The Role of US Policymaking in the Emergence of a Digital Health Assemblage

Abstract

ABSTRACT Promising to improve the quality of care while decreasing healthcare costs, digital health technologies (DHT) are welcomed as a solution to the challenges increasingly faced by healthcare systems in the global north. In recent years, tech developers, consultants, policymakers, and researchers in the US have heralded Big Tech entrepreneurs as driving the emergence of these technologies. However, apart from Silicon Valley visions of DHT, there are a range of regulations, devices, institutions, and practices constituting the DHT assemblage in the US. These include US policies following the global financial crisis of 2008 – such as the US' monetary policy, and the Health Information Technology for Economic and Clinical Health Act (HITECH Act) – and the enactment of the Patient Protection and Affordable Care Act (ACA). Accordingly, a more granular approach is required to understand the rise of DHT beyond these stereotypical ‘Silicon Valley’ accounts of the emergence of disruptive digital technologies. Careful attention on various, seemingly unrelated, policymaking events reveals how the unintended alignment of these US policy visions, regulations, devices, institutions, and practices have played an instrumental role in the successful emergence of DHT, while also impacting ongoing global developments of these technologies.