 

The three major youth organizations in Kerala are on the side of the giant and money-wielding insurance and pharmaceutical companies.


   
01. Original Govt. Order dated 04 05 2013 constituting E-Health Page 01.
 
The government thinks people do not know this but people do know. Because the people are a peace-loving lot they do not revolt. If people do have their vigilant organizations this digital data collection and merchandise would not have been possible. The three major youth organizations of the three political parties in Kerala- of the Indian National Congress, the Communist Party of India (Marxist) and the Bharatiya Janatha Party- are on the side of the giant and money-wielding insurance companies and pharmaceutical companies. These companies also have the Kerala Sasthra Sahithya Parishad (the Kerala Science and Literature Convention), the Indian Medical Association, the Kerala Government Medical Officers’ Association and the Kerala Medical College Students Association in their pockets. The people have none in their pockets including a single parliament member or a state legislative assembly member. So, people’s private medical data and personal data are collected everyday, stored in data banks and sold by politicians and bureaucrats to insurance companies and pharmaceutical companies. This has been going on for a long time and the most lecherous beneficiaries in this nexus are members of the Kerala media from whom never have we heard a word about this clandestine business going on through years. 

We followed Kerala’s e-health project from the beginning till scams publicly broke out.


   
02. Original Govt. Order dated 04 05 2013 constituting E-Health Page 02.
 

E-Health is new to Kerala State in India and, considering the strange avenues into which the massive corruption in this state has penetrated into, we have decided to closely follow the state’s activities in this field from the very beginning to as far as we can follow in time and space such that when something happens good or bad, no one will have to wonder why it happened or how it happened. When corruption occurs in large scale in this field which it surely will and e-health in Kerala reported to be in shambles and disarray in no time, there will certainly be investigations but within that time, millions of rupees will have gone. We wish to report things from the beginning so that we can pinpoint persons who were responsible when considerable amounts money are lost from public funds. We certainly will have to face repercussions, oppositions and even retaliations from those involved, which we do expect to come and will indeed face, which also we hope to report through these pages.

Some said it was 97 crores rupees and some said it was only 92 crores but all wondered where the balance did go.


   
03. Original Govt. Order dated 04 05 2013 constituting E-Health Page 03.
 
The centres of activities in implementing this project in Kerala are the Health Secretary’s office in Government of Kerala in the Secretariate, the Directorate of Health Services, and the Mission Directorate of the National Rural Health Mission, all situated in Trivandrum. The first thing which was got done by those involved in this rigmarole was getting prepared a report on the possibilities and scope of implementing e-health in Kerala which, we believe, was commissioned out to persons not at all with prior experience in this field. This report summarily got approved by government and then what we heard was media news about some funds being brought to Kerala, allocated by the Government of India. (We, in these columns earlier had reported the same in ‘Kerala Health Research Online). Some media reported it to be 97 crores and some reported it was only 92 crores but all wondered in secret where the balance did go, considering the usual rate of commission for getting a project approved and financed in India was ten percent, realized by political agents in government. Government of India usually allots 100 crores. It is inconceivable that the full amount reached Kerala, if it did, in contradiction to the North Indian standards. Or has our country progressed beyond being a puritan state?

Even far advanced countries like England, America, France and Germany fear outsourcing of e-health projects!

  04. DHS Website on 19 03 2014, E-Health Link.
 
If e-health is implemented, all digital health activities in the state will have to be monitored and controlled from a single centre, to minimize misuse or theft of confidential patient medical data which is always at risk and which is always sought by a multitude of commercial organizations ranging from insurance companies to health psychic predictors. We will be startled at the incompetence and lack of imagination with which the Directorate of Health Services is running its own simple website, let alone the massive and complicated encrypted data flow in connection with the e-health governance of an entire state. Theirs is a crude website where people cannot interact; data are scanty, incomplete and unreliable, what shall be there is not there and what shall not be there is there, data never updated since inception and pages will not open and if they do open they will have only a few irrelevant sentences. We enquired and learned that there was no one there to do these things except temporary hands lent from peripheral institutions. No one can believe that such gross neglect and ignorance could be able to be engaged to monitor the digital clinical maneuvers in the whole state, unless the same will have to be outsourced-something even far advanced countries like England, America, France and Germany fear to do. Insurance companies alone will spend millions of dollars to see that a central store of people’s health data is established in the state. 

The DHS’ pilot web site is a laughing stock of all who went there.

 
05. DHS Website on 19 03 2014, E-Health Manager Post Notified.
 
Let us take the example of the E-Health Link in the DHS’ web site. Since the starting of this digital front of the state’s health in 2013, the E-Health link remains skeletally maintained and as a laughing stock of whoever is led there. It has no relevant or important data or information to display. See a snap-shot of this page as on 19 March 2014 which is self-revelatory. There is not even mention of the important things in the field that have happened and have been milestones in the progress of this project if any milestones have been there and also any progress! The importance is laid not in enlightening people on this new subject which even these ‘authorities’ know nothing about and which is going to affect people’s lives every way, but on how the 92 crores could be spent safely without public interference.

Only notification for Expression of Interest for e-health, and no details of bidders or the short-listed.

06. DHS Website on 19 03 2014, Govt. Notification for E-Health Expression of Interest, Page 02 of 30.
 
Notification for an Expression of Interest in May 2013, an inevitable corrigendum six days after, four ridiculous queries in the same month- this was all there was in the e-health link of the DHS’ website. And it was the month of the greatest digital activity in this Directorate! Or that was only what they wished to make public. Five Months later, in October 2013, there was application invited for the post of a Manager but no mention of who applied for and who was selected for this post. 

The Expression of Interest was posted on 03 May 2013 with a deadline on 18 October 2013, with no mention after the deadline of who Expressed Interest and who were approved and short-listed. Note that this was a period in Kerala when the greatest number of fraudulent people and organizations were submitting bids and taking part or collaborating in heavily-funded government projects with Solar Scam in the lead. No wonder the names of people who expressed interest in government’s e-health project could not be publicized!

The internal vigilance wing never caught an officer of authority in the last 25 years.

07. DHS Website on 19 03 2014, Govt. Notification for E-Health Expression of Interest, Page 29-1 of 30.

Things are always dubious in the state where large amounts of public money are involved. Why permit them to steal people’s money in leisure instead of going after them and following their every move from the beginning? We know that there is a Vigilance Wing in the Directorate of Health Services, administered by an Additional Director of Health Services who does nothing but hunt petty lowly employees like Hospital Attendants, Nursing Assistants, Nurses and Clerks. How many doctors and officers of authority did this additional director and his establishment catch, find guilty and charge in the last 25 years? Their main duty is to hand over to the culprits- their loyal subordinates- the names of people who report corruption and misdeeds in the department! Never did this wing detect something on their own initiative without someone from outside reporting or complaining a thing. That is the same situation with the government’s vigilance department also. No one in vigilance detects something on their own account. Everything has to be detected by people or newspaper reporters and details conveyed to them free-of-cost and sweat. Then they will investigate, reluctantly. 

Following the broad, liberal path of the Right To Information.

08. DHS Website on 19 03 2014, Govt. Notification for E-Health Expression of Interest, Page 29-2 of 30.

So it is now people’s duty- our own duty- to detect and report, which we shall do; let us see what they do to charge-sheet and punish if we happen to detect and report something punishable. We decided to follow two routes- the reserved route of private investigation and the liberal route of the Right to Information. What our private investigation revealed shall be reported to you readers in its time but we find it nothing inappropriate in publishing in time to time what we found out via the broad path. 

09. RTI application returned from Govt. Front.

Here is our original Registered Letter to the concerned Public Information Officers on 20 March 2014. We think these questions we asked are pertinent, which everybody may wish to ask:

10. RIA application returned from Govt. Back.

Application for information under the Right to Information Act

To

The Public Information Officer,
Government of Kerala, Secretariate, Trivandrum.
Department of Health and Family Welfare,
Government of Kerala, Secretariate, Trivandrum.
Directorate of Health Services, Trivandrum.
Directorate of National Rural Health Mission, Trivandrum.

Dear Sir,

I request you to kindly make available to me under the Right to Information Act, in writing, the following information which is not classified, within the prescribed time limit. I have affixed Rs.10/ worth of Court Fee Stamps as fees. 

Does Kerala State Government wish to implement E Health in Kerala?

If yes, which are the agencies/offices through which it is to be implemented? Have the Government of Kerala Collaborators/ Nodal Agencies for formulating/implementing this project? 

Did Government of Kerala or any of its departments/offices/collaborators receive any funds from anywhere for formulating, developing or implementing E Health project, and if so, who is the custodian of this fund? Please give name and full official and postal address.

If funds were received or offered, which were the sources of such funds? Please give specific details of communications allowing/releasing/offering of such funds.

Were any amounts from the funds transferred to any individuals/ establishments/ organizations on account of fees, services, salaries, honorarium and/or allowances? If so, please give the mode of payment, their names and full postal addresses and reasons for transfer of money, along with details of cheques, demand drafts and acquittances. 

Were any advertisements given in any media inviting Expression of Interest on this project, and if so, where? What were the dead lines and who were the persons/institutions/organizations who expressed their interest? Please give full postal addresses.

Did the names and addresses of those who expressed interest in the project published in media where the original invitation for EOI was advertised, and if not, why? Where else was it published?

Which are the posts created for implementing this project? Please give full pay scales, incentives and other perks.

Where were advertisements inviting applications to these posts published? Please give specific links and dead lines.

Who were selected for each post? Please give their names, full postal addresses and the last institutions where they served with name of designation and period of service there. Were their names and posts published anywhere?

Which posts are yet/proposed to be created in connection with this project and when and where are they going to be advertised?

Please include names and addresses of Appealing Authorities also in your reply.

Sincerely Yours,

P. S. Remesh Chandran, Padmalayam, Nanniyode,
Pacha Post, Trivandrum-695562, Kerala.
Dated: 20 March 2014.

We sent these requests by registered post, and they have 30 days time to give us their answer, if they ever give answers in time, which is rare. We will wait and post their replies here, along with papers of appeal if it goes to that level. 

The book E-Health Implications And Medical Data Theft announced.

Meanwhile we will see what other things were happening in this field.

 
11. A book- E-Health Implications- being announced in 2014.
 
Here is a book being announced at this time in the course of the investigation, after finding enough worms in the can, and we would have liked to add excerpts from the book here for readers’ knowledge but space here is limited. The image added here of the book was before publishing the book and the published book’s cover can be viewed at the end of this article. 

The address the Public Information Officer, Government of Kerala, Secretariate, Trivandrum is insufficient!

 
The RTI Letter we sent to The Public Information Officer, Government of Kerala, Secretariate, Trivandrum was returned by the Indian Postal Department, with the endorsement, ‘Not Sufficient Address’ and not with ‘There Is No Such Addressee’. We know government functions through its various departments, but why as a single entity the government did not appoint a Public Information Officer for itself? It is dubious. A delivery postman, as per rules, cannot determine in his office whether the designation exists or not or whether the concerned officer would accept the letter or not, provided the name of the government office and the place where it functions is legibly printed in the address. He certainly has to take the letter to that office. So we shall assume the postman did take the letter to the office but the officer-in-charge declined to accept the letter. Note that the government secratariate received and accepted the letter in their office: their office seal is stamped over the stamps on the cover. After receiving it, on second thoughts, they decided to ask the postman to endorse it as they wished and return it to the sender. Think about the lawlessness in a central government employee’s obeying the quite irregular direction of a state government employee! What right has a government officer to reject a letter from a citizen addressed to government, on the basis of whatever technical grounds? Even if a citizen does not mention the Right to Information Act in his letter, is not the government bound by duty to accept the letter and convey the information requested?

 
12. RTI Reply from Govt. on 21 3 2014.

The government does not have any information on a project it has spent 92 crore rupees on!


The Department of Health and Family Welfare sent a reply to us, signed by one Mr. Sudarsanan, Additional Secretary, which stated that ‘the Government of Kerala implemented the e-health through the National Rural Health Mission and details are available with them’. Does not this department have a Public Relation Officer and even a Public Information Officer to reply to RTI letters addressed to the government and why is that designation absent in this reply? He did convey information on point number 1 but omitted point numbers 2 to 10. If government is implementing e-health in Kerala, why are not details of its implementation and its cost sheets available with the Government of Kerala but only with the National Rural Health Mission which is not Kerala government’s but is central government’s? What kind of a government and what kind of an administration is that? Why are details of a project which the Kerala government told press it is implementing in full scale in multi hospitals in different districts not available in the seat of the government which is the Secretariate? Are details of its e-health project available in Secretariate or not is the question and isn’t it dubiousness to hide facts to prevent contradictory information from being released from two sources, i.e. from the Government and the NRHM is the point. These are usual questions which rise in the mind of the common man. We are certainly raising these issues of discrepancy and incompleteness in the reply with this department’s Appellate Authority for record of course, though we understand well in advance from this irrelevant and incomplete reply that these appellate authorities are going to be equally crooked. We are credibly informed that the e-health job assignment bids mentioned in the beginning are in the course of being finalized on the extended date and things are ordered by the political agents in government to be kept secret till then.

Shady recruitment procedures for several e-health posts for selecting favourites and darlings.

 
13. RTI Reply from NRHM on 24 04 2014.
 
Meanwhile dubious advertisements appeared in equally dubious places, inviting applications to various posts in the e-health project of Kerala. In one place, the HOW TO APPLY link led to admissions section of the Manipal University and the CLICK HERE MORE DETAILS FOR THIS JOB link led to http://dhs.kerala.gov.in/index.php/transfer where there was nothing about these posts. The DHS, NRHM and the special and exclusive project of Arogya Keralam had nothing to show on these posts in their websites. It was an old trick- to advertise in places where no one would look and even if someone looked, the links would lead to nowhere. It was clear these posts were reserved for favourites, to be recruited through shadow agencies or appointed at the recommendations of the politicians which they did for a price. And the posts did have handsome salary packages, in Kerala standards.

1. Finance Manager 50,000 rupees per month,
2. Administration Manager 50,000,
3. Technical Manager 50,000,
4. Manager (Change Management) 50,000,
5. Asst. Manager (Finance) 30,000,
6. Asst. Manager (Admn) 30,000, and
7. Office Assistant 15,000.

The following was one of the advertisements (or the only advertisement?) for these posts in e-health. It was online and it appeared in one of the shadiest of places ever known:

‘Directorate of Health Services (DHS Kerala) hiring Managers & Office Assistant (CA/ ICWA, B Tech/ MCA, MBBS, B Com, Any Degree holders). Applications are invited for the following posts in the eHealth Project Management Unit (eHealth PMU) on contract/deputation basis. The contract basis appointment will be for a period of two years. Deputation basis appointments will be based on Government rules. Maximum age limit for posts 1 to 6 is 58 years and for post 7 is 40 years as on 01-01-2014. All the postings will be in Thiruvananthapuram.

Company Name: Directorate of Health Services (DHS Kerala)
Position: Managers & Office Assistant
Education: CA/ ICWA, B Tech/ MCA, MBBS, B Com, Any Degree
Experience: 3-10 yrs
Location: Kerala

Applications may be send to State Mission Director, NRHM, General Hospital Junction, Trivandrum – 35 so as to reach the office on or before 12-03-2014.

http://www.hirelateral.com/directorate-of-health-services-dhs-kerala-hiring-managers-office-assistant/ '

Who make money and who use government projects to do favours and repay those favours received? So, that was why this great reluctance in conveying information under the right to information act was there! If what usually happens in Kerala happens in this project too, we will see that the relatives of the very authorities who were bound to give information out were undergoing this recruitment process. 

 
14. RTI Reply from E-H Project Management on 05 05 2014, Page 1.

(Updated as on 26 April 2014, 02:35 PM, slightly edited since then.)


So, as we feared, government does not know who the custodian of the 92 crores they gave is. The NRHM Directorate also does not know who the custodian of this amount is and how it is spent. See the reply from Smt. Vijayalekshmi P. Nair, Senior Administrative Assistant. We have to wait for months for information which is available under the same roof of her office building.


 
15. RTI Reply from E-H Project Management on 05 05 2014, Page 2.

(Updated as on 30 April 2014, 12:47 AM)

  
 
16. RIA Reply from E-H Project Management on 05 05 2014, Page 3.
 
We received a reply from the E-Health Project Management Unit, directing us to remit by DD an amount of Rs.20/-. Here is their letter (Not published here). 

We obtained a DD and made it for 25 Rupees instead of 20 as we wished to inspect the files also. 

17. Facsimile of Bank DD Dated 13 May 2014 for release of information.

There was no office, no person, not even a name board.

 
We went in search of this E-Health Project Management Unit of Kerala which was entrusted with 92 crore rupees of public money, with the DD to deliver it, receive the details and inspect files. It was 3 P.M., 17th May 2014, Saturday. There was no name board of this supposed institution near the General Hospital Junction. We went and enquired inside the Directorate of Health Services. Many asked us what this e-health project was! Some directed us to a below-ground level warehouse cum go-down where this unit was supposed to be housed. There was no office, no person, not even a name board. And there was also no one to receive the DD. We returned with the decision to enquire further about this ghost institution. 

(Updated as on 17 May 2014, 06:19 PM)


  
18. Expenditure statement of e-health for 2013-14. Page 1.
 
We received some information from E-Health which we doubt to be true. But it proved one thing- Kerala’s Health Director Dr. P. K. Jameela and a few other saints in this department were regularly receiving money from this e-health project. Must be for giving advice though we cannot perceive what expertise they have in this field! This project was serving as yet another of their milking cows. In spite of a government car having been allotted permanently to this project, around 80000 rupees were pocketed every month in the guise of using and paying for a private car owned by a company which in our enquiry never and nowhere existed in Trivandrum. They never would reveal the vouchers for these payments to us as they all were bogus.

  
19. Expenditure statement of e-health for 2013-14. Page 2.
 
The appointments made in the project office contained in the sub-ground floor of the Directorate of Health Services building were all irregular and none were qualified for these posts. They were all recruited under strong recommendations of whoever signed those papers scanned and published here. We needn't mention their names as their names are printed boldly in these communications. The State Health Minister's office also had its quota the enormity of which resulted in feud and many other things and finally nearly reached beating; the Project Manager of E-Health, who was an able administrator, formerly a Superintendent of the Government Mental Health Centre, Trivandrum, and the only person qualified for the post, resigned. We were given details of only minor payments and expenditure from 06/2013 to 06/2014. We are awaiting major payments along with vouchers and payment receipts for the period and those of all payments for all periods. See here the reply forwarded to us: you must search internet for the companies mentioned in the list towards the end. You will see that the majors among them have no experience in implementing, designing and supplying e-health in other states or in other countries. The minor companies never existed; they were just set up as company fronts by politicians in government to loot at will the e-health money allotted by the Government of India. 

Companies enlisted were without previous experience in the field except two.


  
20. Expenditure statement of e-health for 2013-14. Page 3.
 
We were indeed given copies of the various companies which Expressed their Interest in response to the EoE notification. A very few among them were indeed companies with a reputation but it was never revealed which ones among them were short-listed or reached the stage of signing a Memorandum of Understanding. The companies originally bid, in the order of their listing by the e-health authorities were these: Infosys, UST, Bosch, Amritha Technologies, TCS, Madras Security Printers, Tech mahindra, Accenture, Sify, IBM, Equant Tech, Keltron, NSDL Database Management, United Health Group Informatics, Oracle and HCL Infosystems. In our checking only six of them had any kind of credentials and even for of these did not have a policy of disclosure. Most of them had no credentials, and except one or two were previously and practically experienced in the field. It must also be noted that of all these companies listed for the e-health of Kerala with or without credentials but who were actually the first bidders to Kerala’s e-health, none were involved (or were invited to take part?) in the collapsed people’s electronic medical data collection deal 2020 of Kerala.

  
21. Expenditure statement of e-health for 2013-14. Page 6.
 
The official station of this project was one of the front buildings in the compound of the Directorate of Health Services, Trivandrum. This building was originally constructed for housing the Reproduction and Child Health Project (RCH) and a property of the health department and the state government. We believe this building was shown to have been newly constructed or bought for housing the E-Health Project through bogus/fabricated records to convince the central government and steal more crores of rupees from the project on account of a headquarters. 

(Updated as on 27 October 2014, 03:32 PM, slightly edited since then.)


  
22. Expenditure & data statement of e-health for 2013-14. Page 10.

Was it first installment for the pilot project or annual bonanza?

 
By May 2017 the central government had begun to refuse more grants to the Kerala’s E-Health Project. In 2013 they had granted 100 crores for the full implementation of this project in the 14 districts of Kerala but the state did not do that. The state said this amount granted by the centre was not for implementing the project in the 14 districts of Kerala but the first installment towards the pilot project to be spent in Trivandrum district. The state authorities did expect that the central government would grant 94 crores each year for this project to spend extravagantly and foolishly like they did with that ‘first installment’! 

Attempts to secure grants from international agencies fail.

 
So, by 2017, the Government of India’s Department of Electronics and Information Technology went out of the picture. They were already tired of the corruption and mismanagement in the Pilot Project in Trivandrum. So they decided not to fund anymore Kerala’s e-health programme extending to the other 13 districts and taking over the traditional physical medical records libraries in hospitals and setting up digital data banks. The central government’s stand was the state government could do it at its own initiative and at its own expense. So in desperation, the Kerala government tried to secure grants for this purpose from international agencies but they declined. These international agencies were already auditing their previously given grants, asking why the thousands of women’s and children’s deaths in Kerala’s hospitals were not investigated and compensations paid for, and stopping all grant-in-aids to the Kerala health. 

Why break the back window if the front door is open?

In May 2017 in desperation the Kerala government through its health department approached that Shylock, the Kerala Infrastructure Investment Board for a loan. The KIIFB would give loans only based on cost effectiveness and internal rate of return for which a not-for-profit government enterprise will not qualify. So in May 2017 the government was running for setting up an entity of a company for managing the e-health programme of Kerala. The KIIFB’s refusal meant the project had to make money either by realizing exorbitant hospital fees which is safe but which would lead to the immediate fall of the government, or sell the collected data to the interested parties at market rates which is risky but which would extend the life of the government for a few more months till the next elections. The risky path was chosen. The insurance companies, the pharmaceutical companies and a multitude of other types of companies were becoming desperate for this data meanwhile. In 2019 it was reported that there were attempts of hacking and sabotage at the state’s e-health medical data archives and more than one crore people’s data were stolen. In 2020 a foreign company was brought in officially as collaborator. Why break the back window if the archives could be entered through the open front door? 

The politician-bureaucrat nexus with nefarious international connections.

This politician-bureaucrat nexus in Kerala with nefarious international connections knows sometimes things will come out and the bureaucrats in this nexus will have to order enquiries to save their faces. Then they will tell people through press that a few hundred digital devices broke down, the system became down, data were hacked into, and most were tampered with or lost. That was what the government of Kerala through its health secretary Mr. Rajeev Sadanandan told people in 2018- after data of one crore people of Kerala were reported to have been illegally accessed and got hold of by insurance and pharmaceutical companies. So, even from the beginning of this project in Kerala these politicians and bureaucrats and companies were working in cahoots towards the goal of collecting people’s private invaluable medical data officially for the companies. 

Putting these traitors to lie detector tests or applying sodium pentothal on them would just have brought everything out.

Every kind of enquiries is conducted by this nexus when such cryptic data maneuvers occur, except one. The health minister’s and the health secretary’s offices have a multitude of governmental as well as personal private employees including a score of Chief Private Secretaries, Additional Private Secretaries, Assistant Private Secretaries, Chief Personal Assistants, Additional Personal Assistants, Assistant Personal Assistants, and above all Political Secretaries appointed by the ruling party. In addition, there will also be liaisons from the state and district and central committees of the ruling party. Putting these traitors to lie detector tests or applying sodium pentothal on them would just have brought everything out but that is one thing the ‘investigating officers’ take care to never do. 

Saviors of Kerala’s entire electronic health who cannot even manage a couple of social media sites!

E-Health Kerala has a Twitter handle: https://twitter.com/ehealthkerala Joining date March 2015. Tweets Nil. Followers 23, including District Programme Managers and BJP Kollam. Following none. It also has a Face Book Page: https://www.facebook.com/ehealthkeralapage/ . Started on 25 July 2015. Number of posts till June 2018: Five, of which three profile changes! Some windbag will sit in his office and exclaim loudly that social media pages are very important in the modern age to communicate with people. He will order subordinates to open social media pages in Twitter and Face Book and, if they allow, in Linked In immediately and his subordinates will start them immediately as if a great digital revolution was going to begin from their office. The result is there for all to see- no posts for years- abandoned by the master and also his servants! That windbag would have retired and gone or transferred from that post, after getting hold of whatever he or she could from this e-health project. 

E-Health Scheme or E-Health Scam?

We followed this project for six years from 2014 when we predicted this project was going towards heavy corruption, up to May 2020 when we witnessed this project already in shambles and total disgrace, with the government’s massive move to collect people’s electronic medical data in connection with the corona virus epidemic and attempting to sell this enormous data to shady foreign companies rocking the state and creating media headlines, the government standing in court in attention babbling things in explanation and the court ordering to destroy beyond recovery all the data given to the company for crunching. When we read in newspapers ‘E Health Scheme launched by the Chief Minister of Kerala’, shall we not read it correctly as ‘E Health Scam launched by the Chief Minister of Kerala’? So long as there is scope for raising 200 crore rupees yet again for implementing this project in all 14 districts in Kerala, there is still hope for this politician-bureaucrat nexus.



Images Courtesy: Pixabay.
Written and first published in: 24 April 2014


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Editor of Sahyadri Books & Bloom Books, Trivandrum. Author of several books in English and in Malayalam. And also author of Swan: The Intelligent Picture Book. Born and brought up in the beautiful village of Nanniyode in the Sahya Mountain Valley in Trivandrum, in Kerala. Father British Council trained English teacher and Mother University educated. Matriculation with distinction and Pre Degree Studies in Science with National Merit Scholarship. Discontinued Diploma studies in Electronics and entered politics. Unmarried and single.

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