By Dr. Noel Carroll, Lero – the Irish Software Research Centre (www.lero.ie), Department of Computer Science & Information Systems, University of Limerick
In recent years, we continue to learn about the growing concerns in relation to online behaviour and personal data across various digital mediums. The healthcare sector has also placed greater emphasis and trust on availing of digital solutions which has drawn on software innovation to extend the delivery of care. Over the past decade, software companies have increasingly focused on healthcare, yet medical errors are still inevitable because of the fragmented nature of medical information. However, there is growing interest in identifying methods that will transform healthcare from, for example, moving away from reactive care to proactive and preventive interventions and from clinic- to citizen-centred practices by empowering people through greater access to healthcare information.
Connected Health (CH) is supported by an interoperable digital infrastructure that facilitates the exchange of data and knowledge. It optimizes the use of rich and real-time data sources to support evidence-based health and wellness decisions (Carroll, 2016). Thus, through the use of software tools and technologies, CH extends healthcare services and processes beyond traditional healthcare boundaries, delivering more convenient and personalized healthcare services. CH empowers individuals to manage their own health and treatment plans, often facilitated by integrated intelligent systems (for example, wearables) that monitor and support the maintenance of a desired health status.
CH’s ultimate goal is to develop safer and more effective, efficient, equitable, and user-cantered health and wellness services through pervasive computing innovations. Thus, CH software innovation contributes to the coverage and quality of healthcare services, improved health outcomes, reduced costs, and improved quality of life. Improved decision-making tools can increase the likelihood of saving lives, reducing costs, and ensuring a better quality of life before, during, and after treatment.
- Growing Concerns
Central to any healthcare system are people. Therefore, we need to shift the focus away from the hype of technology and uncover the potential impact and change CH has using a human-centric lens. CH software and systems offer much potential for supporting the health and wellbeing of people. However, we are also beginning to witness how it will change the healthcare landscape and how people will interact with healthcare providers and institutions. We must be cautious in avoid removing the human aspects of care by becoming too focused on technology so that we can begin to provide impetus and direction for the emergence of CH and value creation.
CH innovation raises a number of ethical and regulatory issues, such as medical device regulation (fit for purpose), privacy and protection, professional practice, accountability and responsibility, quality and risk management (Carroll and Richardson, 2016). However, to facilitate such dialogue we call for the introduction of a balanced view of CH to examine what we describe as the ‘good, the bad and the ugly’ to generate new theoretical contribution to describe how CH evolution need not be laced with such uncertainties, but rather to consider how the nature of innovation sets a pattern of complexity which we should decipher in an attempt to mitigate risks and ethical issues associated with healthcare innovation. As a CH community of researchers and practitioners, we must open up new discussions on identifying key ethical and regulatory issues with a view of improving the quality and safety of care and influence the development of new policy solutions. CH is not only a question of examining ways to eliminate healthcare bureaucracy but opens new discussions on the right to use new technologies to transcend the limits of the human body. We need to be mindful that the more trust we place on software to deliver care and support clinical decisions, the more susceptible we may be to technological flaws which ultimately jeopardises healthcare outcomes.
- Need to Examine Ethical Issues
When we are designing, developing, implementing and/or using healthcare technology, our mortality untitled resides in how we use the technology – ranging from wellness awareness to invasive surgery. However, the range and pace of healthcare technology solutions now entering the marketplace raises some key questions. For example: Are technology solutions now surpassing medical knowledge? Are technology providers responding to healthcare providers needs or vice versa? How is technology advancing the field of medicine? Can we trust healthcare technology solutions? Where does accountability and responsibility lie in the diagnosis of a condition or the delivery or care using a healthcare software solution? Is a regulated healthcare technical solution ‘good enough’? Such questions generate much needed dialogue regarding the ethical issues associated with CH.
CH solutions may be categorised as incremental innovations that offer evolutionary change on healthcare practice or radical innovations that drive significant change in the healthcare environment. Iserson and Chiasson (2002) also draw our attention to the role of ethics and education when they raise questions on whether physicians should be permitted to use these new technologies without supervision and who is responsible for setting and monitoring standards for new technologies. We explore such questions and we consider the broader ethical implications in the development of CH. Specifically we need to generate real debate and dialogue around the impact of CH solutions on, for example:
- The trust we place on CH software solutions to support monitor and diagnose healthcare conditions;
- The potentially negative impact of CH software solutions on peoples wellbeing, for example, an overload of healthcare information contributing to a persons anxiety because of our growing desire to regularly monitor our wellness;
- The balance in privacy and availing of a personalise service with particular emphasis on personal data and sharing of data;
- The security of CH software solutions to support healthcare practitioners provide care with dignity and respect while securing patient information as prescribed across international standards;
- Determining accountability and responsibility for the delivery of care through CH software solutions, for example, the role of a software engineer in influencing a diagnosis;
The list above is a snapshot of some of the key issues that need further attention, debate and research. Failing to adequately address these issues will hamper CH software innovation in the future. We need to explore such ethical issues in a balanced manner (the good, the bad, and the ugly…) order to support the rapidly growing CH community, software developers and healthcare professionals.
Iserson, K. V., & Chiasson, P. M. (2002, December). The ethics of applying new medical technologies. In Seminars in laparoscopic surgery (Vol. 9, No. 4, pp. 222-229). Sage CA: Thousand Oaks, CA: Sage Publications.
Carroll, N. (2016). Key Success Factors for Smart and Connected Health Software Solutions. Computer, 49(11), 22-28.
Carroll, N., Carroll, N., Richardson, I. and Richardson, I., (2016). Software-as-a-Medical Device: Demystifying Connected Health Regulations. Journal of Systems and Information Technology, 18(2), pp.186-215.