COVID-19 and eHealth standards

As nobody can have missed, the world is under sustained pressure resulting from the COVID-19 pandemic. At ETSI the eHealth group has been trying to work out what the response of the standards world should be. Whilst we have active work items at ETSI looking at the development of the underlying use cases for diagnostic and therapeutic eHealth, and at the requirements for data in support of eHealth, neither of these explicitly addresses the COVID-19 associated crisis. So as part of our response Suno Wood and myself have been working away at a white paper, to be published by ETSI, but presenting a personal opinion. I'm using this blog post to review a few of the points from the white paper, sometimes in a much more forceful way too. 

COVID-19, and pandemics of the same scale, are rare, but even rarer is a health crisis that affects every citizen of our modern, interconnected world leading to a global, economic crisis. Far-reaching political decisions are being made and changed daily. These are supported by data supplied by communications systems and advanced medical technology. But this has not been enough to significantly stem the flow of the crisis.

There are not a lot of positives here and to try and make a silk purse from a sow's ear is not going to help. Our entire society has been caught out by the COVID-19 pandemic and the impact will be felt for many years to come. Confidence in leaders has been impacted, and not just our political leaders, but also our technology leadership. There is no denying the economic cost. There is no denying the human cost. There is no denying the societal cost. One of the few positives we can draw upon is that we can be better prepared next time around, as of course there will be a next time.

The cost in human life of COVID-19 is horrifying: Over 300,000 deaths have been reported worldwide and the mortality rate is now varying from 7% to 19% (the final figures may never be known). I've been using the figures from worldometer for this but many other sources exist.

The flow of data that has been key to public health decisions, whilst offered freely, is often offered without proof of its provenance. An error a school child would not get away with when presenting work for assessment is leaking through to our decision makers. On January 31st 2020 when the pandemic was declared by the WHO all of us should have been in the front line to mitigate the impact. To a large extent however we have continued to drive full pelt to the brick wall in front of us in a vague hope it'll go away before we hit it. It hasn't. Rather we've relied on the crumple zones and airbags of a robust and resilient citizenship to buffer the worst effects of the impact.

One of the many buffers we have come to rely upon is our suite of ICT technologies. Using remote working many of us continue to contribute to worthwhile economic activity, and others use the same technology to remain in contact with friends and family. Many of us rely on the entertainment offered online to maintain a modicum of sanity by simple distraction from the horrors all around.

This blog post is not going to suggest we can solve the myriad of problems of a pandemic at the flick of a switch. What it will suggest is that we ought to be readying our ICT response for the next time this happens. This means using our knowledge of ICT to improve health outcomes for all. This applies to using ICT in diagnosis, in testing, and in therapy. ICT also has a place in maintaining the effectiveness of the quarantine that is all too necessary in containing any virulent contagion.

A pandemic is no respecter of human defined borders. Whilst much of our technology enjoys regional protection, that same protection may act as a barrier to the flow of data and of core technology that may mitigate the worst effects of a contagion. Similarly, complex regulation that surrounds the use of medical devices may act as an unseen barrier that only becomes visible at the worst possible moment. 

However there are simple steps which are worth taking immediately and these are at the heart of our white paper proposal to ETSI: 

1.      An Ethical code and standpoint – the standards that ETSI produce shall follow a general principle of "doing no harm". Additionally the standards that ETSI produce shall encourage a safe, private, and secure society by the use of effective ICT standards.

2.      ETSI shall lead by example to ensure that all standards including those from its partner SDOs are freely and widely available to ensure that standards can never be cited as a barrier to development of solutions.

3.      ETSI and its partner SDOs should work to resolve any uncertainty regarding legislation that applies to the use of ICT in a medical or health care environment, in order to ensure that when ICT standards are designed with the assumption that they will be applied in a health environment, that they can be deployed in such environments.

4.      ETSI and its partner SDOs have to actively engage with the health domain (and vice versa). The response to date of both sides of the debate suggests there is a deep concern and reluctance to get involved, and therefore any barriers to engagement have to be exposed and carefully removed.

These are all small steps but if they are taken they act to make a positive stance of ETSI and any others that adopt the same principles towards social responsibility in eHealth. 

The lesson to ingest from this is the following:

Whilst very little of ICT is eHealth specific, all of eHealth depends on ICT. If eHealth is to be ubiquitous then all technical specifications for the ICT infrastructure have to be eHealth ready. In short ICT standards should be designed with the assumption that they will be applied in a health environment.

This is a complex lesson to learn and if will be difficult to implement. However if, next time around, we cannot apply our ICT capabilities as they fail to be health ready, then we have failed. We should never aim to fail.

Again I have to thank Suno for helping in getting this text together. Whatever comes of this we will continue to do our utmost in making eHealth standardisation a reality and drive it to societal benefit.

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