Digital health

Definition and delimitation

Under keywords such as telemedicine, electronic patient files, big data and networking of actors, technological progress allows new forms of care, improved communication and increased digitalisation of the health care system. Digital health encompasses all applications and measures that use the possibilities of modern information and communication technologies (ICT). These support, for example, the treatment and care of patients or the prevention of diseases. Digital health moves the patient further into the centre. The aim is to avoid overuse, underuse and misuse of care, to achieve cost efficiency and to create transparency. In digital health management, the question is answered, among other things, both at the consumer level and from a company perspective, how health-conscious behaviour can be further promoted and thus shortened sick leave. For employers, it is important to apply the Occupational Health and Safety Act and also to introduce solutions for employees. Data analysis functions here as a methodological toolbox that makes it possible to derive concrete and action-oriented recommendations from the broad mass of available data. Ultimately, the networking of actors through digital processes and systems enables the minimisation of coordination, integration and networking problems and helps to increase quality and efficiency. ^[1,2,4]

History

Generally speaking, the healthcare sector has so far been considered a latecomer in terms of digitalisation. The use of ICT to date is mainly concerned with the digitisation of prevailing processes through workflow management systems and documents with the aim of improving the consistency of health-related data within medical institutions ^[2]. The numerous opportunities and the ever-advancing digital transformation in the economy are changing and broadening the understanding of digital health and opening up new possibilities in healthcare.
The impact of the corona crisis on healthcare is noteworthy, where digital health solutions have been an important building block in combating and containing the viral outbreak and a multitude of implementation hurdles have been rapidly removed. ^[3]

Furthermore, technological progress in the areas of robotics, artificial intelligence and machine learning, augmented reality and virtual reality, among others, is promising and also holds numerous possibilities for the healthcare sector in the future.

In the course of these developments, there has also been a conceptual reorientation in the past. The formerly common term eHealth was gradually replaced by the term digital health ^[4,5].

Application and examples

There are many examples in the field of digital health:

• Telemedicine in patient treatment, such as platforms that allow patients to consult a doctor online or the remote monitoring of vital bodily functions via telemonitoring
• The electronic patient file, in which all patient data on medical history, treatments, medications and other health data can be stored centrally
• Robots in the health care system, e.g. to assist doctors in minimally invasive procedures
• Artificial intelligence in diagnosis, e.g. intelligent systems that independently evaluate imaging material and indicate anomalies
• Augmented reality as assistance systems, e.g. for doctors to prepare for complex interventions or as a learning tool for patients
• Virtual reality, e.g. for use in the physical rehabilitation of heart attack patients

Criticism and problems

Even though the developments surrounding the use of information and communication technologies in the health sector are associated with a multitude of opportunities, the field also faces a number of challenges. Since health-related data are highly sensitive, IT security, data protection and data sovereignty as well as the prevention of cybercrime are among the greatest challenges. But creating trust and acceptance, digital ethics and the provision and availability of digital infrastructure are also important aspects.

In addition, with a view to the central importance of (social) interaction and the necessity of informal action, as well as the personal nature of implicit experiential knowledge in the context of health-related personal services, reference is also made to possible limits of mechanisation and formalisation ^[5,6].

Research

At bidt, the PALLADiUM project is investigating perspectives and design options for the digital transformation of communication and collaboration processes in multi-professional care in the last phase of life. In palliative care, the focus is on people in their last phase of life. PALLADiUM analyses and designs the digital working world of palliative care, which is traditionally a working world remote from technology and digitalisation. Palliative care is characterised by a professional self-image based on personal interpersonal care. The primary goal is not prevention or cure, but to minimise suffering in all its facets – physical, psychological, social and spiritual – within the framework of holistic care. The field of work is accordingly characterised by intensive multi-professional cooperation. At the core of the project is the design of a digitally supported working system to improve the collaboration of professionals from the various professions involved. The comparatively low level of digitisation in palliative care represents an outstanding opportunity to conduct prototypical research into how information and communication technology and digitisation processes can be designed at an early stage and which working conditions and competencies must be created to enable acceptance and confident use of digital technologies. In particular, the question arises as to which AI-supported approaches are suitable for making structured and unstructured data in palliative care more usable for communication and collaboration processes.

The Responsible Robotics (RRAI) project is also concerned with the transformation of healthcare: it is investigating the ethical, social and legal aspects of robots, particularly with regard to their use in nursing and healthcare. The aim is to develop practical recommendations and standards for a sensible and ethically justifiable use of AI-based robots.

Various doctoral projects and junior research groups are dedicated to novel, computer-based procedures at the interface between medicine and (bio)informatics, including the topics:

• ‘Mixed Reality’ as a new rehabilitative approach to disorders of everyday activities after chronic neurological disease,
• Image-based early detection of Barrett’s oesophagus with semi-supervised learning algorithms,
• LipiTUM – A Computational Platform for Lipidomics and Lipotyping in Systems Medicine,
• DIGI TYPE: Digital Medicine-based Endophenotyping.

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