Digital health tools are playing a central role in responding to COVID-19; some are established tools, some are existing tools being used in new ways, and increasingly there is attention to developing specific new digital health tools to respond to the pandemic.
This is the first in a series. Here we present a broad overview of different ways in which digital health tools are being used. This will be followed by more detailed analysis on each of these areas, as well as related posts on topics such as processing of personal data in relation to COVID-19.
We define the term digital health as the use of digital technologies to improve health. This is similar to related terms such as eHealth (the use of information and communication technologies for health) and mHealth (emphasising mobile technologies), with an additional emphasis not only on the technologies but also the data that they create, share and use. Countries were identified using the COVID-19 Health Systems Response Monitor (HSRM) based on the information available (up to 24 April 2020).
Overall, there are three principal areas where digital health tools are being used in responding to COVID-19, as set out in Figure 1: communications; monitoring and surveillance; and supporting provision of health services. How these tools are being used is evolving over time, as countries make more use of some existing tools (for telehealth, for example) or develop new tools (such as apps to support contact tracing).
Digital health tools are being used for communication, monitoring and surveillance
Many countries have digital tools to collect and share information about COVID-19, either through existing tools or developed specifically for COVID-19 (such as in Bulgaria). As well as straightforward web pages, this has included apps to communicate with the public, to provide information about the virus and to support recognition of symptoms or their reporting, testing, or to connect with health services, such as in Croatia, Estonia, Finland, the UK and Canada.
In some countries, more active tools such as tracking mobile phone movements have been used to monitor the effectiveness of social distancing measures, identify people at risk, or to enable reporting of symptoms (such as Austria, Bulgaria and Israel). This links to current initiatives to develop apps to support contact tracing, which are discussed further below.
One issue has been responding to what the World Health Organization (WHO) has called an ‘infodemic’ of misinformation concerning COVID-19. WHO has established a chatbot on Facebook to help address misinformation, and some countries have active efforts to counter misinformation. In contrast to their approach on other health issues, social media platforms have also begun to actively address misinformation relating to the pandemic, though this remains an ongoing concern.
Countries have used remote consultations, remote management of COVID-19 patients and digital tools to manage essential supplies
Much use is being made of digital health tools for remote provision of health care, such as for remote consultations in primary care (e.g. Croatia, France, Malta, Poland, Sweden, United Kingdom), secondary care (e.g. Armenia, Estonia), or more widely across different types of care (e.g. Austria, Belgium, Germany, Israel, Luxembourg).
Some specific initiatives to use digital health tools for remote management of COVID-19 patients with mild symptoms or recuperating at home after hospital care have also been used, in for example: France, Iceland, Italy, Luxembourg, the Netherlands, with also some provision of wider support services for people self-isolating ( Poland). Digital tools can also be used to help manage essential health care supplies and hospital bed capacity related to the pandemic (Greece).
This use of digital health tools has not been without challenges, though, such as whether a remote consultation is appropriate and sufficient, and adaptation of quality or reimbursement rules. Even in countries where these digital health services were in principle already available before the pandemic, the scale and character of use is creating new challenges (e.g. Sweden).
Digital health tools may have potential to support transition to less restrictive measures, but challenges remain
As many European countries look at easing pandemic-related social and economic restrictions, digital health tools are being considered as part of strategies to manage this period during which there may be looser restrictions while we are still without a vaccine or effective treatment. Some countries are already using digital health tools to support monitoring and surveillance, as described above, and others are considering developing such tools. Some models suggest that the speed of contact tracing is particularly important with COVID-19, and that using digital contact tracing tools might help speed up the process.
In terms of responding to the pandemic, two key questions are whether digital health tools would add value in practice, and whether the public would accept them. Not all members of the public have smartphones that would support such apps, for example, and not everyone who has one would necessarily be willing to participate in such an initiative. Some research suggests that an app can be effective, but on the basis that 80% of people with smartphones use the app, or 56% of the population overall. Initial surveys suggest that around three-quarters of the population in countries such as the UK, France, Italy and Germany would be willing to do so, though with the people in some countries notably more willing than others. The European Commission has made a Recommendation regarding a common European Union (EU) toolbox for such digital health tools, in particular concerning mobile applications and the use of anonymised mobility data. This includes limits on use of processing personal data and ensuring that personal data is not used for any other purposes (including commercial). Work to develop a common EU toolbox is being led by the EU’s eHealth network.
Countries could learn from each other on using effective digital tools and take lessons from the broad scaling-up during the pandemic
While digital health tools are being widely used in responding to the COVID-19 pandemic, countries are doing so in quite different ways. Some of this reflects different challenges and different health system contexts, but there remains clear potential for countries to learn from each other on effective digital tools, in particular for communication (and responding to misinformation), monitoring and surveillance, and maintaining essential health services. This includes not only the technological dimension of digital health tools, but also their integration into the health system, such as rules concerning quality or reimbursement.
The current situation is accelerating the adoption of digital health tools enormously. For example, many health systems already had the possibility to provide health services remotely using digital tools, but their use in practice was small, with technical, procedural, legal and financial barriers hindering progress. The pressures of the pandemic have enormously increased adoption of such tools in many systems. It is unclear how this will continue after the current pandemic, with some provisions being explicitly time-limited. However, this is also an opportunity to learn from such broad scale-up of digital health technologies that may help to improve provision of health services for the future.
At the moment, though, the key emerging issue is the potential role of digital health tools to help control transmission through improved contact tracing. This raises technical, societal and legal challenges, which are being considered through Europe-wide platforms such as the EU’s eHealth network. Here again there is scope for countries to learn from each other in order to maximise the effectiveness of such approaches, which may help to support relaxation of some current restrictions pending the availability of a vaccine or effective treatment for COVID-19.
Nick Fahy