Ethical implications in digital

health
Prof. Naveen T.S.
Assistant Professor
Department of Medical Electronics Engineering
Dayananda Sagar College of Engineering
Bangalore
• The field of digital health has grown dramatically, leveraging technological
developments to transform healthcare delivery.
• From wearable devices to telemedicine platforms, digital health innovations
provide unprecedented opportunities to improve patient care, results, and access
to medical services.
• However, the fast use of these technologies poses ethical issues and privacy
concerns that must be addressed in order to assure responsible and secure data
use.
Ethical Considerations in Digital Health:
• Ethical considerations in digital health are crucial for ensuring responsible and
patient-centered healthcare practices. Some key ethical considerations include:
• Obtaining informed consent
• Protecting data privacy and security
• Addressing algorithmic bias and fairness
• Promoting equity and accessibility
• These issues highlight the significance of transparency, individual autonomy, data
privacy, and equal access to digital health tools for all. Stakeholders may create
trust, avoid risks, and maximize the positive impact of digital health on patient care
by adhering to ethical norms.
Informed Consent:
• It is critical to obtain informed permission from persons who participate in
digital health programs. Users must be properly informed about the
purpose, dangers, and benefits of data collecting, as well as how their data
will be utilized.
Data Privacy and Security:
• Massive volumes of sensitive personal data are generated by digital health
technologies. It is critical to protect the privacy and security of this data. To protect
against unwanted access and data breaches, organizations should establish
comprehensive security measures such as encryption, access limits, and regular
audits.

Algorithmic Bias and Fairness:

• In digital health, artificial intelligence and machine learning algorithms are
increasingly being used to make patient care choices. Addressing potential biases
and ensuring fairness in algorithmic decision-making processes is critical. To avoid
perpetuating healthcare disparities, businesses should aggressively work on
designing and deploying unbiased algorithms.
Equity and Accessibility:
• If digital health technologies are not used with caution, they have the potential to
exacerbate existing health imbalances.
• Firms must ensure that their operations facilitate fair access to digital health tools,
taking into account problems such as affordability, literacy, and connectivity, to
avoid creating or expanding the digital divide.
Privacy Challenges in Digital Health:
• Data sharing and interoperability, secondary data usage, de-identification and
re-identification concerns, and regulatory compliance are all privacy challenges in
digital health.
• Individual privacy must be protected in the digital health ecosystem by ensuring
secure data sharing, honouring privacy preferences, limiting re-identification
threats, and complying with privacy legislation.
• It is critical to address these issues in order to retain confidence and secrecy in the
usage of personal health information.
Data Sharing and Interoperability:
• Sharing health data across platforms and systems can greatly enhance healthcare
coordination and outcomes.
• Interoperability concerns, on the other hand, arise as a result of mismatched
systems and incompatible data standards.
• Businesses should prioritize the development of standardized methods and
standards for secure data sharing while protecting patient privacy.
Secondary Use of Data:
• Secondary use of health data presents privacy concerns since data obtained for
one purpose is used for another.
• When repurposing data for research or commercial purposes, firms should have
stringent data governance standards to ensure that individual permission and
privacy choices are followed.
De-identification and Anonymization:
• To protect individual identities, it is critical to de-identify or anonymize
health data before sharing it. However, because to the enormity of health
databases and the potential combination of numerous sources,
re-identification issues arise.
• To properly limit re-identification threats, enterprises should adopt
rigorous de-identification procedures and stay current of developing
privacy-enhancing technology.
Regulatory Compliance:
• Digital health efforts must follow current privacy rules and regulations,
such as the European Union's General Data Protection Regulation (GDPR)
and the United States' Health Insurance Portability and Accountability Act
(HIPAA).
HIPAA and Patient Confidentiality Laws
• Under the Health Insurance Portability and Accountability Act (HIPAA), your
medical records and other health information that you share with healthcare
professionals, facilities, and insurers are kept private.
• They can’t share it without your permission unless it’s for the safety and
well-being of others. Patient privacy, confidentiality and security are the
cornerstones of the American healthcare system.
HIPAA does the following:
• Allows millions of employees and their families to transfer and keep their
health insurance coverage when they change or lose jobs.
• Reduces fraud and abuse in the healthcare system.
• Mandates industry-wide medical information standards for electronic billing
and other processes; and
• Mandates the protection and confidential handling of protected health
information
• The HIPAA Privacy regulation requires that healthcare providers and
organizations, as well as their business associates, develop and follow
procedures which guarantee the confidentiality and safety of protected
health information (PHI) when it is transferred, received, managed or shared.
Confidentiality in Healthcare
• Confidentiality in healthcare refers to the obligation of professionals who
have access to patient records or communication to hold that information
in confidence.

• This professional obligation to keep health information confidential is

supported in professional association codes of ethics, as can be seen in
principle of the American Health Information Management Association
Code of Ethics, “Advocate, uphold, and defend the individual’s right to
privacy and the doctrine of confidentiality in the use and disclosure of
information” (AHIMA, 2011).
Privacy in Healthcare

• In a healthcare setting, privacy refers to the distinct form of confidentiality, that is

viewed as the right of the individual patient to be let alone and to make decisions
about how personal information is shared.
• You have a legal right to privacy, and laws govern how health service providers
collect and record information about your health, how they must store it, and
when and how they use and share it. This also means that you can give any of your
healthcare providers your consent to share your health data, for instance, when
you change doctors and you want your new doctor to access your medical history.
• You have the legal right to obtain access to your medical records, as well.
• Moreover, the federal HIPAA Privacy Rule establishes national standards for health
information privacy protection and defines “protected health information.”
• The Privacy Rule’s main goal is to ensure that individuals’ health information is
properly protected while allowing the flow of health information required to
provide and promote high-quality health care and protect the public’s health and
well-being.
• The Rule strikes a balance between allowing important uses of information and
protecting the privacy of those seeking care and healing.
• Given the diversity of the healthcare marketplace, the Rule is intended to be
flexible and comprehensive in order to cover the wide range of uses and
disclosures that must be addressed.
Security in Healthcare
• Security refers to the means used to protect the privacy of health
information and to support professionals in keeping that information
confidential.
• The concept of security has long been applied to paper-based health
records; secured file cabinets are one example.
• As the use of electronic health record systems increased and the
transmission of health data to support billing became the norm, the need
for regulatory guidelines specific to electronic health information became
clear.

• The HIPAA Security Rule established the first national standards for
health information security.
• The stated goal of the HIPAA Security Rule, which addresses technical and
administrative safeguards, is to protect individually identifiable
information in electronic form—a subset of information covered by the
Privacy Rule—while allowing healthcare providers appropriate access to
information and flexibility in technology adoption.
 Reasons Patient Data Privacy, Security and
Confidentiality are Important

• Consider what would happen if the person you most trusted decided to reveal all of
your secrets in public. You’re not likely to trust that person again. The concept of
trust lies at the heart of your medical care, which is why these are all so crucial in the
medical field.
• The integrity of the health system relies on the protection of privacy and
confidentiality because:
• Patients must have the freedom to determine who has access to their health
information, except in specific limited circumstances.
• People may be hesitant to seek medical help if they are concerned that their
information may be shared with others. This could have implications for future
medical disease prevention, treatment, and research.
• Individuals who have tested positive for HIV/AIDS or other STIs, mental disorders and
the like may face societal stigma and discrimination;
• In digital healthcare world, the availability of accurate health data to providers is
critical to care delivery.
• If patients are reluctant to share information due to lack of trust, a disruption in
access to that data can delay care; and Lastly, a health system with strong privacy
protections will boost public trust.
Telehealth and Cybersecurity
• Many of the challenges confronting health care delivery can be addressed by
innovative Connected Health Technology.

• Connected health refers to a variety of care delivery models that use

communications technologies (also known as telehealth and telemedicine) to
assist patients in managing their conditions through improved self-care and to
extend clinical care outside of traditional settings.

• Patient-centric personalized health interventions can be created using healthcare

systems that combine patient-generated health information with objective data
from medical devices and sensors.

• Although these new technologies promise to improve care quality, lower costs, and
increase patient satisfaction, they also raise a number of ethical concerns.

• Establishing best practices is the first step toward more secure telehealth. Because
healthcare organizations have sensitive information, providers and the vendors
they choose to work with must focus on core elements of data security and privacy
through related tools and strategies.
1. Identity Authentication
• Multi-factor authentication, or the requirement to sign in with two pieces
of proof, is one of the most prevalent and has been shown to block 99.9%
of all automated cyber-attacks.
• Aside from that, users must create strong, unique passwords for not only
their telehealth platform accounts, but for all of their online logins and
accounts.
2. HIPAA-compliant and Improved Telehealth / Telemedicine Platform
• Choosing HIPAA-compliant vendor is important as they incorporate
encryption and other precautions into their communications with patients
under HIPAA rules.
• A remote patient monitoring company, is a good example. The software is
designed in a secure environment and contain numerous ways of
establishing secure connections between patients and providers.
3. Proper Patient Education
• In telehealth, cybersecurity and patient data privacy also rely on the
end-users. Most of the end-users are the elderly with chronic diseases or
recovering from post-operation.
• Hackers continuously exploit these new vulnerabilities. Telehealth
companies and healthcare providers should educate and support patients
on how to protect their data.