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OPINION
Year : 2022  |  Volume : 20  |  Issue : 2  |  Page : 115-117

Medicolegal practice in India: Is digitalization the way forward?


Department of Forensic Medicine and Toxicology, Christian Medical College, Vellore, Tamil Nadu, India

Date of Submission23-Jan-2022
Date of Decision28-Jan-2022
Date of Acceptance01-Feb-2022
Date of Web Publication07-May-2022

Correspondence Address:
Dr. Ranjit Immanuel James
Department of Forensic Medicine and Toxicology, 2nd Floor ASHA Building, Ida Scudder Road, Christian Medical College, Vellore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_13_22

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  Abstract 


In India, most of the medicolegal records are still kept as paper documents, even though technology has become integral in every other field of the health sector. Digitalization of the medicolegal processes would allow records to be easily stored and accessed. In addition, it would improve security, accuracy, and readability. Despite some steps in the right direction, most Forensic Medicine departments in India seem to be lagging behind. The authors will attempt to highlight the pressing need for the digitalization of medicolegal services in our country.

Keywords: Digitalization, documents, medicolegal, software, technology


How to cite this article:
Manoj D, Johnson LR, James RI. Medicolegal practice in India: Is digitalization the way forward?. Curr Med Issues 2022;20:115-7

How to cite this URL:
Manoj D, Johnson LR, James RI. Medicolegal practice in India: Is digitalization the way forward?. Curr Med Issues [serial online] 2022 [cited 2022 May 25];20:115-7. Available from: https://www.cmijournal.org/text.asp?2022/20/2/115/344928




  Background Top


Technology is now deeply integrated into every facet of modern medicine. In India, hospitals have digitized medical records to reduce costs, increase security, and most importantly, improve access to records. Although most fields of modern medicine have incorporated technological advances, most Forensic Medicine departments seem to be lagging behind. Even today, many medicolegal reports such as postmortem reports, wound certificates, reports of age estimation, opinions regarding sexual assault, requisitions for forwarding samples to Forensic Science Laboratory (FSL), summons to attend courts for deposing evidence, requisitions from police, etc., are handwritten and photocopies of the same are generally submitted in a court of law. Poor handwriting or faulty photocopied reproductions may lead to difficulty in reading such reports resulting in errors in interpretation.

Despite mounting evidence supporting the need to digitize medical records, the challenges involved with integrating technology with medicolegal documentation and digitalizing medicolegal reports have not been satisfactorily addressed. A much sought-after change among the Forensic Medicine fraternity is a robust and complete digital solution which will enable shifting the medicolegal work onto a digital platform.[1] This system should allow them to receive e-requisitions from the police or magistrates and prepare and submit medicolegal reports online.

In September 2020, the Madras High Court had instructed the Government of Tamil Nadu to ensure the use of software throughout Tamil Nadu for medicolegal reporting to minimize impropriety in Forensic Medicine departments.[2] National Informatics Centre, Haryana, has developed the software “Medical Legal Examination and Postmortem Reports System” (MedLeaPR) with input from experts in the field from institutions like Postgraduate Institute of Medical Education and Research, Chandigarh and Rohtak. MedLeaPR is a centralized web-enabled solution hosted from the state data center. A few states like Punjab, Haryana, and Madhya Pradesh have already adopted the use of online platforms, but there have been some problems with connectivity.[3] Other states like Tamil Nadu are considering adopting an online platform for common medicolegal record generating and archiving in government colleges and hospitals.

The Forensic Medicine fraternity in India should strive for complete and uniform digitalization of the various medicolegal processes. Before illustrating the benefits of digitalization, we must first remove any ambiguity between the terms “digitization” and “digitalization.” Digitization is the process of transforming information from a physical format to a digital version, for example, scanning medical documents. Digitalization is the practice of utilizing digital technology to enhance processes such as preparing and submitting reports online. In a nutshell, digitization relates to information, whereas digitalization relates to processes.[4]


  Advantages of Digitalization Top


Paper documents are inherently insecure and those stored in file cabinets and file rooms present a security risk. A printed sheet of information can go anywhere, anytime, with anyone. If medicolegal documents are made digital, they can be backed up and encrypted. Digital data that is encrypted cannot be decoded even if it is copied or stolen. With cloud storage becoming cheaper and more accessible, encrypted digital documents and files can be easily stored on off-site servers. These documents can then be accessed from anywhere in the world with the proper credentials and access codes. Measures such as enabling encryption, multiple level verifications for access, etc., will ensure that the information cannot be accessed by unauthorized individuals. It will also be possible to track who has accessed specific documents.[5]

To prevent tampering of medicolegal documents, they can be encrypted or locked, preventing further edits. Mitigating the risk of loss of paper documents through physical security can be costly, and ensuring employees constantly follow security protocols can be difficult. However, once the digitalization of medicolegal documents is done, digital security protocols can be enabled as default. Using digital records will free up vast amounts of physical storage space, enabling efficient use of space. Physically storing medicolegal records can be cumbersome, requiring additional space for new cases which can lead to misfiled or misplaced documents. Precious time may be lost searching for misfiled or lost documents. Paper is also degradable and deteriorates further every time it is handled manually. Furthermore, information stored in paper formats is susceptible to fires, floods, and other natural disasters. Digital documents ensure that not only is data saved and preserved for future but also accessible.


  Disadvantages and Challenges Top


Despite the growing volume of literature on the benefits of digitizing medical records, some authors have identified potential disadvantages associated with digital technology.[6],[7] These include financial costs, temporary loss of productivity associated with changes in workflow, potential privacy and security concerns, and several unintended consequences.

The financial costs include costs for developing and maintaining the digital platform, initial upgradation of computers and other equipment, server, storage costs, etc., which can seem very high in the beginning. In addition, there is a cost for periodic upgradation of hardware and software, digitization of old records, software and hardware support, and training of the end users. However, the use of digital technologies has already become commonplace in other medical fields over the past decade. Electronic hospital records for routine patient outpatient and inpatient visits, digital discharge summaries, medical reports, etc., have already become common, thus bringing down the initial cost of digitalization dramatically.

Most Forensic Medicine departments already have computers, printers, and internet connections which will reduce the cost of transition. If the software user interface is not user friendly and intuitive, there will be difficulties faced by the end users, resulting in a reluctance to adopt the digital platform and possibly disruption of workflow. Digitalization may cause some unintended consequences, such as increased errors and overdependence on technology.[8] There is the possibility of technical difficulties or failure of the platform in which case the departments should still be able to prepare the reports with minimal disruption of services.


  Way Forward Top


A national task force should be formed which includes experts from the fields of forensic medicine (both government and private), networking, information technology, bioinformatics, police, FSLs, judiciary, and representatives from the government. The digitalization process should include all aspects of medicolegal services such as postmortem report, wound certification, age estimation, opinions regarding sexual assault, e-requisitions for forwarding samples to FSL, e-summons for attending courts for deposing evidence, e-requisitions from police, etc. A uniform digital platform should be created, which would facilitate documentation, receiving requests, and dispatching reports between the major stakeholders, i.e., police, judiciary, Forensic Medicine experts, and Forensic scientists. This platform should cater to the requirements of all the states. This will help with standardization of practices across the country. This would ensure that these digital medicolegal documents are recognized by any court of law in the country. This system should have the provision for local backup and encryption of photographs and videos that may be pertinent to medicolegal cases. The encrypted digital files should only be accessible with unique log-in credentials. The digital platform once developed should be made available all over the country including rural areas. The end users of the digital platform, like the Forensic Medicine experts, Forensic scientists, police, and judicial officials, will need to be trained regarding the use of the system to minimize difficulties during the transition and improve efficiency. There may be a wide array of technical problems that may be faced by the end users, hence there should be a support team providing round-the-clock assistance.

Containers with specimens for analysis should be labeled with barcoded stickers generated from this system, ensuring chain of custody.[3] This would further improve the efficiency of the system and reduce delays. The concerned investigation officer, magistrate, forensic scientist, and forensic medicine expert should have access to the pertinent documents of the case.

Experts recommend pilot testing the digital platform among various stakeholders in the medicolegal system before the final rollout. If this platform is initially rolled out in at least one district of each state, the feasibility and efficacy of the digital platform can be ascertained.[3]


  Conclusion Top


As technology is increasingly integrated into every facet of the health-care sector, there is a pressing need for the digitalization of medicolegal services in our country. Although there are some challenges in digitalization, they are outweighed by the advantages. Digitalization will mark a new era in the field of medicolegal practice in India, by improving efficiency and increasing transparency of the services provided.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Verma V. MedLEaPR – First step towards ICT enabled integrated justice delivery system. Informatics 2013;21:12-4. Available from: https://informatics.nic.in/uploads/pdfs/4384993a_april2013.pdf. [Last accessed on 2022 Jan 19].  Back to cited text no. 1
    
2.
Swaminathan A vs. The Principal Secretary to the Government, Health and Family Welfare Department, Government of Tamil Nadu. WP (MD) No. 78 of 2019 Before the Madurai Bench of Madras High Court Dated; 28 September, 2020.  Back to cited text no. 2
    
3.
Kattamreddy AR, Ganja CD, Khan MT. A strong need for digitalization in medico-legal practice in India. J Forensic Med Sci Law 2021;30:69-71.  Back to cited text no. 3
    
4.
Digitization vs. Digitalization: Differences, Definitions and Examples. TruQC; 2021. Available from: https://www.truqcapp.com/ digitization-vs-digitalization-differences-definitions-and-examples/. [Last accessed on 2022 Jan 20].  Back to cited text no. 4
    
5.
How to Digitize Healthcare Records (+Benefits). Image API; 2021. Available from: https://www.imageapi.com/blog/digitize-healthcare-records/. [Last accessed on 2022 Jan 20].  Back to cited text no. 5
    
6.
Zurita L, Nøhr C. Patient opinion – EHR assessment from the users perspective. Stud Health Technol Inform 2004;107:1333-6.  Back to cited text no. 6
    
7.
Westin AF. Public attitudes toward electronic health records. Priv Am Bus 2005;12:1-6.  Back to cited text no. 7
    
8.
Campbell EM, Sittig DF, Ash JS, Guappone KP, Dykstra RH. Types of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc 2006;13:547-56.  Back to cited text no. 8
    




 

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