Keywords
One digital Health - one health - digital health - informatics - eHealth - medicine
- veterinary medicine - ecology - green computing - sustainable development - environmental
monitoring - education - patient engagement - citizen science - data science - smart
growth
Celebrating “One Health” is great, but …
Celebrating “One Health” is great, but …
Each year on November 3rd, we “celebrate” One Health day [[1]] throughout the world. This is an important initiative to give scientists a town
square where they can share their challenging questions, research, and understanding
of health and environment with the public, under the overarching concept of One Health
[[2], [3]]. Nevertheless, one day per year is insufficient to raise awareness of issues such
as environmental pollution and climate change impacting human and animal health, the
risk of emerging infectious diseases and viruses associated with the spread of antimicrobial
resistance (e.g., reducing the chances of treatment efficiently), or the lack of prophylactic
solutions (e.g., vaccines). Population education and engagement are essential to enhance
understanding of what One Health is and why everyone needs to take care of themselves,
others (i.e., humans and animals), and ecosystems near and far.
…we need to be more digital…
…we need to be more digital…
The achievement of the 17 health-related sustainable development goals comprised in
the WHO’s 2030 Agenda [[4]] requires the development, to a worldwide extent, of networked infrastructures connecting
physical devices with computing systems for data collection, processing, exchange,
and analysis, with the scope of addressing critical global health issues, such as
antimicrobial resistance, infectious disease outbreaks, and natural disasters.
Developing a correct understanding of what One Health is, means (also) exploring and
using digital ways capable of providing the opportunity to develop a consistent approach
to “Management of Information, Communication and Knowledge” (or MICK [[5]]) flows. The scope is to develop and improve communication effectiveness and efficiency
between all health-related professionals and consumers (e.g., patients, caregivers,
but also healthy people for follow-up and activity tracking).
Digitalization in healthcare means, on the one hand, heading towards 4P (Predictive,
Preventive, Personalized, and Participative) medicine for humans and animals [[6], [7]]. From an environmental viewpoint, it involves accurate real-time monitoring and
warning of hazardous events, but also predicting short- and long-term weather and
climate change, evaluating the need to develop, update, or replace governance policies
and regulations.
Far from being a mere label, Informatics for One Health embodies the will to endow
One Health with computational tools to support active prevention and management of
zoonotic diseases on a global scale, and aims even more to build an integrative, multi-
and inter-disciplinary Public Health approach to understanding communicable diseases
[[8]]. By extension, the One Digital Health [[9]] framework looks at digitalization:
-
on the one hand, as a way to magnify the One Health approach by providing it with
an augmented technological workaround, and
-
on the other hand, as a systematization of Digital Health by integrating the management
of data, information, and knowledge, over the existing humans’, animals’, and ecosystems’
(herein, to be understood such as aquatic, wooded, industrial, and urban) health silos.
… and digitalization needs to be green
… and digitalization needs to be green
Technologies are changing the world. Such a change must aim at improving the quality
of life for humans and animals. It demands as well to manage natural resources in
such a way that any negative impact is minimalistic and viable, such as supporting
health systems that reduce their significant greenhouse gas (GHG) emissions [[10]]. Therefore, we need to encourage, develop, educate, train, produce, and maintain
medical informatics and digital health activities, services, and products for modeling
healthcare informatics solutions that are as eco-friendly and green as possible, to
get to “green by design” digital systems [[11]]. These tools are meant to help face the challenges coming with the One Health approach,
typically arising from the intertwined human, animal, and environmental spheres, and
improving the original autonomy-based idea of Smart Planet [[25]]. In detail, the tools should allow figuring out and deploying interoperable smart
healthcare ecosystems capable of seamless, secure health data exchange and processing.
However, digitization is challenging as it involves the design, development, and production
of new systems, services, products, and thus new abilities, competencies, research
fields, and practice fields. Even though from this point of view, One Digital Health
is looking over the technological and informatics prisms. The combination of the three
ODH perspectives (i.e., “individual health and wellness”, “population and society”,
and “ecosystem”) and its five dimensions (i.e., “human and veterinary healthcare”,
“environment”, “education”, “citizen’s engagement”, and “healthcare industry 4.0”)
allows many opportunities to improve and change our personal, professional, and institutional
behaviors. These opportunities then provide and obtain better healthcare-related services
and products in a more responsible way, and protect and restore the quality of our
neighborhood ecotopes and ecosystems.
One Digital Health is a Framework for Eco-friendly Medical Informatics and Digital
Health
One Digital Health is a Framework for Eco-friendly Medical Informatics and Digital
Health
Thus, implementing a digitization project to somehow boost One Health initiatives
cannot be separated from supporting a “green-driven” One Digital Health, whose peculiar
features can help to: (i) develop and enhance professional abilities and product features
to “think green”; and (ii) work out critical questions such as which potential financial
sources will be able to support the different costs at each step, or how to set up
the right budget, and for how long.
Education and Human & Veterinary Healthcare
“Providing the right information at the right time at the right place” [[12]] by the right user (i.e., professional, patient, caregiver), and using the right
technology is not trivial.
In this regard, it is essential to educate and train the next generations of healthcare
professionals (whoever they may be) and health-related service customers in the use
of digital technologies. In first place, it is crucial to train both categories to
choose the most suitable technology for a need by considering its short-, mid-, and
long-term ecological impact. On the other hand, an important focus must be on engineering
and informatics: a lesson in “eco-friendly thinking” of utter importance to be learned
concerns, in fact, the awareness of the need to reduce the often (excessively) resource-consuming
processes of coding and “ideation-proof of concept”.
Enhancing students’ education and training allows them to think carefully about algorithm
design and validation before coding and running programs. The enhancements can substantially:
-
reduce energy consumption,
-
slow down the hardware, and thus
-
reduce the need to renew electronic components.
In other words, future health informaticians and digital health professionals must
return to the basics to reduce ecological fingerprint of the field.
Citizen and Industry 4.0 Engagement
The considerable volumes of data generated by the use of digital services (e.g., websites,
applications) and products (e.g., smartwatches, electronic tensiometers, imaging systems),
especially in the context of Smart (Healthy) Cities, while witnessing active citizen
engagement and participation, now need to undergo a “Smart Choice” process [[13], [14]] in order to decrease the overuse and misuse of exams (for both humans and animals
[[15]]) and treatments [[16]], especially if involving health technologies. While, on the one hand, healthcare
professionals are already called upon to follow training paths to develop critical
thinking about digital solutions in their practice, on the other hand, customers of
healthcare services (i.e., patients and their caregivers) also need to learn how to
understand advertisements and buy what is actually necessary for them [[17]].
The industry, which is one of the drivers of medical informatics, has to conduct its
current digital revolution, also tackling the One Health paradigm. This means pursuing
a commitment to the development of standards and best practice guidelines to realize
systems and products (from conception to recycling via production and distribution) that cause the least possible impact on the environment
- e.g., by looking at optimizing the development of tools designed to consume the
least amount of computing time and resources [[18]].
Environment
Many critical phenomena persist around us. It is the case of e.g., antibiotic resistance
- also known as antimicrobial resistance or AMR, as the ability of pathogens to not
react to drugs that must eliminate them. Animal and human excrement that contain antibiotics
and antibiotic-resistant pathogens are disseminated in natural ecosystems from agricultural,
industrial, and urban sewage systems. Such pathogens are then found in all natural
water resources (from streams to oceans), and first have an impact on the life of
aquatic systems by inducing a broad fragilization of aquatic fauna and flora before
returning to humans [[19]].
Monitoring and evaluating the level of risk connected to the impact of AMR on living
beings can mainly result, from a One Health’s point of view, in an active support
role in the prevention, preparedness, response, and mitigation phases, as formalized
in the Disaster Management Cycle [[20]]. Shifting to One Digital Health, the original intentions are somehow “upgraded”—e.g.,
the capacity to design, develop and use decision support systems - to improve the
personalization of the prescription process to reduce the misuse or overuse of broad-spectrum
antibiotics with poor outcomes [[21]]. Even better, developing digital education tools may avoid the unjustified use
of antibiotics (e.g., the use of antibiotics for treating influenza) [[22]].
Conclusion and Take-home Message
Conclusion and Take-home Message
The One Digital Health concept blends two existing frameworks under one roof: Digital
Health and One Health. This kind of synergy aims to create a functional and dynamic
framework to track potential environmental hazards and prevent (if necessary, confront)
potential health-related crises that may arise. All this needs to combine the existing
methods, infrastructures, and long-term experience stored in health-related platforms
(such as Electronic Health Records, Patient Health Records), environmental and ecological
monitoring platforms, social media services, the Internet of Things, and more “big
data” resources. The main goal of One Digital Health is to provide every relevant
scientific community and the grand public with an efficient and straightforward framework
for everyone to contribute to and benefit from improvements in assessing and treating
health and ecological issues as a whole, in a FAIR and smart way [[23], [24]]. In any case, it is critical to keep in mind that, to be “green” and “responsible”,
all the health-related devices, systems, and processes allowing monitoring, data collection,
storage, analysis, and (re)action must be developed in such a way that the ecological
fingerprint is as small as possible at every steps.
