EXECUTIVE SUMMARY With the enormous progress in digital technologies, it ispossible to envision high functioning and continuouslylearning health systems that can improve resourceallocation and lower costs while advancing research,healthcare, and patient experience and outcomes. Health systems positioned for continuous learning andimprovement are increasingly able to gather and applyevidence routinely and systematically in real-time; ensurethat care delivery is optimized for the individual, includingend of life; address barriers to health equity; manage thehealth of populations; identify and control emergingdiseases; and assess outcomes to improve processes andtraining. Biomedical science will soon be able to drawupon vastly larger databases to generate new scientificknowledge and reduce impediments to healthcare forindividuals and populations. While digital health technology—e.g. bioinformatics andmedical informatics—already makes these advancesfeasible, their realization will require extensive individual,organizational, national, and international collaboration.Action is required to ensure that actors across the worlddevelop trustworthy technologies for deployment inapplications to the benefits of people at all stages of theirlives. Careful stewardship is required to ensure that thebenefits of these technologies are shared across society. Priorities requiring global cooperation include: 1) cybersecurity, safety, and privacy; 2) interoperability; 3)availability of reliable data and information; 4) securevirtual data repositories; 5) integrative analytics andpredictive modeling; 6) mathematics of learning; 7)knowledge representation and management; and 8) ITliteracy, public understanding, and ethics.

MAY 2020 G-Science Academies Statement

Digital Health and the Learning Health SystemG-SCIENCE ACADEMIES STATEMENT 2020

MAY 2020 G-Science Academies Statement

tools, we now have profound opportunities to generatenew health-related knowledge, monitor its application,predict results, and guide courses of action. Theapplication of these tools has transformative implicationsfor each of the domains that determine the health ofindividuals and populations: genetics, behaviors, socialcircumstances, physical environments, and health care.Improving health depends on our ability to understand thenature of those domains, their causal relationships, and

DEPENDENCE OF HEALTH ON RELIABLE INFORMATIONFLOW: APPLICATIONS OF DIGITAL HEALTH Health progress depends on the optimal generation andflow of reliable knowledge and information.  Digital healthis a broad term applied to a range of digital tools to record,organize, store, analyze, link, and share information—text,images, signals—for use in observing, assessing, learning,managing, and improving the healthcare of individuals andpopulations. (Figure 1). With the development and rapid growth of these digital

analyzers), monitors (e.g. cardio-pulmonary), and manyothers functioning through digital signals that generatedata with the potential for more integrated insights, andfor better and faster integration in individual care. Application in medical treatment includes use of decisionaids, predictive modeling, care coordination, doseregulators, and 3D printing of organic matrices treatingconditions such as burns or joint damage. Genomic data

Figure 1. Evolving applications of digital technology in health Source: National Academy of Medicine, Digital Health Action Collaborative, 2019.

the health effects of their interplay, as well as our abilitiesto share information across domains in operations andlearning processes.   Health care. Movement of patient health records ontodigital platforms offers enhanced prospects for moreeffective care for individuals, both within and among caresites, as well as for greater individual and familyinvolvement and control in the care process. Diagnostictools are increasingly developed on digital platforms, withimaging systems, lab on a chip (blood and serum chemistry

assume an increasing role for cancer prevention,diagnosis, and targeted treatment. Digital monitoringtechnologies allow real-time assessment in settingsranging from intensive-care units to daily activitiesthrough wearable devices. Cardiovascular diseases andmedication adherence are examples in which monitoringcan be improved. A basic application of digital technologyis for patient safety. Harm to patients can result not onlyfrom human factors but also from system technicalincompatibilities, disjointed communication, orbreakdowns. All applications can benefit from digitallybased safeguards. Digital health technology carries thepotential to support continuity of care among providers aswell as during care location transitions. Remote site care access. Digital remote-site healthmonitors, including cell phones, smartwatches,implantable devices, and signal enabled clothing, are nowused in the real-time assessment of a patient’s condition.Telemedicine advances provide consultation outsidecustomary healthcare-organization care sites. Rapidlyevolving remote-site treatment, even for acutemanagement, now includes wearable and implantablesensors and medical devices, e.g. cardioverterdefibrillators. Remote robotic surgery, using wirelessnetworking, allows surgeons the prospect of performingoperative procedures at a distance. The hospital-in-the-home is an increasingly accepted practice. Promotion and protection of health. Digital health hasenabled enhanced personal risk identification, which canbetter pinpoint and predict individual vulnerabilities.Digital health has improved the ability of individuals tomonitor their own exercise, diet, pulse, blood pressure,weight management, menstruation, sleep patterns, andstress management, meaning increased engagement andcontrol over one’s personal health. On a population-wide scale, disease and injury surveillancedraws directly on digital health capacity. Electronic casereporting automates the flow of data between providersand public health agencies about disease and preventableconditions (e.g. through immunizations). Geospatial andenvironmental sensors provide insights into factors suchas environmental exposure, neighborhood risks related tosocial determinants of health, and impacts of the builtenvironment, such as inaccessible sidewalks leading tosedentary habits. Geo-trackers embedded in inhalers, forexample, can help pinpoint sites and conditionsendangering asthma patients.

Discovery, innovation, and knowledge development. Asvery large data sets and exploration tools evolve, morestructured and systematic generation of hypotheses andvirtual testing will be enabled. This will acceleratedevelopments in arenas such as genomics  (understandingthe nature and function of  genomic factors that shapehealth, including gene mutations, differential geneexpression, and epigenetics); integrative analytics andpredictive modeling, through artificial intelligence, withexpert systems natural language processing, and machinelearning; and protocols for data repositories. REQUIREMENTS FOR PROGRESS: SECURE AND RELIABLEDIGITAL HEALTH INFRASTRUCTURE With potential applications of digital health technology ofthe breadth noted above, certain operational preconditionsmust be met, both to facilitate attainment of the potentialand to safeguard against possible risks. Figure 2 offers agraphic representation of the facilitative and governinginfrastructure required to steward the development andapplication processes.

MAY 2020 G-Science Academies Statement

Figure 2. Infrastructure requirements for progress in digitalhealth

Cybersecurity and privacy. There are many challenges, andrisks to achieving the potential benefits from advances indigital health. Sustained multi-sector, multi-site, and multi-national collaborative efforts are required to develop and 

MAY 2020 G-Science Academies Statement

trusts. A basic, related need is development andcultivation of the digital health workforce, which is acutein most countries. This is especially critical for developingcountries that have limited infrastructure, digitizedrecords, weak data security systems, and often lose thefew trained workers they have. The training challenge forleveraging digital health is vast—in health care, publichealth, and biomedical science. Equity, ethics, and public engagement. Health data areintensely personal. Capturing the full potential from digitalhealth will require a much deeper understanding andappreciation at the individual level.   Responding to thepublic demand for progress and participation in buildingthe digital health frontier is a compelling priority. Therapid development and application of digital health is alsoaccompanied by the need for vigilance on ethical issuesranging from unauthorized access to misuse of personalinformation. Capacity building remains an essentialcomponent of global progress in health.  In a data centricapproach, developing countries may suffer from lack ofdigital data to make intelligent decisions. Carefulstewardship is needed to ensure that the benefits ofdigital health are shared across society and the globe.

BROAD PRIORITIES To realize the benefits that digital health offers toenhance the human condition, individually andcollectively, systemic and dedicated collaboration isrequired across fields, sectors, and nations. The followingare identified as key priorities in this respect. 1) Cybersecurity, safety, and privacy: technical,governance, and legal protocols and standards, as well asinter-governmental agreements for the safety, security,and privacy of the digital health infrastructure, ensuringproper ownership of personal data. 2) Interoperability: standards to ensure seamless deviceinterfaces and reliable information exchanges. 3) Availability of reliable data & information: standardsand curation protocols for data and information, includingtools to track provenance, and improvements in theamounts and quality of open data. 4) Secure virtual data repositories: structure andmaintenance guidelines, as well as storage, access, andrelease requirements to safeguard the operationalintegrity and security necessary for the virtualfunctionality of data repositories.

apply creative solutions. A major priority for nations andhealth organizations is the collaborative development andimplementation of system security protocols. Technicaland process safeguards are essential to ensure thatindividual privacy is protected in accordance with individualwishes. Approaches are needed to share immutablerecords of transactions among network participants.Blockchain may offer one such approach. Interoperability. Just as the flow of information amongcare sites is a basic requirement, the connectivity andcommunication among devices is an essential prerequisitefor patient safety. Incompatible interfaces can and havehad catastrophic consequences. Health Level SevenInternational (HL7), a non-profit standards organization forthe exchange, integration, sharing and retrieval ofelectronic health information, has created a promising setof international interoperability standards (e.g.  HL7 onFast Healthcare Interoperability Resources). Suchstandards allow information to be shared and processed ina consistent manner. Full functionality will require actionby all health care providers, as well as internationalcollaboration. Data reliability, storage, and access.  The most basicdeterminant of the utility of digital health is dataavailability, quality and reliability. This requires standardsand curation protocols for data and information (e.g. FAIRprinciples) to ensure their seamless utility acrossinstitutions, languages, and jurisdictions.  Structure andmaintenance guidelines as well as internationalcooperation is essential.  Equally important are protocolsfor data storage, access, control, sharing, and use. Inprinciple, authority over individual data lies with theindividual from whom they derive, and access to andcontrol of use belongs to the individual or their designee.Every step in the use of information, however, generallyrequires an element of ceding control, as well as thepotential for value to be added. Economic, legal,philosophical and practical issues must be addressed. Thedifferences that exist among nations concerning dataaccess, control, and monetization clearly present limitingcircumstances for the contributions of digital health. Thus,mechanisms for ongoing cooperative exchange areneeded. Data science and artificial intelligence. There is a clearneed to invest in the capacity and cooperation necessaryto foster advances in data science and artificialintelligence. This will require developing data-sciencetools as well as developing the pathways, agreements, andprotocols for establishing curated virtual health-data

MAY 2020 G-Science Academies Statement

5)  Integrative analytics and predictive modeling: artificialintelligence tools (including machine learning and deeplearning) that are transparent to clinicians and patients, tomine large and heterogeneous databases for insights forindividuals and populations as well as to serve in digitaldecision support systems. 6) Mathematics of learning: computational algorithms andmathematical models are foundational to the applicationof machine learning approaches to biologic processesthat highly variable, introducing epistemic uncertainty andrequiring novel adaptive mathematical concepts andappropriate context sensitivity.

7)  Knowledge representation & management: informationmanagement software and tools for access, vetting, anddelivery of information 8) IT literacy, public understanding, and ethics: publicdialogue about digital health, bringing a range ofstakeholders into the policy process as part of agovernance system that builds trust and maintainsvigilance and safeguards against abuses and unintendedconsequences, and in which the public can haveconfidence.

Academia Brasiliera de CiénciasBrazil

Indian National Science AcademyIndia

Deutsche Akademie der NaturforscherLeopoldina, GermanyNationale Akademie derWissenschaften

The Royal Society of CanadaCanada

Academié des SciencesFrance

Science Council of JapanJapan

The Royal SocietyUnited Kingdom

Korean Academy of Science andTechnologyKorea

Accademia Nazionale dei LinceiItaly

Indonesian Academy of SciencesIndonesia

Nigerian Academy of ScienceNigeria

Global Young Academy

The National Academy ofSciencesUnited States of America

Chinese Academy of SciencesChina