As the NHS embraces the use of digital technology, AI expert Professor Luciano Floridi, Oxford Internet Institute, University of Oxford, warns of the inherent risks in relying solely on digital health tools to transform the UK health care system.
Many would argue that digital health is now entering a golden age, with organisations such as the WHO and European Commission recognising its potential to transform health systems, empower individuals and improve the quality of health care. Here in the UK we are full speed ahead on our digital journey, with the recent launch of NHSX, a new government body which brings together a broad team of experts for the first time, tasked with transforming the use of digital technology across the national health service.
It’s a widely held view that DHTs have a role to play as part of the digital health mix, helping to encourage individuals to take greater ownership over their own health and should be part of the solution in how we create better patient outcomes. However, it is my view that policymakers, clinicians and health care professionals should be aware of the limitations of DHTs and must exercise a degree of caution before rushing to embrace them as the latest panacea for an overstretched health care system.
Typically, DHTs require individuals to log and record their data, which are then measured against established baselines for health. Yet in most cases, people may have little or no understanding of how these baselines were established and whether or how far they may apply to them. For example, people using their Apple watch to check their heart rate may not know whether their default optimum heart rate is actually optimum for them or only for those included in the design trial.
From a more critical perspective, it can be argued that DHTs do not promote specific actions and behaviours always based on objective knowledge. Instead they may promote certain norms, lifestyles and values over others in a way that disciplines or at worst may even frustrate and marginalise people with supposedly inferior moral beliefs about health until they meet the standards of the healthy ideal body type.
This potentially dangerous manipulative process may nudge people to take more responsibility for monitoring their own health, but may also feel like an elaborate mechanism for ‘victim blaming’. In other words, it may lead to circumstances in which blame for becoming unhealthy or sick is placed on people for whom it would have been difficult, or perhaps even improper, to achieve the defined standards of health in the first place.
Given the unintended consequences associated with DHTs, it is essential that they are used in the right way for individuals, rather than adopting a one size fits all approach. All too often we see digital health benefits over-hyped by policymakers as part of the empowerment narrative in the broader discussion about how we shift responsibility from the state to the individual, without considering the nuances and variations at an individual level.
Yet, when harnessed in the right way, similar digital technologies have huge potential to help individuals or groups and deliver significant benefits, such as improving choice of access, increasing patient care, lowering the cost of care, enabling better preventative care, and providing faster and more accurate diagnosis.
In the long term, policy makers are faced with the challenge of designing an infrastructure that supports ethically good outcomes of a responsible digital health ecosystem that promotes the positives, while avoiding the pitfalls. Exactly how to do this remains an open question and one which is very much up for debate.
Read the full article ‘Enabling digital health companionship is better than empowerment’ by Professor Luciano Floridi and Researcher Jessica Morley, published in The Lancet 11 July 2019.
