Rebooting consent in the digital age: a governance framework for health data exchange

Macro and micro ethics in fetal and embryological collections: Exploring the paradigms of informed consent among Australian education-focused stakeholders

The management of human fetal and embryological collections presents an ethical challenge that can be explored from different perspectives, particularly when considering informed consent. The "micro ethics" level focuses on parties engaged in giving and receiving human tissue while the "macro ethics" level focusses on the collective responsibility of the discipline and society. Additionally, adopting a framework, where ways of working are designed with relevant communities, requires understanding the perspectives of individuals, communities, and organizations. The aim of this study therefore was to assess the perceptions of education-focused Australian stakeholders. A survey collected the perspectives of 198 participants. The majority of participants (61.6%; n = 122/198) indicated that human fetal and embryological remains obtained prior to era of informed consent should be retained for use in education/research. It is likely that their perspective is based on the notion that if human fetal and embryological collections are used for good, then disposing of them would deny this benefit. Women (p < 0.001) indicated a preference for obtaining fetuses and embryos with informed consent for education and research (38.4%; n = 76/198). Majority were in favor of recording both maternal (MI) (59.6%; n = 118/198) and paternal information (PI) (58.1%; n = 115/198) with each donation. Majority (56.1%; n = 111/198) expressed that donations should be accepted from both parental sources. Consideration of stakeholder perspectives is important in developing guidelines regarding these collections. The results from this study demonstrate a level of discomfort with respect to collections without informed consent, which should be considered at the macro ethical and micro ethical level.

The role of remote data capture, wearables, and digital biomarkers in decentralized clinical trials

Decentralized clinical trials (DCTs) are gaining momentum in clinical research as these studies can be executed remotely through telemedicine and mobile/local health-care providers. The COVID-19 pandemic has further accelerated advances and adoption in this area. In the past few years, there has been significant development and growth in the use of remote data that are electronically transmitted from a clinical trial (CT) participant, from outside the clinical setting, to a data repository. Such data may include laboratory data, safety data, or outcome measures reported by the participant, the clinician or the observer. Similarly, wearable health monitoring devices are being increasingly used in health-care and CT settings. Digital biomarkers, which can support continuous measurement of physiologic parameters outside the physical confines of the clinical environment, are also creating new and improved opportunities for patient care and biomedical research, enabling remote monitoring and DCTs. There are several benefits to using remote data capture, wearables, and digital biomarkers in clinical health-care research; however, several questions and challenges still need to be addressed. In an effort to understand the adoption of these technologies in DCTs, and the challenges therein, the authors of this workstream conducted an online survey of clinical research stakeholders across India and reviewed 80 responses. The review article summarizes the key findings from this online survey.

Patient Perspectives and Preferences for Consent in the Digital Health Context: State-of-the-art Literature Review

BACKGROUND

The increasing integration of digital health tools into care may result in a greater flow of personal health information (PHI) between patients and providers. Although privacy legislation governs how entities may collect, use, or share PHI, such legislation has not kept pace with digital health innovations, resulting in a lack of guidance on implementing meaningful consent. Understanding patient perspectives when implementing meaningful consent is critical to ensure that it meets their needs. Consent for research in the context of digital health is limited.

OBJECTIVE

This state-of-the-art review aimed to understand the current state of research as it relates to patient perspectives on digital health consent. Its objectives were to explore what is known about the patient perspective and experience with digital health consent and provide recommendations on designing and implementing digital health consent based on the findings.

METHODS

A structured literature search was developed and deployed in 4 electronic databases-MEDLINE, IEEE Xplore, Scopus, and Web of Science-for articles published after January 2010. The initial literature search was conducted in March 2021 and updated in March 2022. Articles were eligible for inclusion if they discussed electronic consent or consent, focused on the patient perspective or preference, and were related to digital health or digital PHI. Data were extracted using an extraction template and analyzed using qualitative content analysis.

RESULTS

In total, 75 articles were included for analysis. Most studies were published within the last 5 years (58/75, 77%) and conducted in a clinical care context (33/75, 44%) and in the United States (48/75, 64%). Most studies aimed to understand participants' willingness to share PHI (25/75, 33%) and participants' perceived usability and comprehension of an electronic consent notice (25/75, 33%). More than half (40/75, 53%) of the studies did not describe the type of consent model used. The broad open consent model was the most explored (11/75, 15%). Of the 75 studies, 68 (91%) found that participants were willing to provide consent; however, their consent behaviors and preferences were context-dependent. Common patient consent requirements included clear and digestible information detailing who can access PHI, for what purpose their PHI will be used, and how privacy will be ensured.

CONCLUSIONS

There is growing interest in understanding the patient perspective on digital health consent in the context of providing clinical care. There is evidence suggesting that many patients are willing to consent for various purposes, especially when there is greater transparency on how the PHI is used and oversight mechanisms are in place. Providing this transparency is critical for fostering trust in digital health tools and the innovative uses of data to optimize health and system outcomes.

The COVID-19 pandemic: an opportunity to strengthen telemedicine in low and middle-income countries

IMPACT

During the peak of the COVID-19 pandemic the healthcare systems of several countries came under strain and were even crippled, especially in LMICs, necessitating the exploration of alternate mechanisms for scaling-up healthcare services. Telemedicine can be an invaluable modality for complementing standard modes of pediatric healthcare delivery, not only during crises like the COVID-19 pandemic, but also for reducing the inequities that exist in access and delivery of pediatric healthcare in LMICs. A well-coordinated approach in health policy, development of infrastructure, and effective community participation is required for effective integration of pediatric telemedicine in LMICs healthcare systems.

Approaches to priority identification in digital health in ten countries of the Global Digital Health Partnership

BACKGROUND

To promote shared digital health best practices in a global context, as agreed within the Global Digital Health Partnership (GDHP), one of the most important topics to evaluate is the ability to detect what participating countries believe to be priorities suitable to improve their healthcare systems. No previously published scientific papers investigated these aspects as a cross-country comparison.

OBJECTIVE

The aim of this paper is to present results concerning the priorities identification section of the Evidence and Evaluation survey addressed to GDHP members in 2021, comparing countries' initiatives and perspectives for the future of digital health based on internationally agreed developments.

METHODS

This survey followed a cross-sectional study approach. An online survey was addressed to the stakeholders of 29 major countries.

RESULTS

Ten out of 29 countries answered the survey. The mean global score of 3.54 out of 5, calculated on the whole data set, demonstrates how the global attention to a digital evolution in health is shared by most of the evaluated countries.

CONCLUSION

The resulting insights on the differences between digital health priority identification among different GDHP countries serves as a starting point to coordinate further progress on digital health worldwide and foster evidence-based collaboration.

Human Rights Implications of the Digital Revolution in Health Care in India

The COVID-19 pandemic has ushered in rapidly evolving developments in digital health, and governments around the world are experimenting with different ways of introducing technological tools in the management and delivery of health care services. India, among the countries that faced one of the most serious outbreaks in the second wave of the pandemic, recently rolled out the National Digital Health Mission, which promises an integrated but federated digital architecture and a digital health ecosystem that will solve the information asymmetries of the health care sector in India. While the promises of the National Digital Health Mission are many, India's experience with using another digital tool during the pandemic-the CoWIN portal for vaccine management-alerts us to the human rights concerns of rapid introductions of digital tools to address infrastructural and governance challenges in health care. This paper attempts to take a closer look at these two digital tools and the potential human rights implications of the National Digital Health Mission, particularly for the right to health.