What is missing the in the European digital health infrastructure: in policies, in regulatory compliance, in health data security and ownership, in interoperability of national digital health platforms across Europe, in health data principles, in digital therapeutics, in European EHRs, in perceptions of digital health by healthcare stakeholders and by European populations? What to expect in the next decade? Here is a brief overview.

PROACTIVE DIGITAL HEALTH POLICIES REQUIRED

Proactive health data policies are still rare. Even most recent European initiatives often rely on old regulatory practices: limiting and high-risking, rather than on mitigation of side effects in adoptions.

SHIFT TO AUTOMATED, PERHAPS TOKENISED COMPLIANCE

Still costly and manual, most regulatory compliance in healthcare arose when legacy procedure were computerised. New approaches are required, with focus on digital tools to achieve seamless automation with inherent interoperability. Future automated compliance may be tokenised, to implement decentralised governance based on smart contracts.

FOCUS ON DATA SECURITY

Security threats to health data and digital health infrastructure are aggravated in scale with spread of IoMT and support by some state actors, due to perceived sensitivity of health data. Further, strain on existing networks result in reliance of new digital functionalities on old communication networks rendering the new functions useless or expensive.

EUROPEAN DIGITAL HEALTH PLATFORMS TO ACHIEVE INTEROPERABILITY AND EMPLOY ACTION-BASED SERVICES

Every EU country has a national digital health platform, sometimes more than one. Interoperability is missing, as the IT architecture behind leans on national legal requirement and own best practices for safety. Also, most digital platforms provide basic, informational services only, such as management of doctor appointment. Currently, a lookup into results of own blood test is considered to be an advanced feature. Action based services are missing, such as a remote analysis of the blood test by a human or a bot, with human or NLP interpretation plus recommendations or an (automatic) referral to a relevant doctor. In the near future, the national health platforms are expected to become backbones to smart services (e.g. digital therapeutics), in the same fashion as public blockchains become backbones for smart contract based services.

DIGITAL THERAPEUTICS: MORE APPROVED APPS ONCE THE LEGAL FRAMEWORK IS THERE

We may expect further adoptions of national approval systems, following the recent German experience. We may expect a common EU regulatory approach, that will allow further approvals. Hence, further demand for DTx applications is expected, once more experience with approvals has been accumulated.

EASY AND INTELLIGENT EHRS TO BE ADOPTED ACROSS EUROPE

Some EU countries are fully EHRed, some are entitled to but not EHRed yet, some are still predominantly paper based, only basic info is in electronic form. Total EHR coverage is missing and is expected to be achieved in the coming years. National EHR systems have limited compatibility, hence interoperability is missing. Telemedicine and travel inside Europe suffer. Full open but secure access across Europe is expected. Some currently adopted EHRs are notoriously frustrating to doctors. NLP in EHR is its infancy, an area with potential rich opportunities.

AWARENESS AND MOTIVATION IN TELEMEDICINE

Currently, we observe very different degrees of nation-wide adoptions in Europe. Technically possible long time ago, but neglected almost everywhere due to legal issues and traditional perceptions (extreme sports and rural patients). Covid helped, many employ telemedicine now. Public awareness of telemedicine is missing and is a future focus area, with priority on participation programmes, and development of other functionalities than an online talk with a doctor.

FULL-SCALE ADOPTION OF FARE DATA PRINCIPLES

FARE (Findable, Accessible, Interoperable, Reusable) data principles are recognised but are very often not implemented. Most health data is currently hard to find, not easily accessible, software dependent, hard to re-use by other clinicians. Further adoption of FARE principles is expected to e, ase search, access to and re-use of health data, make it non-dependent of proprietary software. Currently, access is ensured by most national laws, but besides basic information available via national online health web-based services, the rest is limited for access to patients, per request at best, we may expect instant access in the future, including trans-border health data access across Europe.

BLACK BOX PERCEPTION AND DIGITAL HEALTH LITERACY

In healthcare personnel: lack of digital health skills by recipients of digital health services on one hand, and lack of understanding ‘how it works’ by decision makers in the healthcare sector, are reasons to the black box perception of digital health infrastructure. Results in low quality decision making, services feeding grounds to conspiracy theories.

Population-wide: Not enough for the healthcare workforce, virtually absent for the wide population. Future proof skills have to cover navigating the healthcare IT system, communication with healthcare providers, rights awareness, informed choice and shared decision making. Rewards-based motivation initiatives are missing to become digital health literate, here we may also see new initiatives and successful adoptions.

OWNERSHIP OF HEALTH DATA

Ownership of health data is protected, but not ensured. Patients are deprived of proceeds when their health data is sold, also no C2B sales channels. The first projects arise, such as Ethereum based health data market by Nokia and a couple of startups), but it is the blue ocean for now. Winners will suggest large scale solutions with effective automated, perhaps decentralised, governance models.

DIGITAL SCRIBES

Intelligent clinical support systems are currently of early generations, where their role is limited to references, while they are envisaged to become full scale assistants to doctors. Also, virtual nursing assistants are expected. AI is expected to become a standard feature in such tools.