The research ‘field’ of Digital health is dedicated to realising digital technologies’ potential and developing knowledge about their feasibility and impacts. With the introduction of several new journals (such as Sage Digital Health, The Lancet Digital Health and Frontiers in Digital Health), Digital health is in many ways an emerging field.
Yet, drawing on a critical review of the articles in the most prominent multidisciplinary digital health journals in our article Article A critical review of the role of technology and context in d...
, we show that the digital health field has not profoundly engaged with its core subject, namely technology. The features of digital technologies remain in the background, and research is disconnected from the complexities of healthcare settings, including multiple technologies, established practices and people. Instead, the overarching focus in the Digital Health literature is the processing capabilities of digital technologies and their posited impacts. The technologies are treated as black boxes and the context of the lab seems to be considered similar to the context of use (care, planning, coordination etc).I would argue that if we do not take this issue seriously, the potential of the Digital Health field will be limited and eventually a dead end.
How can we develop Digital Health into a field where technology and the context of use take a more prominent role?
I believe Post Covid there will be a lot more investment in the digital health.
Digital technology has been a revolutionary foray in various sectors and domains like education, industry, research, and recently, healthcare. The concept of digital health is an evolving entity and has gained tremendous importance in the time of the Pandemic with social distancing and lockdowns forcing the entire globe to adopt digital health and health technologies on a large scale. The digital health concept was first introduced in 2000 by Seth Fran, which largely encompasses internet-based applications and media to enhance medical subject matter, commerce, and connectivity. With the advancement in technology, digital health has expanded to encompass a much wider set of scientific concepts and technologies, including the internet of things, big data technology, artificial intelligence techniques, genomics, analytics, wearables, mobile applications, and telemedicine. The various domains of digital health have been explained by WHO in 2018.
With the advancement in digital health and literacy rate in the country, The Government of India laid importance on digitalization in India’s healthcare sector in the National Health Policy, 2017 using The National Digital Health Mission (NDHM) which can act as the foundation on which national digital health ecosystem can be built. On the occasion of the 74th Independence Day, the Government of India embarked on its journey to achieve Universal Health Coverage by launching the National Digital Health Mission.
NDHM aims to build a holistic, integrated, and comprehensive digital health ecosystem that will lay the foundation of a strong public digital infrastructure, digitally empower individuals, patients, health care staff, health institutions, and aid streamline the healthcare delivery system of the country. This will help inequitable, affordable, and accessible health care to all. It may be useful for health planners and policymakers as well in monitoring and surveillance of health-related events better and in an efficient way.
G'day Petter,
Great topic regarding the future trends of the health digitalization system on the global scale, I am posting some great journal papers covering the topic, you will need to go through them to depict the most probable outcomes of health digitalization. I shall add that in order to keep the full potential of the digital health field, keep it alive & improve it, the organisational best practice strategy should be fully implemented, with ongoing benchmarking (i.e., KPIs, balanced scorecard, etc..) to reach long-term & lasting sustainability, this could be a research paper study topic or proposal, All the best with tour excellent topic Petter.
Best wishes,
Sofiane
1. [HTML] Digital health is a cultural transformation of traditional healthcare
B Meskó, Z Drobni, É Bényei, B Gergely, Z Győrffy - Mhealth, 2017 - ncbi.nlm.nih.gov
Article Digital health is a cultural transformation of traditional healthcare
2. The history and future of digital health in the field of behavioral medicine
D Arigo, DE Jake-Schoffman, K Wolin… - Journal of behavioral …, 2019 - Springer
https://link.springer.com/article/10.1007/s10865-018-9966-z
3. [HTML] The future of digital health with federated learning
N Rieke, J Hancox, W Li, F Milletari, HR Roth… - NPJ digital …, 2020 - nature.com
https://www.nature.com/articles/s41746-020-00323-1
4. [HTML] Digital health strategies to fight COVID-19 worldwide: challenges, recommendations, and a call for papers
G Fagherazzi, C Goetzinger, MA Rashid… - Journal of Medical …, 2020 - jmir.org
https://www.jmir.org/2020/6/e19284/
5. HTML] One digital health: a unified framework for future health ecosystems
A Benis, O Tamburis, C Chronaki, A Moen - Journal of Medical Internet …, 2021 - jmir.org
Article One Digital Health: A Unified Framework for Future Health Ecosystems
Just as more healthcare spending does not result in better outcomes, having more digital solutions does not necessarily lead to better care. This line of reasoning can be extended to better patient experience and higher value.
Only an integrated, systems and requirements-driven digital approach will put the whole patient back at the center of the digital ecosystem. The path forward requires a systems-based, patient-centric, and requirements-driven approach.
In practice, this means building a solution with a core set of digital health capabilities that is also modular enough to integrate third-party solutions into a unified and personalized patient and customer experience, i.e. systems integration of healthcare technologies and services is needed to avoid the mentioned dead end.
Dear Prof. Nielsen!
You raised a topic of critical importance! May I argue that mankind has not faced a serious crisis, yet. We are on the way: the war in Ukraine. The context of a large-scale war sets digital health platforms at the center of attention:
1) Tharwani Zoaib Habib, Farah Ennab, Lolita Matiashova, Faisal A. Nawaz, Anastasiia Volkova, Vira Trill, Mohammad Yasir Essar Double trouble: COVID-19 vaccine misinformation amidst conflict in Ukraine, Annals of Medicine and Surgery,2022, Open access: https://www.sciencedirect.com/science/article/pii/S2049080122008871
2) Ibrahim MS, Mohamed Yusoff H, Abu Bakar YI, Thwe Aung MM, Abas MI, Ramli RA. Digital health for quality healthcare: A systematic mapping of review studies. DIGITAL HEALTH. January 2022. doi:10.1177/20552076221085810, Open access:
Article Digital health for quality healthcare: A systematic mapping ...
3) Quinn, M., Dickinson, S. & Shukla, S. Training Military Psychiatrists to Adapt and Overcome: How COVID-19 Highlighted the Unique Flexibility of Military Psychiatry in Training and in the Fleet. Curr Psychiatry Rep (2022). https://doi.org/10.1007/s11920-022-01342-3, Available at: Article Training Military Psychiatrists to Adapt and Overcome: How C...
Yours sincerely, Bulcsu Szekely
Dear Bulcsu Szekely We know that the protracted proxy war in Ukraine is an attack on our standards of civilization, with respect to markets, democracy and free individual choice. Let me cite Lajos Kossuth: The principle of evil in Europe is the enervating spirit of Russian absolutism (1848).
Now, and with respect to the posed query by Petter Nielsen , I do think that patient centered healtcare is the way. People, who design such systems, should take one serious question in mind: what would help me best, if I would be ill ?
Stephen I. Ternyik, I agree that patient-centeredness is vital when designing digital health systems. However, we must also have the perspective of healthcare workers in mind: what would help me best if I were a clinician, a nurse or a health manager? To design digital health solutions, we need to understand patient' needs and the practices and context of healthcare workers. Without this knowledge, we risk making digital health solutions with little value, adding burden to already over-burdened healthcare workers, and alienating patients.
Yes Petter Nielsen am in agreement with your interactive approach to consider both ends of the communication line in digital health architecture.
Dear Prof. Nielsen and Mr. Ternyik!
May I kindly recommend to both of you BrightTALK - a free-of-charge online platform to register and use:
1) https://www.brighttalk.com/join/
2) https://www.brighttalk.com/search/?q=digital+healthcare
3) A case-study: " Introducing a global EA practice at Johnson & Johnson" - webinar: Presenters: Mr. Nils Schlote, Johnson & Johnson | Mr. Mike Heremans, INNOCOM | Mr. Gerard van Wijk, LeanIX, July 12, 2022, Available at:
https://www.brighttalk.com/webcast/18723/549204?utm_source=brighttalk-portal&utm_medium=web&utm_content=digital%20healthcare%20transformation&utm_term=search-result-5&utm_campaign=webcasts-search-results-feed
It is a quality experience to be involved in this discussion with YOU!
Yours sincerely, Bulcsu
Suraj Kapoor , thank you for the insights from India, the NDHM and the country's journey towards UHC.
I agree that digital technologies have great potential and have wide-ranging impacts on various sectors and domains. Moreover, the pandemic has indeed pushed this development forward. Still, I am concerned that the research area of digital health appears driven by techno-optimists, promoting faster, better and bigger digital technologies as the solution even where digital technologies are a part of the problem.
The pandemic is also an example of digital technologies' down/dark side. Where the lockdown has pushed digital health globally, it has marginalized 'non-digital' populations even more (disempowering them, not empowering them, and promoting inequity rather than equity). UHC is another example where new digital health solutions are needed, typically introducing a heavy burden on already over-burdened health workers (see the following paper for discussions on this in the context of India:Article Grand Challenges of Public Health: How can Health Informatio...
My concern relates to a general lack of understanding of digital technologies and the relationship between technologies and the context of use. Without an understanding of architecture and the inherent longevity of digital technologies, once implemented, mega-systems supposed to solve 'everything' are proposed. The more of it, the better. The faster (more efficient algorithms etc.), the better.
The common disconnect in digital health research between technology and context is even more challenging. Context is where digital technologies are used and become a part of the work practices of clinicians, healthcare workers, health managers, policy makers etc. And context is where digital technologies are connected to other digital technologies. The context comprises the ecosystem a digital technology will be based on and contribute to. But as with any other ecosystems, digital health ecosystems cannot be planned and controlled but a place where different components interact and develop slowly over time (if it is not, we should call it something else).
Experiments in the lab may yield relevant insights, but whether the technology will be used in and support healthcare workers and promote better health in a particular ecosystem is an empirical question.
Digital technologies are shaped by the context in which they are used, and the wider ecosystem defines their utility and value. Therefore, we need to make space for research in digital health where we can develop our understanding of the consequences of digital health technologies. This will require us to examine digital technologies in different contexts and perspectives.
Digital technologies could improve health in many ways. For example, electronic health records can support clinical trials and provide large-scale observational data. These approaches have underpinned several high-profile research findings during the COVID-19 pandemic.
Significant scientific advances made possible by AI will hasten the development of new treatments and disease-fighting vaccinations. Digital treatments powered by AI and individualized advice will enable users to stop health problems before they start. Diagnoses and treatment options will be influenced by AI-generated insights, resulting in safer and more efficient therapies. There are still innovations carrying out to discover new ways to improve health quality.
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