Tuesday

23rd Jan 2018

Column / Health Matters

Digital health has potential but needs to be secure

  • Some hospitals' IT infrastructures still use long-forgotten versions of the Windows operating system. (Photo: Wikimedia)

The Estonian presidency of the Council of the EU has put e-health under the political spotlight once again.

But this year's cyberattacks - affecting the UK's National Health Service (NHS) and targeted at consumer credit company Equifax in the United States - has highlighted how vulnerable sensitive personal, social security and health data can be to hackers.

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Within the EU, Estonia is considered a digital leader. The country was ranked sixth overall in a recent report on data innovation in the EU.

The victim of a major cyberattack in 2007 (the first known on an entire country) - that took down internet sites and servers of media outlets, banks and government bodies - Estonia has recovered by investing greatly in data and cybersecurity.

Healthcare blockchain

One of Estonia's flagship digital health policies is to put its citizens' medical records on blockchain.

The encrypted, peer-to-peer method of storing data is seen by the Estonian government as a good bet to keep its citizens data safe from malicious state or criminal attempts to access it.

Estonia is far ahead of many other EU member states, where patient records may not even be digitised.

A change in the government's mindset, first prompted by security risks, has now developed into genuine digital enthusiasm over the past decade. It came about by understanding the benefits of delivering public services online and engaging citizens directly.

The investment has also proved to be a boost for Estonian tech companies and entrepreneurs.

Digital health and big data are particularly exciting because solutions have been presented for all the biggest public health challenges.

Consider the case of cervical cancer screening. Currently, the holders of healthcare purse-strings may primarily set a crude barrier - age - to decide when women are to be offered screening. While risk clearly does increase with age, other risk factors are not properly taken into account - such as diet, alcohol consumption and smoking.

Cross-fertilisation of data could enable more targeted screening for women who are "at risk" for cervical cancer, and allow healthcare providers to identify specific individuals.

This allows healthcare spending to be far more accurately targeted.

Targeted care

Involving citizens in their own health and well-being is another notable area of digital promise.

Deeper understanding of genetics, in tandem with technological progress, will drive an ever more personalised approach to healthcare. This is essential in an ageing society where antiquated financial models are already stretched.

At the e-Health Tallinn 2017 Conference, the EU commissioner for health, Vytenis Andriukaitis, pointed out how only two percent of healthcare spending by EU member states is for prevention. So much for the mantra 'prevention is better than cure'.

The growing use of health, well-being and fitness apps points to an encouraging trend of self-analysis and behavioural change.

Users of running and cycling apps, for example, have shown the motivation factor of self-tracking. Health practitioners hope to tap into this instinct to improve public health.

Traditional healthcare companies, and new entrants to healthcare - such as tech companies and app developers - are racing to bring new digital technologies to patients.

Governments and healthcare companies repeatedly assert their credentials as part of the next wave of change in technology and healthcare. However, their impact on daily lives remain minimal.

Policymakers can, however, make a bigger difference on citizens' access to emerging technologies by making clear and logical legislation for health products and data protection which will ensure rapid assessment of safety and efficacy of apps and products.

Fast technology, slow legislation

The rapid pace of technological change makes this difficult - as legislation is soon rendered out of date.

The European Commission, European Medicines Agency (EMA) and the US Food and Drug Administration (FDA) cooperate to try to stay ahead of the curve and seek regulatory convergence. However, the breadth and depth of applying types of technology, such as artificial intelligence, will only become more challenging.

And balancing user and societal benefit with privacy and security is more important in digital health than in other applications of new technology.

A clear explanation to the public on the potential value of big data for social good will be essential to build trust.

To become a genuine early-adopter of technology, like Estonia, requires high-level governmental and medical community commitment, and consistent investment over the long term.

Funding for appropriate digital health technologies will have to come from decidedly traditional budget holders in healthcare, governments, insurers and individuals purchasing private healthcare.

To reassure citizens that their data is in good hands, equivalent investment on security will be necessary.

But the irony of governments professing to be digital health leaders - when IT infrastructures in hospitals still routinely use long-forgotten versions of the Windows operating system - is not lost on healthcare professionals.

Steve Bridges is an independent health policy adviser in Brussels. His Health Matters column takes a closer look at health-related policies, issues and trends in the EU.

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