“We need to discuss what we expect from a digital healthcare system” – an interview with Christiane Woopen
In which areas of healthcare are algorithms applied – both today and in the future? How can they improve medical care? And what are new challenges that arise from their implementation? On behalf of the Bertelsmann Stiftung, the research center ceres at the University of Cologne has carried out a review and analysis of algorithms in digital healthcare. In an interview, Prof. Christiane Woopen, head of the research group, explains where she sees the greatest disruptive potential in the use of algorithms in healthcare.With a view to the various opportunities and risks, the ethicist demands that we, as a society, have to discuss what price we want to pay for digital progress, how we create trust and how we maintain solidarity in the healthcare system. In short, how do we want to shape digitalization in the healthcare system?
Where do you see the greatest opportunities, and what are the greatest challenges when using algorithms in healthcare?
Woopen: “The biggest opportunity of using algorithms in healthcare is a leap in quality – in several respects. If we assume that algorithms are methodologically well developed and are used under suitable conditions, they can contribute to determining the right diagnosis and the optimal therapy for each individual patient. Clinical decision support systems can help doctors to make treatment adjustments and give them access to the best available medical knowledge. Treatment processes can be designed to be patient-centered and more efficient across the different sectors of the healthcare system. In addition, more data from everyday healthcare can be used to improve the care of future patients. Of course, algorithms cannot do all this on their own, but they are able to support healthcare professionals from different occupational backgrounds. Digital systems can compile and evaluate the scientific knowledge found in the large number of studies available – a task that would be unmanageable for a human being. However, treatment decisions have to and should still be made jointly by doctor and patient.
In my view, the greatest political challenge is to motivate the various stakeholders involved in the healthcare system to work together in order to bring about a powerful and rapid transformation of our healthcare system. In technical terms, the greatest challenge is to make sure that the development and use of algorithms avoids treatment errors or any systematic discrimination due to distorted algorithms. From an ethical point of view, guaranteeing data protection, privacy and data sovereignty also constitutes a crucial concern.”
You and your team considered concrete application areas of algorithms for the analysis. Which ones are the most striking to you in terms of their disruptive potential – both positive and negative?
Woopen: “I see an especially disruptive potential in applications with which external actors who have not previously been involved in healthcare or health research enter the health market. Major tech companies such as Apple and Facebook possess massive amounts of data from all areas of life and on top of that, they have the technological means to evaluate and use them. Think of all the possible applications of a smartwatch or smartphone that could result from this. A patient with a weak heart can exercise because his smartwatch warns him when he is overexerting. Or an app can find out the best and quickest way for a patient to treat a headache and, if necessary, immediately organise a doctor’s appointment. If good quality is assured, this can be very useful.
It becomes more problematic when algorithms on social media calculate risk profiles for diseases, especially mental illnesses. For trained algorithms, photos and likes on Facebook, shopping lists and comments from a user on social platforms can reveal a lot about a person. But is this really the place, and are these really the key players who are best placed to take care of our mental health concerns? As desirable as the prevention and early treatment of mental disorders may be, in this particularly sensitive area we should pay particular attention to the protection of privacy and personal integrity as well as to the professionalism and quality of care.”
Which ethical questions concerning the use of algorithms should be addressed by the stakeholders of the healthcare system in the near future? Where do you see regulatory tasks for politics?
Woopen: “The ethical standards for the design of digital healthcare are not new. For the patient, it is above all a question of well-being and safety, of respecting his or her self-determination – also in the sense of his data sovereignty –, of maintaining the physical and mental integrity and of protecting privacy and delivering healthcare under conditions that do justice to his or her dignity. For health professionals, it is a matter of professional self-determination, of the possibility of fulfilling their responsibilities and of therapeutic freedom. In healthcare, attention must be paid to the equitable distribution of scarce resources, the avoidance of discrimination and the promotion of solidarity.
From a regulatory point of view and the given rapid technological development, this is not easy to implement and guarantee. We need new institutions such as data cooperatives in order to make health-relevant data available for research. We need new regulatory frameworks to enable cross-sector health networks. And we need new institutional frameworks that enable and secure the evidence-based development and control of algorithms in healthcare.”
Healthcare affects all of us. What should we, as a society, discuss when it comes to the use of algorithms?
Woopen: “As a society we should discuss how we can move towards a patient-centred, digitally supported system of evidence-based healthcare. We should also debate what is required for citizens to gain confidence in this system. In addition, we should find innovative solutions for not giving up our privacy so that large tech companies take care of our health.
Ultimately, we need to discuss what we expect from a digitalized healthcare system. How many resources do we as a society want to invest in prevention? What price are we willing to pay for medical progress? And how much solidarity do we want to maintain in the healthcare system if health insurance companies increasingly individualize their insurance coverage through behaviour-based bonus programs and premium regulations?
Christiane Woopen is Professor of Ethics and Theory of Medicine at the University of Cologne. Since 2013 she is executive director of the Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres).
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