Digital health and artificial intelligence: a research approach to enable sustainable and personalised local healthcare

Has traditional medicine had its day? The need to redefine academic medicine

Artificial intelligence and digital health in global eye health: opportunities and challenges

Digital health (DH) and artificial intelligence (AI) in healthcare are rapidly evolving but were addressed synonymously by many healthcare authorities and practitioners. A deep understanding and clarification of these concepts are fundamental and a prerequisite for developing robust frameworks and practical guidelines to ensure the safety, efficacy, and effectiveness of DH solutions and AI-embedded technologies. Categorizing DH into technologies (DHTs) and services (DHSs) enables regulatory, HTA, and reimbursement bodies to develop category-specific frameworks and guidelines for evaluating these solutions effectively. DH is the key in generating real-world data, which is increasingly important in decision-making processes. The potential benefits of DHTs in improving health outcomes and reducing health system costs can position them alongside traditional health technologies in certain medical conditions. AI, one of the potential tools for DH, can be embedded in technologies, such as medical devices or applications, to enhance functionality and performance. AI excels at handling numerical and perceptual data. In the context of numerical data, machine learning algorithms enable prediction, classification, and clustering. In managing perceptual data, AI recognizes image/video, voice, and text. In recent years, generative AI, a form of AI that generates new content by employing a combination of a wide range of learning approaches, has become prominent in research and influences the health sector. A thorough understanding of DH and AI, along with accurate terminology use, would facilitate the timely generation of regulatory and HTA-grade evidence that helps improve health outcomes and decision-making certainty.

Artificial intelligence and other digital health technologies may optimize nurses' work. Therefore, we aimed to examine the roles of nurses in facilitating the adoption of digital health technologies and identify opportunities for these technologies to reduce burnout. We conducted a cross-sectional survey study focused on nurses' use of digital health and artificial intelligence technology with nursing informaticists. Data collection was guided by the implementation science framework, Non-Adoption, Abandonment, Scale-up, Spread, and Sustainability. Participants were recruited electronically through professional nursing informatics organizations. Survey data were analyzed using basic descriptive statistics. Fifty-two participants from across the United States completed the survey. Telehealth (73%), patient portals (71%), and medical-grade devices (69%) were most frequently used, whereas artificial intelligence was frequently used by only 38%. Staffing shortages (88%), low staff retention (81%), and inadequate support when adopting new technologies (52%) were among the key drivers of nursing burnout. Participants endorsed most nursing tasks as being supported by digital health, especially patient assessment and evaluating outcomes, and especially artificial intelligence. Engaging nurses early in the process of developing and deploying digital health, especially artificial intelligence, may help address burnout by producing more nursing-centered technologies and providing technology-enabled nursing work alternatives to bedside care.

Background Digital health (DH) presents vast opportunities, but also dynamic shift in viewpoints, which is reflected in academic works. Since DH concerns patient data, a major issue is complying with the bioethical principles, and ensuring patients’ privacy and security. The aim of this research is to explore avenues, in which ethics and privacy are reflected in DH, especially in terms of research, legislation, artificial intelligence (AI) and blockchain applications in medicine and public health. Methods Literature search for full text publications in PubMed, Scopus and ScienceDirect focused on ethics and privacy in DH in the period 2019-2023 found 325 articles in English authored by academicians. Six thematic categories were identified: ethics (fundamental principles; ethics in using novel DH tools); privacy (in use of apps/wearables; as a challenge/barrier to DH interventions/technologies); ethics/privacy in: DH research (data gathering, use, sharing); policy and legislation (for DH applications); AI and blockchains (in medicine and public health). Results Articles were from 32 countries: USA-24.3%; UK-13.5%; Germany-7.7%; Canada-7.4%; Australia-6.7%; Netherlands, Italy, Switzerland-4.7% each; China, India-3.0% each and 20.3% from 22 other countries; 86.5% in medical/DH journals. Only 10.2% were published in 2019; 17.8% - 2020; 19.4% - 2021; 27.1% - 2022 and 25.5% - 2023. Privacy was discussed in 26.5%; ethics-23.7%; research-19.4%; AI-15.1%; policy and legislation-9.5% and blockchains-5.5% of the articles. The publication activity of all six categories increased after the unfold of the pandemic in 2020. In 2023 publications for ethics (13%), privacy (5.8%) and research (6.3%) decreased; for legislation (12.9%), AI (14.3%) and blockchains in healthcare (16.8%) increased. Conclusions The pandemic and its aftermath present a change in academic interest. Traditional ethical fundaments in DH slightly lose position in favor of top notch technologies and apt legislation. Key messages • The pandemic and modern technologies enforced new digital health applications. Further research will reveal the needs of AI and blockchain applications respecting privacy and the ethical principles. • Besides existing legislation and regulations, in order to catch up with the dynamic developments in DH, the legal base needs to become more flexible. Technologies change, privacy importance does not.

Artificial intelligence to complement rather than replace radiologists in breast screening

Artificial intelligence, machine learning, and digital health innovations have tremendous potential to advance patient-centred, data-driven mental healthcare. To enable the clinical application of such innovations, the Krembil Centre for Neuroinformatics at the Centre for Addiction and Mental Health, Canada's largest mental health hospital, embarked on a journey to co-create a digital learning health system called the BrainHealth Databank (BHDB). Working with clinicians, scientists, and administrators alongside patients, families, and persons with lived experience (PFLE), this hospital-wide team has adopted a systems approach that integrates clinical and research data and practices to improve care and accelerate research. PFLE engagement was intentional and initiated at the conception stage of the BHDB to help ensure the initiative would achieve its goal of understanding the community's needs while improving patient care and experience. The BHDB team implemented an evolving, dynamic strategy to support continuous and active PFLE engagement in all aspects of the BHDB that has and will continue to impact patients and families directly. We describe PFLE consultation, co-design, and partnership in various BHDB activities and projects. In all three examples, we discuss the factors contributing to successful PFLE engagement, share lessons learned, and highlight areas for growth and improvement. By sharing how the BHDB navigated and fostered PFLE engagement, we hope to motivate and inspire the health informatics community to collectively chart their paths in PFLE engagement to support advancements in digital health and artificial intelligence.

Background: Nurses have long used different types of technologies in clinical practice and nursing education. Technology is rapidly evolving, and nurses must keep pace. Purpose: This study aimed to explore nursing students’ perspectives on their preparedness for digital health. Methods: A mixed-methods design was used. Senior-level undergraduate nursing students from two schools of nursing in Eastern and Western Canada participated in focus group interviews and completed a 45-item cross-sectional researcher-developed survey consisting of four parts. We applied in the survey a five-point rating ranging from very low to very high or strongly agree to strongly disagree. Curricular documents were also reviewed to identify how digital health concepts are being incorporated and used to aid in the interpretation of the findings. We analyzed qualitative data using thematic analysis and quantitative data using descriptive statistical analysis. Results: A total of 18 participants took part in focus groups, and 74 completed surveys were included in the analysis. Themes included experiences influencing students’ learning about digital health and suggestions for improving learning about digital health. Survey results were as follows: Self-rated knowledge about digital health and confidence (five items: mean = 17.50/25; SD = 3.30); perceived digital health preparedness and current nursing education opportunities (12 items: mean = 43.65/60; SD = 6.90); perceived benefits and concerns and relevance of digital health to nursing and future practice (22 items: mean = 82.92/110; SD = 6.18); digital health education needs (six items: mean = 23.31/30; SD = 4.59). Findings from both sources corroborate gaps identified in curricular materials. Conclusion: Nursing students have strong digital capabilities and access to some educational opportunities in their schools and in the clinical setting. However, there is a need for more systematic education and improved learning experiences about digital health (existing and emerging technologies such as artificial intelligence) so that the next generation of nurses is better prepared for this era of digital revolution.

Artificial Intelligence (AI) is revolutionizing the field of health sciences, reshaping how we teach, learn, and practice medicine. As AI technologies become increasingly integrated into healthcare systems, their impact on health sciences education cannot be overstated. From personalized learning experiences to advanced diagnostic training, AI is poised to enhance the quality and accessibility of education for future healthcare professionals. However, this transformation also raises critical questions about ethics, equity, and the future role of educators in an AI-driven world. The transformative role of Artificial Intelligence (AI) in health sciences education is increasingly recognized as a pivotal factor in shaping the future of medical training and practice. As AI technologies continue to evolve, their integration into educational curricula presents both opportunities and challenges that must be carefully navigated to enhance the learning experience for future healthcare professionals. One of the most significant contributions of AI to health sciences education is its ability to personalize learning. Traditional teaching methods often follow a one-size-fits-all approach, which can leave some students struggling to keep up while others are not sufficiently challenged. AI-powered platforms, such as adaptive learning systems, analyze individual student performance and tailor content to meet their unique needs. For example, tools like Osmosis and AMBOSS use AI to provide customized study plans, ensuring that students focus on areas where they need the most improvement (Topol, 2019). This personalized approach not only improves learning outcomes but also fosters a more inclusive educational environment. AI is also transforming clinical training by simulating real-world scenarios. Virtual patient simulations, powered by AI, allow students to practice diagnosing and treating conditions in a risk-free environment. These simulations can replicate rare or complex cases that students might not encounter during their clinical rotations. For instance, platforms like Touch Surgery and SimX use AI to create immersive surgical and emergency care simulations, providing students with hands-on experience before they enter the operating room (McGaghie et al., 2011). Such tools bridge the gap between theory and practice, preparing students for the complexities of modern healthcare. Moreover, AI is enhancing the role of educators by automating administrative tasks and providing data-driven insights into student performance. Grading, attendance tracking, and even curriculum design can be streamlined using AI, allowing educators to focus on mentoring and engaging with students. AI-driven analytics can also identify at-risk students early, enabling timely interventions to support their academic success (Wartman & Combs, 2018). By augmenting the capabilities of educators, AI empowers them to deliver more impactful and student-centered teaching. AI's potential to revolutionize health sciences education lies in its ability to personalize learning experiences and improve educational outcomes. For instance, AI-driven tools can facilitate realistic simulations and automated assessments, allowing students to engage in practical scenarios that mimic real-world clinical situations (Santos & Lopes, 2024). This capability not only enhances the learning process but also prepares students for the complexities of patient care in a technology-driven environment (Grunhut et al., 2022). Furthermore, the incorporation of AI into curricula can foster critical thinking and decision-making skills, essential for navigating the ethical dilemmas that arise in medical practice (Grunhut et al., 2022). Despite the promising applications of AI in education, the integration of these technologies into medical curricula has been slow. A scoping review highlighted that many medical schools have yet to adopt AI training, primarily due to a lack of systematic evidence supporting its implementation (Lee et al., 2021). Additionally, concerns regarding data protection and the ethical implications of AI use in healthcare education have been raised, indicating a need for comprehensive AI education that addresses these issues (Veras et al., 2023; Frehywot & Vovides, 2023). Students have expressed a desire for more robust training in AI, emphasizing the importance of understanding its role in healthcare delivery and decision-making processes (Ahmad et al., 2023; Derakhshanian et al., 2024). Moreover, the rapid advancement of AI technologies necessitates continuous curriculum updates to keep pace with emerging trends. As noted in recent literature, the integration of AI into biomedical science curricula should include subjects related to informatics, data sciences, and digital health (Sharma et al., 2024). This approach not only equips students with the necessary skills to utilize AI effectively but also prepares them for the evolving landscape of healthcare, where AI will play an integral role in diagnostics, treatment personalization, and patient management (Santos & Lopes, 2024; Secinaro et al., 2021). However, the implementation of AI in health sciences education is not without challenges. Ethical considerations surrounding AI's impact on healthcare equity and the potential for bias in AI algorithms must be addressed (Frehywot & Vovides, 2023; Han et al., 2019). Ensuring that AI technologies are used responsibly and equitably in education and practice is crucial to avoid exacerbating existing disparities in healthcare access and outcomes (Rigby, 2019). Furthermore, the lack of faculty expertise in AI poses a significant barrier to its integration into medical education, highlighting the need for targeted training and resources for educators (Derakhshanian et al., 2024). However, the integration of AI into health sciences education is not without challenges. Ethical concerns, such as data privacy and algorithmic bias, must be addressed to ensure that AI tools are used responsibly. Additionally, there is a risk of over-reliance on AI, potentially undermining the development of critical thinking and clinical judgment skills. Educators must strike a balance between leveraging AI’s capabilities and preserving the human elements of teaching and learning. Equity is another pressing issue. While AI has the potential to democratize education, access to these technologies remains uneven. Institutions in low-resource settings may struggle to adopt AI-driven tools, exacerbating existing disparities in global health education. Policymakers and educators must work together to ensure that the benefits of AI are accessible to all, regardless of geographic or socioeconomic barriers. In conclusion, AI is a powerful tool that holds immense promise for transforming health sciences education. By personalizing learning, enhancing clinical training, and supporting educators, AI can help prepare the next generation of healthcare professionals to meet the demands of an increasingly complex healthcare landscape. However, its integration must be guided by ethical principles and a commitment to equity, However, the successful integration of AI into educational curricula requires a concerted effort to address ethical concerns, update training programs, and equip both students and faculty with the necessary knowledge and skills. As the healthcare landscape continues to evolve, embracing AI in education will be essential for fostering a new generation of healthcare providers who are adept at leveraging technology to improve patient care. As we embrace this technological revolution, we must remember that AI is not a replacement for human expertise but a complement to it. The future of health sciences education lies in the synergy between human ingenuity and artificial intelligence.

BackgroundArtificial intelligence (AI) and digital health technological innovations from startup companies used in clinical practice can yield better health outcomes, reduce health care costs, and improve patients' experience. However, the integration, translation, and adoption of these technologies into clinical practice are plagued with many challenges and are lagging. Furthermore, explanations of the impediments to clinical translation are largely unknown and have not been systematically studied from the perspective of AI and digital health care startup founders and executives.ObjectiveThe aim of this paper is to describe the barriers to integrating early-stage technologies in clinical practice and health care systems from the perspectives of digital health and health care AI founders and executives.MethodsA stakeholder focus group workshop was conducted with a sample of 10 early-stage digital health and health care AI founders and executives. Digital health, health care AI, digital health–focused venture capitalists, and physician executives were represented. Using an inductive thematic analysis approach, transcripts were organized, queried, and analyzed for thematic convergence.ResultsWe identified the following four categories of barriers in the integration of early-stage digital health innovations into clinical practice and health care systems: (1) lack of knowledge of health system technology procurement protocols and best practices, (2) demanding regulatory and validation requirements, (3) challenges within the health system technology procurement process, and (4) disadvantages of early-stage digital health companies compared to large technology conglomerates. Recommendations from the study participants were also synthesized to create a road map to mitigate the barriers to integrating early-stage or novel digital health technologies in clinical practice.ConclusionsEarly-stage digital health and health care AI entrepreneurs identified numerous barriers to integrating digital health solutions into clinical practice. Mitigation initiatives should create opportunities for early-stage digital health technology companies and health care providers to interact, develop relationships, and use evidence-based research and best practices during health care technology procurement and evaluation processes.

Inflammatory bowel diseases (IBD), subdivided into Crohn’s disease (CD) and ulcerative colitis (UC), are chronic diseases that are characterized by relapsing and remitting periods of inflammation in the gastrointestinal tract. In recent years, the amount of research surrounding digital health (DH) and artificial intelligence (AI) has increased. The purpose of this scoping review is to explore this growing field of research to summarize the role of DH and AI in the diagnosis, treatment, monitoring and prognosis of IBD. A review of 21 articles revealed the impact of both AI algorithms and DH technologies; AI algorithms can improve diagnostic accuracy, assess disease activity, and predict treatment response based on data modalities such as endoscopic imaging and genetic data. In terms of DH, patients utilizing DH platforms experienced improvements in quality of life, disease literacy, treatment adherence, and medication management. In addition, DH methods can reduce the need for in-person appointments, decreasing the use of healthcare resources without compromising the standard of care. These articles demonstrate preliminary evidence of the potential of DH and AI for improving the management of IBD. However, the majority of these studies were performed in a regulated clinical environment. Therefore, further validation of these results in a real-world environment is required to assess the efficacy of these methods in the general IBD population.

AI telemedicine screening in ophthalmology: health economic considerations

Artificial Intelligence (AI) is not just a future promise but an urgent necessity for modern public health. By providing invaluable insights into disease patterns, therapeutic interventions, and overall public health management, AI has the potential to revolutionise healthcare. To tackle essential public health functions effectively, harnessing AI must become a top priority. However, there is an urgent need for a cohesive strategy across Europe. Currently, varying readiness levels among European nations regarding AI adoption in health result in uneven progress across the continent. This disparity must be addressed to ensure all countries benefit equally from AI advancements. Recognising this, the World Health Organization European Regional Office launched a regional report on digital health in 2023. The report evaluated the integration of big data and advanced analytics, including AI, in health systems. Findings revealed that while 60% of Member States have a national data strategy, only 35% have a policy regulating big data and AI in health, and 38% lack both. This highlights a critical gap that must be filled urgently. Our upcoming session will address these challenges head-on. Organised to provide visionary insights, practical applications, and a landscape view of artificial intelligence in public health, the presentations will be followed by a roundtable discussion in which panellists will delve into practical challenges surrounding AI adoption. They will reflect on the profound impact AI could have on the future of European health systems and offer pragmatic and responsible steps forward, culminating in achievable recommendations for public health professionals. To enhance the session, we will utilise existing Generative AI tools to provide a real-time summary of the plenary and reinforce the call to action in alignment with panellists’ recommendations. This approach ensures that the session discusses the urgent need for AI in public health and actively demonstrates its practical applications. Moderators Natasha Azzopardi Muscat Director, Division of Country Health Policies and Systems, WHO Regional Office for Europe Dimitra Panteli Programme Manager/Senior Health Systems Analyst, European Observatory on Health Systems and Policies Facilitator Stefan Buttigieg Vice-President, EUPHA Digital health section Speakers/Panellists Martin McKee Professor of European Public Health, London School of Hygiene & Tropical Medicine, UK Katharina Ladewig Director, Centre for Artificial Intelligence in Public Health Research, Robert Koch Institute, Germany Marco Marsella Director Digital, EU4Health and Health systems modernisation, Directorate-General for Health and Food Safety (DG SANTE), European Commission Keyrellous Adib Technical Officer Data Science and Digital Health, WHO Regional Office for Europe

Introduction: the digitalization of domestic healthcare is one of the strategic tasks facing the digitalization of the Russian economy. The solution of this task is not possible without the creation of a proper legal basis. Without removing legal barriers, there can be no chance of introducing the latest information and communication technologies that provide significant advantages in achieving the highest level of health. Purpose: to investigate the legal aspects of the use of artificial intelligence in medicine. Methods: the methodological framework for the study is the methods of scientific cognition, among which the main ones are the methods of systemacity, analysis and comparative law. Results: the paper highlights the directions of digitalization of Russian healthcare, the possibilities of using artificial intelligence technologies in medicine, and the main problems of using these technologies in healthcare. Conclusions: artificial intelligence technologies are actively developing in modern healthcare due to the widespread appearance of big data, increased computing power, the development of cloud services, as well as numerous examples of the effectiveness and prospects of applied solutions and their ability to respond to modern challenges and problems in healthcare. The Russian Federation already has a sufficient legal framework regulating the relations in the digitalization of healthcare and the use of artificial intelligence. The main task in the course of the upcoming work is to improve the existing legal tools, identify and eliminate the legal barriers that hinder further digitalization. It is necessary to consolidate the provision whereunder a wide range of specialists, including medical professionals, representatives of the legal community, representatives of software development firms, should be involved in the discussion of introducing artificial intelligence in healthcare, so that they can fully share their analysis of the impact and possible consequences of the introduction of applications based on artificial intelligence into the healthcare system, as well as to develop the necessary ethical framework in which they should act.

Next generation public health: towards precision and fairness