Digital preparedness of the healthcare sector
Digital preparedness of the healthcare sector

Gabrielle Speijer, MD

Multidisciplinary Aspects of COVID-19 Apps, 03/2020

Digital preparedness of the healthcare sector

Acting under time pressure in a situation in which a great deal is unknown also means risking less optimal choices, on emotional grounds. COVID-19 proved to be an outright accelerator for technology. In the Netherlands, the CoronaMelder was developed, an app that allows you to yourself decide whether your data are made available to the public health authority (GGD), which is responsible for coordinating testing and tracing efforts. How paradoxical this development emerges to be can be seen if we analyse the current healthcare system. Today’s technological possibilities are proving quite a challenge to the Hippocratic Oath, which represents the deepest professional values of the physician. There is literally a gap between the world of healthcare as we know it in a hospital, physician’s practice or GGD and the one that Big Tech companies would like to project. Getting rid of this parallel universe requires the fundamental step of translating deep professional and societal values into the orchestration of technology and data processing. This can bring us to global healthcare at an entirely different level: datadriven, sustainable, learning and value-based.

Time machine in fast-forward: 2020

The ‘appathon’, which had nothing of the air of a dusty bureaucratic government project, was supposed to result, in a space of less than two weeks, in two apps to help combat the pandemic.269 At the same time, the tech giants made a deal270 to embed Bluetooth-enabled contact tracing capability in the system. In lockdown, with our daily life on ‘mute’, together we were writing history in fast-forward. From the midst of the crisis, we took steps, supported by the technology world that has been ready to deliver for ages, but what about the recipients?

Digitally prepared?

Globally, we saw that the pandemic forced us to act, under significant time pressure, without clear reliable guidelines based on evidence proved in practice. The challenges faced in taking decisions, (271,272) the demand for reliable insights available at short notice, and models have never been so prevalent. Various models appeared; for instance, to help policymakers simulate the potential consequences of various measures, (273) to chart out the contribution of digital tracing, (274) based on epidemiological variables, and even combined with the impact of behaviour in the population. (275) Socio-economic and ethnic differences determine health (SDoH) and therefore infection and mortality rates due to the virus. (276,277) Fine-tuning on the subpopulation level is possible by charting out the heterogeneity of our society, such as a mobility model that provides insight in the short term into the substantial contribution of policy measures. (278) For instance, the tightening of a facemask policy in certain public places, ample availability of (free) testing, and financial support for people who would otherwise be forced to work instead of following quarantine measures can strengthen the lockdown strategy.

The view on a total health situation is missing

From a clinical perspective, the pressure to quickly obtain valuable insights into the COVID-19 virus was at least as great. Symptoms linked to and organs involved in the clinical picture were gradually adjusted, based on new insights from the various disciplines. This exposes how essential insight into the overall health situation is in order to be able to be of added value as a healthcare professional, from every position, in advising, treating and providing guidance. Although technological possibilities are widely available to interpret insights that are continuously digitally connected with each other and collectively contribute to knowledge, it appears that there is still some way to go when it comes to using technology for the benefit of (global) healthcare. (279)

Life-threatening data silos

Interoperability, a description of the exchangeability of information between the different systems, is usually mainly approached technically. In clinical terms, faulty interoperability translates as: in a healthcare process, not being able to access health information, not being able to access this on time or adequately, or not being able to access the correct health information: a serious problem worldwide. (280,281) Today’s healthcare system was literally digitalised during the period when a ‘memoir’ and writing to one’s colleague as a ‘paper’ one-way street was still commonplace. The healthcare landscape has since developed into countless separate virtual silos, each representing separate clinical practices. With growing super-specialisation, the average patient receives care at different places, and the lack of interactivity is resolved separately from these digitalised units, for example via e-mails, telephone consultation, apps. This costs healthcare professionals extra time and effort, but more importantly, it often does not contribute to safeguarding that there is one reliable truth for the clinical interpretation of the patient’s health situation (in time). The healthcare information systems that are used in clinical practice are therefore primarily focused on supporting financial administrative processes and to a much lesser extent supporting patient characteristics. (282) Moreover, it appears, despite the stimulus subsidies for online access to patient dossiers (283,284) and the provision concerning electronic copies of patient information, (285) not enough progress has been made in making (all) healthcare information digitally available to the patient in real-time. (286,287)

Confidentiality as basis

Without confidentiality between the patient and healthcare professional, the basis for the (treatment) relationship is missing. From the basis of trust, there is room for vulnerability. Which is crucial in order to accurately get a picture of the health situation together with the patient. Based on the Hippocratic Oath, confidentiality is a fundamental professional value. (288) Aside from the fact that healthcare information can now be found in so many places, despite all the efforts, (289) no one can say with certainty where which information is located. Moreover, it cannot be (transparently) guaranteed where and by whom healthcare information is used. We can expect today’s healthcare director to have skills, knowledge and oversight of the digital developments. In order to constantly guarantee the integrity, privacy and security of healthcare information, the director is therefore also an ‘orchestrator’. He or she has a view on the expertise in-house, but also knows when and how to escalate to outside the organisation, at, for instance, the larger and smaller specialist companies, scientific teams and specialised consultants. Unfortunately, we see an extremely recent example of negligence in this area under the responsibility of the GGD. (290) Freedom to innovate not obligation-free Managing technology with the inclusion of individualised user experience optimisation based on practice is crucial for proper and safe care. (291) The development of artificial intelligence without taking into account the values of healthcare and society risks causing extraordinarily harmful consequences, for example from the interest of a limited group with power or profit interests. However logical it may be to have management from the perspective of the doctor, it is perceived as very difficult, to say the least. Oft-cited motives are vendor lock-in (‘preferred partner model’), certification, financing or alleged privacy objections. However, a fundamental approach is appropriate. Fulfilling everyone’s role based on responsibility supported by technology, instead of the passive form of accountability that results in an administrative burden, with ultimate steering based on missing expertise. (292 293) This kind of ecosystem, in which technology is added, replaced, or removed in parts by the healthcare professionals and domain experts (in consultation with the care recipient in question) requires deliberate steps informed by the deep values of society and healthcare. (294)

Learning healthcare system

It is only through awareness that a genuinely digital healthcare will become possible. The importance of communication between patient and healthcare provider(s) as the ultimate source of healthcare data deserves muchmore attention. As soon as communication must yield simultaneously sustainable, confidential, ethical and unambiguous healthcare data freed from the context, however, considerable demands are put on the technology itself and the way in which it is orchestrated. For example, interpretation within the expert groups requires flexible connectivity supported by technology that allows not only the use of international standards, but feeds these seamlessly with knowledge directly from clinical practice. Global availability of reliable (traceable), unambiguously interpretable and valuable healthcare information, also for subsequent generations, and technology orchestration based on responsibility (instead of accountability), from the basis of each person’s field and expertise, with broad, multidisciplinary, flexible teams can put in motion a (globally) learning system. (295, 296)


Society, and in particular our healthcare system, is dealing with an acceleration in the use of technology driven by the COVID-19 pandemic. While most technological capabilities, and many promising ones, have been ‘waiting’ outside of clinical practices, they appeared good enough, without too much consideration, to serve as a remedy during the crisis, even for the citizen receiving care. The CoronaMelder app, launched via a much-talked-about process, painfully shows how much progress still needs to be made in the rest of the healthcare landscape in terms of digital maturity, data-drivenness, and, above all, necessary management from the heart of the healthcare system. Broadly speaking, there is a largely passive digitalised healthcare landscape, in which technology is usually considered a ‘finished’ product that can be taken into use; based on the consumer ‘user’ perspective. This mindset is now dated and upholds a route that brings with it potentially big risks of expanding the interests of a minority with, for example, an exclusively financial or polarising interest. For safe and good care, it is crucial to take the first step: translating the values of healthcare and society in the orchestration of information and technology principles. An ecosystem that is designed in such a way that everyone’s expertise, skills and knowledge contributes sustainably 297 will simultaneously require new business models,298 so that data will flow as a return for global health. Cooperation, mindset and those orchestration principles can yield an unprecedented breakthrough for healthcare.

Points for attention

  • In today’s healthcare landscape, which has largely become virtual, the fundamental and structural safeguarding of its deepest values is missing. The Hippocratic Oath and the broader societal values emerge not to have been translated into the principles for information and technology, and that is indeed what we, as citizens needing healthcare, count on in the professional relationship with the physician.
  • Freedom to innovate and confidentiality are crucial not only to provide safe, state-of-the art or innovative healthcare, but to be able to provide that necessary direction to the rapid developments occurring now in the growing healthcare landscape (even outside the regular clinical practice). The fact that the input from the heart of healthcare is so indispensable in that context will be evident from the data-driven doctor skills, such as specification of technology, optimisation of user experience and communication (data curation) and cooperation across divergent disciplines. New business models will support this, based on, among other things, the principles of value-based healthcare. (299, 300)
  • A conscious approach in orchestrating technology is necessary to be able to (continue to) guarantee individual freedom, since value creation in the cyberphysical systems will follow the direction of their underlying orchestration principles. The fact that technology will never accelerate without direction is evidenced by initially seemingly innocent social media like Instagram and Facebook. The responsibility we bear as society for the development of technology is not without obligation, therefore. Leadership is required in every position: as physician, policymaker, director, ICT provider, UX designer, scientist, lawyer, etc.

About the author

Gabriëlle Speijer is a Radiation Oncologist at the Haga Hospital, founder of the healthcare innovation company CatalyzIT, HIMSS Future50 International HealthIT leader and member of the ICT&health editorial board.