Keywords
COVID-19 - Medical Informatics - Artificial Intelligence - Global Health - World Health
Organization
1 Introduction
During the COVID-19 worldwide pandemic, the essential role of biomedical and health
informatics to improve preparedness, surveillance, and continued delivery of evidence-based
best practices became evident. The International Medical Informatics Association (IMIA)
is the world body for biomedical and health informatics, providing informatics leadership
and expertise with the world-wide vision of improving the health of the world population.
The International Academy of Health Sciences Informatics (IAHSI) is the honorific
society of IMIA and consists of elected Fellows who represent many of the world’s
leading experts in health and biomedical informatics. Recognizing the potential impact
of IMIA and IAHSI to contribute towards combat of the physical pandemic as well as
manage the concurrent “infodemic”, the IAHSI Committee on Health Informatics in Pandemics
addressed the World Health Organization (WHO) in a statement on the use of informatics
in pandemic situations. In this statement, the WHO was invited to collaborate with
IMIA/IAHSI specifically in four areas: artificial intelligence (AI), virtual care,
patient-centered health data sharing, and data and information quality [[1]].
When the WHO issued a call for proposals to organize dialogues between civil society
organizations (CSO) and the WHO Director General on different topics of interest for
the civil society related to COVID-19 response, IMIA/IAHSI applied for a dialogue
on digital health. This dialogue about the opportunities and challenges of digital
health during the COVID-19 global pandemic was held on December 16, 2020.
The dialogue, in form of a webinar, consisted of short introductions by the WHO Director
General (DG) and the authors, and was followed by more than 200 participants posing
numerous questions and engaging in discussions. This paper provides a summary of the
presentations and discussions and proposes further actions.
2 Aim of the IMIA/IAHSI – WHO DG Dialogue
2 Aim of the IMIA/IAHSI – WHO DG Dialogue
During COVID-19, health informatics and the use of information and communication technology
in general has become the norm for health care delivery. Use of telehealth and telemedicine,
contact tracing, health data processing, and mapping and use of social media to fight
misinformation (infodemics) are some examples of the way digital health has been used
recently. Absence of policies, strategies, trained personnel, and appropriate digital
health applications has resulted in much of the unpreparedness in many countries in
handling the pandemic.
IMIA as an international association represents health and medical informatics professionals
and academics from around the world, who are experts in adequate management of data
and information. These professionals offer knowledge and propose solutions, but seek
guidance at policy level and require a platform to express their views at global level
to support health systems worldwide. Given the status of WHO as the global body in
charge of health policy setting and evidence-building, it becomes imperative to engage
different stakeholders via WHO leadership.
The dialogue with the WHO DG was an opportunity to reach out to different actors within
WHO and global CSOs pursuing the common aim of strengthening health systems. This
dialogue aimed to refocus the WHO global leadership role in this area, as digital
health constitutes a major component in health systems. The objectives of the dialogue
were:
-
to establish a higher profile of digital health to support health systems;
-
to create awareness of the value of digital health based on the experience of experts
in the field;
-
to identify challenges facing digital health: technology infrastructure, organizational,
legal and ethical issues.
3 Conducting the IMIA/IAHSI – WHO DG Dialogue
3 Conducting the IMIA/IAHSI – WHO DG Dialogue
WHO Director General Dr. Tedros Ghebreyesus opened the dialogue session. In his opening
address [[2]], he highlighted the evolving potential of digital technologies for transforming
the health of entire populations and promoted a proactive and inclusive approach to
protect safety, human rights and privacy. He further stated the co-creation of the
digital transformation of health and the importance of bringing together the global
digital health community to implement the WHO Global Strategy on Digital Health.
The session moderator Dr. Najeeb Al-Shorbaji gave a short introduction into the topic
and the objectives of the session, highlighting the importance of the topic and the
potential contributions IMIA as an organization in official relations to WHO could
make to further strengthen the relationship and contributing to the implementation
of the Global Strategy on Digital Health.
IMIA President Dr. Sabine Koch presented IMIA as a global organization, a federation
comprising 57 member societies and including representatives from roughly 100 countries
around the world. She reported how the COVID-19 pandemic has accelerated the use of
digital health, as well as having emphasized the need for high quality data capture,
timely management and ethical use of the data. She further described the need to guide
the implementation of WHO strategies and policies in a national context, and to follow
up on the effects of the implementation.
IAHSI President Dr. William Hersh represented the 179 Fellows of IMIA’s honorific
society and gave an overview of the competence and knowledge available in this group
regarding research and education worldwide. He also highlighted some of the ongoing
IAHSI activities in form of panels for informatics in standards and interoperability,
AI, and computational knowledge. Dr. Hersh also highlighted the critical role that
many IMIA members play in academic institutions, leading research and education of
the next generation of informatics professionals and leaders who will advance the
field.
Dr. Riccardo Bellazzi spoke on behalf the 26 IMIA Working and Special Interest Groups,
thematically covering all areas of biomedical and health informatics. He mentioned
the initiatives of the Working Groups carried on during the pandemic [[3]], and he presented the 4CE initiative [[4]] for the clinical characterization of COVID patients on the basis of electronic
health record data. Finally, he highlighted the natural partnership between the IMIA
and WHO, since IMIA feeds the WHO strategic vision about digital health with knowledge
and wisdom of its scientists and educators.
Dr. Tze-Yun Leong shared her experiences about the use of AI in Singapore during the
COVID-19 pandemic. She explained how AI and digital technologies can contribute to
the care continuum, especially in rapid diagnosis, process management, vaccine development
and distribution, and remote consultation for telehealth and mental health. She summarized
the challenges and solutions of introducing technology-enabled contact tracing in
practice. She also highlighted the importance of building trust to facilitate AI adoption
through responsible innovation with relevant ethical, governance, regulatory considerations,
digital competency, and risk communication to support resilient pandemic response
and recovery.
Mr. Moctar Yedely reported from his long-standing work in setting up and managing
telehealth infrastructures and networks in the African Union, and the importance of
local adaptations.
In between the short presentations by the panelists, live discussions between panelists,
the WHO DG and WHO representatives took place. The audience was able to post questions
in the chat and/or question/answering module of the webinar. The moderator took up
several posts by the audience for live discussion. The written discussions were saved
with participants’ consent and analyzed to write this paper. The webinar as such has
not been recorded.
4 Results and Discussion
The analysis of the written discussions is presented according to different themes
that were brought up by the audience.
4.1 Opportunities and Challenges in General
Many opportunities with digital health and informatics were mentioned such as developing
structures and processes for capturing high quality data, the use of AI for early
detection and surveillance of pandemics, and virtual care and remote triage to lessen
the strain on health systems.
Several challenges were also brought up such as securing the ethical use of AI, securing
the quality of healthcare information, avoiding infodemics, and to better understand
and respond to local needs, especially in low and middle-income countries (LMIC) settings.
Concerns for human rights by digital health surveillance during COVID-19 were referred
to [[5]], and strong governance requested to secure the potentials of digitalization for
health while also addressing the concerns.
4.2 Ethics and AI
Several ethical questions were raised. Some participants believed that individual
privacy should not be maintained if one’s infectious disease impacts others, and data
about individual health need to be shared. Others promoted a demonstration project
by IAHSI members about COVID-19 data that can be ethically and securely shared without
impeding on individual privacy. Sharing (and selling) personal data for commercial
purposes was seen as a serious threat.
Several participants seemed to agree that we need to accelerate the sharing of codified
clinical knowledge for COVID-19 research and care around the world and the use of
open, findable, accessible, interoperable and reusable (FAIR) COVID-19 data was recommended
[[6]], under close surveillance of ethical, legal, and social implications.
WHO has been conducting webinars on ethical and legal issues of digital health and
plans to issue guidelines on these, especially in the context of AI. WHO, together
with partner organizations such as the International Telecommunication Union (ITU),
has convened expert panels and working groups to deliberate on and formulate best-practice
guidelines for Ethics and Governance of AI in Health, and Regulatory Considerations
on AI for Health. Some IMIA/IAHSI informatics experts are serving on these panels.
As AI can produce novel and unpredicted solutions, even “transparent” AI can be very
difficult to reason about. This raises an ethical issue: can patients give truly informed
consent if neither they nor the healthcare provider can fully understand how AI is
influencing healthcare?
We urgently need more evidence about AI solutions and their effects. Can we create
trustable and reusable AI and data analytics code and share it openly together with
implementation guidelines? WHO should provide governance for the responsible use similar
to those already published for parts of the AI field [[7]].
4.3 Digital Divide
Digital Health requires Internet access and a device to access and use the Internet.
Disparities exist, not only in LMICs. High income countries also have digital divides,
creating challenges depending on individual socio-economic, geographic, educational
and health backgrounds. Can WHO and partners such as ITU help make true global access
to the Internet a goal? IMIA can help to increase e-health literacy through education
as well as promote inclusive design of digital health.
We also need to bridge the digital divide and reduce health disparities regarding
COVID-19 data collection and reporting. Whereas WHO can work towards universal access
to vaccines, the IAHSI panel on standards for digital health works on common structures
for vaccination records. This will lay the ground for vaccine safety surveillance.
Documentation of post COVID-19 complications was discussed as another important area.
To build up the knowledge base, high quality, structured documentation in EHRs and/or
registries is necessary as the pandemic pointed out severe limitations in EHR data
quality.
4.4 Education
Health literacy and e-health literacy are critical to move forward. Education and
prevention of infodemics of inaccurate health information can contribute to improve
health literacy throughout the world. The question whether WHO would consider making
a third attempt at setting up a dot health (.health) top level domain for trusted
sources of health information was raised.
IMIA-affiliated academic institutions could directly participate through providing
education for many audiences from health care to informatics professionals, and also
collaborating from others in other academic organizations through the WHO Academy
[[8]], an effort to disseminate health-related learning worldwide. This would be one
way to help to disseminate the knowledge around best practices in informatics, data
science, digital health, and related areas.
Digital health is one tool towards achieving global health goals, and the digital
health community needs to integrate more fully with other disciplines and movements
such as Healthcare Information For All (HIFA) [[9]]. Communities of Practice (CoPs) have an important role here to ensure alignment
with wider learning and best practice.
5 Proposed Actions for IMIA/IAHSI & WHO
5 Proposed Actions for IMIA/IAHSI & WHO
Based on the lessons learned from the COVID-19 pandemic, WHO in partnership with IMIA
should create a roadmap including:
-
Creation of a digital health library of evidence-based, reusable digital health approaches
that support: (1) vaccine development and monitoring; (2) digital health care practices
to support social distancing; (3) day-to-day healthcare during the current pandemic;
(4) pandemic management; and (5) citizen uptake of evidence-based health information
and digital health, thereby supporting evidence-based citizen decision making regarding
health;
-
Disseminating knowledge and education through IMIA academic members and collaboration
with the WHO Academy;
-
Furthering stakeholder engagement: various communities need to be brought together
to enable effective digital health globally. Most importantly, support of the governments
and the engagement and commitment of every country are needed. WHO as a global organization
can make that happen.
6 Conclusion
Decision making by policy makers needs to be evidence-based and health informatics
research should be used to support decisions surrounding digital health. IMIA and
its international members have deep knowledge and experience of research, education,
and day-to-day management in different areas of digital health, and we are eager and
willing to contribute with our expertise.
More specifically, we propose the development of a research programme that aims to
collect, synthesize and present evidence how and under which circumstances digital
health can contribute to equity, reduce cost and provide efficiency in health care
delivery. This effort should include a focus on the role of informatics professionals
in developing and leading such efforts. IMIA/IAHSI can contribute with evidence building
and knowledge dissemination, and through its society members influence policy making
in many countries together with WHO.
Proposed next steps in the IMIA-WHO collaboration include engagement of the IMIA working
groups and IAHSI task forces in writing of WHO policy documents in the area of digital
health such as the guidance on ethics and governance of AI for health, as well as
to inform member state representatives and to host a side event on digital health
at the World Health Assembly.
