Technology and Infrastructure
Technology and Infrastructure concerns related to health are not uniquely tied to the health space; the content and application issues that make up the infrastructure basket are the same across their uses:
Interoperability is both a concern and an opportunity at the confluence of technology and the digital space. The way in which data is collected and stored in numerous countries, varies widely from department to department, and between different health care organisations. However, properly executed digitisation could alleviate this issue, lowering costs and improving quality by creating or enabling a patient data ecosystem.
The issue of net neutrality may be functionally related, as hospitals and other health providers may ask for dedicated fast lanes for patient data traffic. Some jurisdictions, such as the EU, have carved out specific exceptions for health and specialised services.
When looking at the nexus of health and the digital field, cybersecurity is a key concern. Beyond the stable, functional, and reliable use of the Internet, the underlying baseline assumption in the use of technology and its applications in the health field is that the data is safe.
As more data is collected, stored, and used, data breaches become more common. Health data is, by definition, sensitive, and health-data breaches carry a significant extra burden in how the public relates to them.
Encryption is crucial to the safety of health data. It both protects data from prying eyes, and helps assuage fears patients and consumers may have about sharing or storing sensitive data through the Internet.
Ransomware attacks threaten the proper functioning of hospitals and other care providers. For example, the Wannacry ransomware attack affected a significant part of the UK’s National Health System. The exploited vulnerability had been patched in an updated version of the operating system, but the affected hospitals were still running older versions.
Connected devices produced by manufacturers from industries not traditionally bound by cybersecurity standards will have an outsized impact on the overall security of health data.
Legal and Regulatory
Legal and regulatory concerns that may affect health are not necessarily of the digital variety. However, data governance is a crucial element. The mesh of international and national legal and regulatory bodies, treaties, and agencies that govern data, specifically as it pertains to the health space, is one that deserves further consideration.
Jurisdiction issues concerning health data collected by devices or wearables further complicate the landscape, as international companies that manufacture and maintain the products may very likely be in different locations than the users, each governed by dissimilar or even substantially divergent regulation. Ongoing disputes, legal cases, and conversations on the broader aspect of the jurisdiction of data will hopefully elucidate at least a small portion of this complex layer.
Consumer protection may be the most important aspect of the economic basket regarding the digital health space. Levels of consumer protection in general, and in the (digital) health space in particular, vary widely around the world. They depend on each jurisdiction’s approach to consumer harm, deceptive and harmful practices, and fairness.
Consumer trust factors into decisions that consumers make when dealing with technology-enabled products and services, and even more so when it relates to their health. Many data-enabled products and services carry with them a sense of increased uncertainty, as proprietary algorithms and opaque processes allow for very little insight into their mechanisms and decision-making structures. However, a transparent approach that leverages accountability can lead to not just more users and consumers, but also to an increase in their willingness to share data in exchange for the promise of better results or better health care.
As a result, the bioinformatics market could grow substantially, where government and private companies spend significant amounts of money on a wide range of applications and in many fields from molecular medicine to agriculture.
Health data is considered protected and highly sensitive, regardless of jurisdiction. It encompasses stricter rules, specific and stringent baseline assumptions on privacy and security, a limited scope in terms of who gets access and how, and the precise levels of disclosure, all under serious penalty when breached. But countries and regions differ in their approach. The EU, for example, with its General Data Protection Regulation, has broader regulation (and some areas, like genetic or biometric information, require additional protection), while the USA, with its Health Insurance Portability and Accountability Act, limits these constraints to traditional healthcare providers.
As conversations about the implied tradeoffs of free digital services heat up, privacy is becoming a mainstream topic. Although the health space brings with it an inherent privacy-protective framework, what constitutes ‘health’ data is up for debate, as wearables, applications, and data brokers look to disrupt this area, and may bypass more lax regulation. Conversely, patients, users, and citizens must have access to their own health information, in a format that allows for easy digital transfer. Ransomware and other cyber-attacks, along with data leaks from originators, intermediaries, or final users of health data bring these concerns into sharp focus. Data protection has become a significant and obligatory hurdle that both companies and legislators have to negotiate, as health and technology further converge.
As digital health is embraced in the developed world, the digital issues that the developing world faces, such as the lack of a reliable communications infrastructure, are coming to the fore with the implementation of new health technologies and services.
Fundamentally, the crossroads of health and technology relies on not just electricity and other basic services, but also on access to the Internet. Many services require good connectivity, sometimes long, uninterrupted sessions, and produce high amounts of traffic. As innovation and progress push health towards an interconnected digital future, the provision of universal access, and the necessity of alleviating the digital divide, become increasingly important.