Digital Health Ecosystem Research Articles

Imagining a lean and agile digital health ecosystem - a measure of pandemic responsiveness.

Imagining a lean and agile digital health ecosystem - a measure of pandemic responsiveness.

Towards a European Health Data Ecosystem

The digital health ecosystem is rife with opportunities to improve healthcare through data-driven services in the European Union (EU). The value of health data, in the multiple forms in which they come (from health records to lifestyle data collected by smartphones or wearables), can truly emerge when they are allowed to flow in the ecosystem within a governance framework supported by all relevant stakeholders, with trust as the common and clear thread underpinning it. The coronavirus pandemic has provided an additional impetus for change, showing the importance of coordination and adequate communication between Member States and quality data to inform decision-making. Significant challenges remain, however, in order to achieve a fully integrated European digital health ecosystem, including: (1) the potentially diverging rules set by Member States at the national level and the need for an EU framework for the secondary use of health data; (2) the need for transparency and accountability for sustaining a data-sharing framework involving public authorities, research organisations, industry and citizens; and (3) the need for interoperable data and processes. Taking stock of these challenges, this article puts forward policy recommendations to enable the provision of pan-European data-driven healthcare services and to build a transparent and trustworthy framework for citizens.

Regulatory Sandboxes: A Cure for mHealth Pilotitis?

Mobile health (mHealth) and related digital health interventions in the past decade have not always scaled globally as anticipated earlier despite large investments by governments and philanthropic foundations. The implementation of digital health tools has suffered from 2 limitations: (1) the interventions commonly ignore the “law of amplification” that states that technology is most likely to succeed when it seeks to augment and not alter human behavior; and (2) end-user needs and clinical gaps are often poorly understood while designing solutions, contributing to a substantial decrease in usage, referred to as the “law of attrition” in eHealth. The COVID-19 pandemic has addressed the first of the 2 problems—technology solutions, such as telemedicine, that were struggling to find traction are now closely aligned with health-seeking behavior. The second problem (poorly designed solutions) persists, as demonstrated by a plethora of poorly designed epidemic prediction tools and digital contact-tracing apps, which were deployed at scale, around the world, with little validation. The pandemic has accelerated the Indian state’s desire to build the nation’s digital health ecosystem. We call for the inclusion of regulatory sandboxes, as successfully done in the fintech sector, to provide a real-world testing environment for mHealth solutions before deploying them at scale.

What is the value of digital health?

Abstract The panellist Anant Jani will discuss about: What is the value of digital health? There is much hope and hype surrounding the potentially transformative effect that digital health tools can have in health and care systems but it is very difficult to ascertain the true value that digital health tools currently deliver or could deliver in the future. Compounding this uncertainty is the diverse, large and ever-changing digital health landscape - there are currently over 300,000 health and care apps on the market place in comparison to the less than 2000 drugs health and care systems normally have to deal with. In this session, we highlight how the quadruple value framework, recently endorsed by the EU Commission, can be used to help rationalize the digital health ecosystem by promoting the interventions that have the greatest potential to promote primary, secondary or tertiary prevention while optimising resource utilisation.

Re-envisioning the Pharmacist's Role in the Era of Digital Health—CPhA's Inaugural Digital Health Conference

Digital health is rapidly evolving and promises to transform how health care is delivered and consumed. To explore advances at the intersection of health and technology and how pharmacy can embrace emerging modalities moving forward, the California Pharmacists Association (CPhA) hosted a Digital Health Conference on October 12 and 13, 2019, in Garden Grove, California. This conference provided an opportunity for pharmacists to gain a deeper understanding of the digital health ecosystem, explore opportunities, and share perspectives for leveraging digital health products to improve patient care. This commentary provides an overview of new and emerging digital health technologies, and a summary of the conference. It is not a comprehensive or systematic review of the field of digital health, rather its scope is limited to the key concepts and perspectives shared at the conference by presenters and participants. Table 1 provides information summarizing what is already known about this subject and what is added by this commentary. During the conference, pharmacists were introduced to definitions and concepts in digital health, discussed opportunities and challenges related to integration of digital health into existing health care infrastructures (including legal and regulatory frameworks, pharmacy practice models and payment), and explored educational needs to prepare pharmacists for their evolving roles. As digital health technologies are being integrated within the healthcare system, this conference aimed to focus on opportunities specific to pharmacy.

Digital Health Technology to Enhance Adolescent and Young Adult Clinical Preventive Services: Affordances and Challenges

The lives of adolescents and young adults (AYAs) have become increasingly intertwined with technology. In this scoping review, studies about digital health tools are summarized in relation to five key affordances—social, cognitive, identity, emotional, and functional. Consideration of how a platform or tool exemplifies these affordances may help clinicians and researchers achieve the goal of using digital health technology to enhance clinical preventive services for AYAs. Across these five affordances, considerable research and development activity exists accompanied by signs of high promise, although the literature primarily reflects demonstration studies of acceptability or small sample experiments to discern impact. Digital health technology may afford an array of functions, yet its potential to enhance AYA clinical preventive services is met with three key challenges. The challenges discussed in this review are the disconnectedness between digital health tools and clinical care, threats to AYA privacy and security, and difficulty identifying high-value digital health products for AYA. The data presented are synthesized in calls to action for the use of digital health technology to enhance clinical preventive services and to ensure that the digital health ecosystem is relevant, effective, safe, and purposed for meeting the health needs of AYA.

Inside Industry

The following topics are under this section: Scaling Up the Digital Health Ecosystem Cohort Analysis of Remdesivir as Antiviral Treatment for COVID-19 Pharmaceutical Giants Join Forces in Fight against COVID-19 Reinventing Healthcare in Asia Accelerating Efforts to Combat the Global COVID-19 Pandemic Evaluation of Stem Cell Therapy as Potential Treatment for COVID-19 Pneumonia Factors that Influence Hybrid Cloud Adoption in Healthcare Organizations Commencing Sale of Nutraceuticals in China Research Collaboration to Develop Novel Therapies Easing Strain on Healthcare Systems with COVID-19 Patient Management Platform

Health Information Systems in the Digital Health Ecosystem-Problems and Solutions for Ethics, Trust and Privacy.

Digital health information systems (DHIS) are increasingly members of ecosystems, collecting, using and sharing a huge amount of personal health information (PHI), frequently without control and authorization through the data subject. From the data subject’s perspective, there is frequently no guarantee and therefore no trust that PHI is processed ethically in Digital Health Ecosystems. This results in new ethical, privacy and trust challenges to be solved. The authors’ objective is to find a combination of ethical principles, privacy and trust models, together enabling design, implementation of DHIS acting ethically, being trustworthy, and supporting the user’s privacy needs. Research published in journals, conference proceedings, and standards documents is analyzed from the viewpoint of ethics, privacy and trust. In that context, systems theory and systems engineering approaches together with heuristic analysis are deployed. The ethical model proposed is a combination of consequentialism, professional medical ethics and utilitarianism. Privacy enforcement can be facilitated by defining it as health information specific contextual intellectual property right, where a service user can express their own privacy needs using computer-understandable policies. Thereby, privacy as a dynamic, indeterminate concept, and computational trust, deploys linguistic values and fuzzy mathematics. The proposed solution, combining ethical principles, privacy as intellectual property and computational trust models, shows a new way to achieve ethically acceptable, trustworthy and privacy-enabling DHIS and Digital Health Ecosystems.

Moving Beyond the Rhetoric of Shared Decision-Making: Designing Personal Health Record Technology With Young Adults With Type 1 Diabetes

ObjectivesEngaging young adults with type 1 diabetes (T1D) in the self-management of daily tasks and decision-making provides opportunities for positive health outcomes. However, emerging adulthood and care transitions are associated with decreased clinic attendance and diabetes complications. Shared decision-making (SDM) is an optimal approach for health decisions; however, it has been difficult to implement in practice. Personal health record (PHR) technology is a promising approach for overcoming such barriers. Still, today, PHRs have yet to root themselves into care and present an opportunity for improvement in SDM and engagement in self-management decision-making. The objective of this study was to confirm a functional model of an integrated shared decision-making-personal health record system (e-PHR) by young adults with T1D and care providers. MethodsUser-centred design approach whereby young adults with T1D, 18 to 24 years of age, and care providers matched PHR functions for the SDM process to confirm an e-PHR functional model. ResultsAn e-PHR functional model justified by young adults (n=7) and providers (n=15) was confirmed. The conceptual design was architected within an interconnected digital health ecosystem and integrated 23 PHR functionalities for SDM with a moderate level of agreement between patients and providers (Cohen kappa 0.60 to 0.74). ConclusionsThe establishment of an e-PHR functional model is a precursor to system design requirements. Results highlight the conceivable value of integrating SDM into PHRs for engagement of young adults with T1D in self-management decision-making. Design implications highlight key challenges for future research and system development, including information exchange across disparate systems, usability considerations and system intelligence for information personalization and decision-support tools.

Fit for purpose? The GDPR and the governance of European digital health

ABSTRACT The introduction of the General Data Protection Regulation (GDPR) in 2018 served as the cornerstone of the new data governance regime of the European Union. Informed by principles and values such as privacy, accountability, transparency, and fairness, the GDPR is premised on the objective to balance the protection of individual privacy and the promotion of a thriving European data economy. Still, shortcomings of this regulatory effort have been noted by recent ethical, socio-political, legal, and policy scholarship. Focusing on the deployment of digital health technologies and big data practices within the European digital health ecosystem, this article draws upon these bodies of literature to chart the main lines of tension emerging between the current GDPR-based data governance regime and the broader societal shifts coming along with the expansion of digital health. Central aspects of the GDPR–i.e. key underlying data protection principles and regulatory categories, the reliance on the “notice-and-consent” model, the (narrow) remit of the Regulation vis-à-vis possible harms and discriminations–are misaligned with the surge in digital health. This throws into doubt whether the Regulation is fully fit for the purpose of governing current developments in this field, while also calling for swift and adequate policy responses.

Review of guidelines related to the regulations on telehealth and internet-based prescribing from selected countries

Introduction: Telehealth related services are spreading rapidly throughout many countries of the world. Proper guidance on the provision of these services is essential to provide quality healthcare. Internet-based prescribing is an important component of telehealth services. If allowed, Internet-based prescribing must be done within a proper regulatory framework. Method: Guidelines related to the regulation of telehealth services, from registration of physicians to practice medicine to delivery of medicine to patient through internet-based prescriptions were identified through a web-based search using standard medical/ health databases. These documents were reviewed and comparatively analysed. Results: 14 regulatory guidelines were identified. They were from countries/ states with established digital health ecosystems such as Australia, Canada (country wide and for the states of British Columbia and Ontario), Denmark, France, New Zealand, Portugal, Singapore, United Kingdom, United states of America (for the states of California, Maine, North Carolina and Washington). The guidelines were related to the practice of Telemedicine including internet-based prescribing. These guidelines were uniform in relation to the following: any medical prescription was valid, if it is prescribed /issued by a health professional with a licence to prescribe; there was no distinction between ‘telemedicine license’ and the standard ‘medical license’; in cross border practice, the physicians were required to have a licence to practice medicine in the country where the patient was a resident, at the time of care; general requirements needed to start telehealth services [ensuring that telehealth was appropriate to the situation; ensuring that there was a pre-established relationship with the patient in case of prescription of controlled medications; ensuring that the physician was able to access sufficient patient information prior to prescribing; training of physicians on providing the telehealth service]; ensuring that valid informed consent can be obtained; ensuring the privacy and confidentiality of patient data; ensuring that the patient knows the physician’s identity, qualifications, and where he is providing the service from.; ensuring that the patients know the limitations of telehealth methodology; ensuring that patient identify can be confirmed prior to the consultation; ensuring that suitable distance diagnostic devises are used, and ensuring that medical records are retained. Conclusion: The above-mentioned guidelines would be useful in developing a telehealth regulatory framework for Sri Lanka.

Building Capacity and Training for Digital Health: Challenges and Opportunities in Latin America.

Tackling global health challenges demands the appropriate use of available technologies. Although digital health could significantly improve health care access, use, quality, and outcomes, realizing this possibility requires personnel trained in digital health. There is growing evidence of the benefits of digital health for improving the performance of health systems and outcomes in developed countries. However, significant gaps remain in resource-constrained settings. Technological and socio-cultural disparities between different regions or between provinces within the same country are prevalent. Rural areas, where the promise and need are highest, are particularly deprived. In Latin America, there is an unmet need for training and building the capacity of professionals in digital health. This viewpoint paper aims to present a selection of experiences in building digital health capacity in Latin America to illustrate a series of challenges and opportunities for strengthening digital health training programs in resource-constrained environments. These describe how a successful digital health ecosystem for Latin America requires culturally relevant and collaborative research and training programs in digital health. These programs should be responsive to the needs of all relevant regional stakeholders, including government agencies, non–governmental organizations, industry, academic or research entities, professional societies, and communities. This paper highlights the role that collaborative partnerships can play in sharing resources, experiences, and lessons learned between countries to optimize training and research opportunities in Latin America.

Digital health eco-systems: An epochal review of practice-oriented research

This article describes an epochal review of research literature on practice-oriented digital health ecosystems that have emerged during the period between 1998 and 2018. Practice-orientation refers to efforts that have resulted in positive impact and transformations in the delivery of healthcare. The review is epochal in the sense that there have been 3 major stages of innovation and diffusion in digital health that are identified. The year 1998 was deemed a significant starting point for the literature search because it marked the introduction of the term e-health. The main objective of this review is to track the evolution of digital health and the conspicuous developments in the field - crucial steps to get a grasp of the key issues involving the delivery of healthcare. The article includes a general discussion of these various key issues and sensitizing concepts. The sense-making thus shed some light on the areas of enquiry, which are central to identifying the direction in which the practice of healthcare is headed. These areas of enquiry often referred to as ‘substantive areas’ in qualitative research terminology, were identified as ‘electronic medical records’, ‘health cloud’, ‘data analytics’, ‘Internet-enabled devices’, and other ‘emerging information technologies’. The article concludes with a synthesis of key inferences drawn from the epochal review. The digital disruption of healthcare has created necessary conditions for its offering as a global, interoperable service.

How to Design a Governable Digital Health Ecosystem

It has been suggested that to overcome the challenges facing the UK’s National Health Service (NHS) of an ageing population and reduced available funding, the NHS should be transformed into a more informationally mature and heterogeneous organisation, reliant on data-based and algorithmically-driven interactions between human, artificial, and hybrid (semi-artificial) agents. This transformation process would offer significant benefit to patients, clinicians, and the overall system, but it would also rely on a fundamental transformation of the healthcare system in a way that poses significant governance challenges. In this article, we argue that a fruitful way to overcome these challenges is by adopting a pro-ethical approach to design that analyses the system as a whole, keeps society-in-the-loop throughout the process, and distributes responsibility evenly across all nodes in the system.

Sharing information safely and securely: the foundation of a modern health care system.

Sharing information safely and securely: the foundation of a modern health care system.

Integrating Digital Health Services: An Open Platform Approach for Resource-Constrained Countries

Better health enables greater wealth. And digital health enables better healthcare. Also across resource-constraint countries digital health applications are becoming more prevalent. To establish a resilient national or district Digital Health Ecosystem, not only a holistic strategy – based on health policy priorities – is mandatory, but it must also be followed by a realistic roadmap and its comprehensive implementation,taking into account the success factors needed for its long-term sustainability and growth.A key challenge in this context is that deployed eHealth systems are usually in silos, such that no system or application is integrated with another. It is the missing interoperability of the many siloed systems which constitutes a core barrier towards reaping greater benefits from digital health. To successfully transform the provision of quality healthcare services it is mandatory to put into place an open digital health platform that comprehensively integrates eHealth services across all healthcare facilities in a timely, efficient and seamless manner. The open platform concept and its technical approach are developed, and core elements and aspects are critically explored. A constituent complement of such an open approach is a detailed interoperability framework which must be adhered to by all services and applications coordinated via the platform. The key question in this context of how to determine interoperability requirements is briefly discussed. This is complemented by identifying leading open source eHealth software products available and being applied in emerging market and developing economies around the world.Digital health is different from almost any other sector. By identifying the challenges encountered in healthcare the discussion reviews how the open platform approach helps to overcome these barriers, and identifies important pitfalls to be avoided.

Reimagining Health Data Exchange: An Application Programming Interface-Enabled Roadmap for India.

In February 2018, the Government of India announced a massive public health insurance scheme extending coverage to 500 million citizens, in effect making it the world’s largest insurance program. To meet this target, the government will rely on technology to effectively scale services, monitor quality, and ensure accountability. While India has seen great strides in informational technology development and outsourcing, cellular phone penetration, cloud computing, and financial technology, the digital health ecosystem is in its nascent stages and has been waiting for a catalyst to seed the system. This National Health Protection Scheme is expected to provide just this impetus for widespread adoption. However, health data in India are mostly not digitized. In the few instances that they are, the data are not standardized, not interoperable, and not readily accessible to clinicians, researchers, or policymakers. While such barriers to easy health information exchange are hardly unique to India, the greenfield nature of India’s digital health infrastructure presents an excellent opportunity to avoid the pitfalls of complex, restrictive, digital health systems that have evolved elsewhere. We propose here a federated, patient-centric, application programming interface (API)–enabled health information ecosystem that leverages India’s near-universal mobile phone penetration, universal availability of unique ID systems, and evolving privacy and data protection laws. It builds on global best practices and promotes the adoption of human-centered design principles, data minimization, and open standard APIs. The recommendations are the result of 18 months of deliberations with multiple stakeholders in India and the United States, including from academia, industry, and government.

A demand for wearable devices in health care

With the popularity of wearable devices, along with the development of telecommunication system there is a need for obtaining the health and fitness outcomes. So the recent advances in data analysis techniques have opened up new possibilities for using wearable technology in the digital health ecosystem. In past, it’s too difficult to use the wearable devices for healthcare system because of the size of those sensors. But now with front end amplification and wireless data transmission, the wearable devices are deployed in health monitoring systems. Although the devices are continuously monitoring the human’s body activity and collect various physiological data to increase the quality of human’s life. In this paper first we provide a research survey on available wearable or gadgets. Also we conclude with future directions in wearable research and market.

FHIRbox, a cloud integration system for clinical observations

With the recent technological developments new possibilities arise for the use of wearables and medical monitoring devices by patients and their respective integration into the digital health ecosystem. FHIRbox is a distributed system under development by the authors for integrating data from various diagnosis devices, complying with FHIR - the latest HL7 standard for exchanging clinical information. The innovative aspects of FHIRbox constitute a reference to drive a paradigm shift in terms of access to health information; as it is a solution that places the patient as the true owner of his clinical data. In this work the authors present the project requirements and the system architecture.

Identifying Essential Components of a Digital Health Innovation Ecosystem for the Namibian Context: Findings from a Delphi Study

AbstractThe concept of digital health innovation ecosystems is an emerging body of literature which suggests that components of digital health, innovation and digital ecosystems are important in the administration and delivery of healthcare services. The current literature indicates which components of digital health, innovation and digital ecosystems constitute a digital health innovation ecosystem, but it is less clear as to which components of digital health, innovation and digital ecosystems are relevant to the development of such an ecosystem for the Namibian context. The purpose of this paper was to identify the components of digital health, innovation and digital ecosystems relevant to the development of a digital health innovation ecosystem for the Namibian context. Therefore, the Delphi method was adopted in which 22 knowledgeable professionals from within the Namibian context were purposively selected to take part. The findings revealed essential components of digital health, innovation and digital ecosystems which are considered relevant to the development of a digital health innovation ecosystem for the Namibian context. Additionally, there are differences noted between the components of digital health, innovation and digital ecosystems essential for the Namibian context and the components of digital health, innovation and digital ecosystems identified in literature. The essential components identified will inform decision makers in the Namibian healthcare sector on the implementation of a digital health innovation ecosystem for Namibia.