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The Futures of Telemedicine: Knowledge, Policy, Regulation

Digital health cards, electronic health records, medical telematics infrastructure – these are the terms dominating the public and political debates on the digitalization of the health care system in Germany. At EU level, electronic health services (eHealth) are also seen as a great opportunity. As part of its digital health and care strategy, the European Commission expects to improve public health by facilitating greater cross-border healthcare access, enabling citizens to access their health data and researchers to share patient data and medical expertise across the EU. Digital tools are expected to provide efficient, user-friendly and widely accepted electronic health services.

At the same time, eHealth applications and services have become an important market within the digital economy, with an estimated global turnover of around 18 billion euros in 2018. Well-known applications range from medical patient counseling and consultations or self- monitoring devices to virtual expert networks. Technological paradigms such as the “Internet of Things”, “Artificial Intelligence” or “Smart Devices” are increasingly integrated into research and development goals of eHealth applications, also promoting medical (self-)surveillance and control.

The diagnostic or therapeutic use of digital technologies has a strong effect on doctor-patient relationships and therefore affects the level of acceptance of these new technological solutions. In addition, eHealth applications and practices produce, store and evaluate highly sensitive data on individuals, resulting in a particular need for legal and regulatory frameworks.

In this context, the project “The Futures of Telemedicine: Knowledge, Policy, Regulation” focused on two closely interwoven research perspectives:

1. Social norms, standards and acceptance

The project looked at how and to what extent political institutions or companies define the development targets in the field of telemedicine and eHealth. It focused on country-specific cultural and social differences in order to gain insight into which practices of medical surveillance are considered either acceptable or a violation of personal privacy. With eHealth applications, a comprehensive knowledge of individuals was produced that extended beyond medical contexts and allowed for far-reaching conclusions about behavioral patterns, personality traits or psychological dispositions. Therefore, it was necessary to critically assess the data that has been collected and the extent to which individuals were subjected to evaluative and normative processes.

2. Challenges for regulation and legislation

Globally operating digital networks pose particular challenges for the regulation of eHealth services and practices. The project examined existing problems in the fields of patient data protection, cybersecurity or liability in national and transnational contexts. In concrete terms, for example, the regulation of data protection or liability often remains vague with “therapeutic service providers” operating from abroad, thus inducing a need for analyzation. At the same time, another research objective was to analyze how the culturally specific levels of social acceptance can be taken into account in legislation and regulation. This includes knowledge about individuals that extends beyond medical contexts and is in need of special protection.

The project was funded by the Silicon Valley Community Foundation through a research fund provided by Cisco Systems.

Duration07/2018 – 06/2019
FundingSilicon Valley Community Foundation/Cisco Systems

Edited works

Bächle, T. C., & Wernick, A. (Eds.) (2019). The futures of eHealth. Social, ethical and legal challenges. Berlin, Germany: Humboldt Institute for Internet and Society. Publication details

Book contributions and chapters

Wernick, A., & Klünker, I. (2019). Prohibitions on long distance treatment: Historical roots and continuities in limiting the use of electronic telemedicine. In T. C. Bächle, & A. Wernick (Eds.), The futures of eHealth. Social, ethical and legal challenges. (pp. 169-177). Berlin, Germany: Humboldt Institute for Internet and Society. DOI: 10.5281/zenodo.3297377 Publication details

Klünker, I. (2019). Conference report: Markets for eHealth – Perspectives from innovators and entrepreneurs. In T. C. Bächle, & A. Wernick (Eds.), The futures of eHealth. Social, ethical and legal challenges. (pp. 99-102). Berlin, Germany: Humboldt Institute for Internet and Society. DOI: 10.5281/zenodo.3297185 Publication details

Lectures and presentations

Regulatory, ethical and social aspects of emerging eHealth technologies
Symposium on eHealth: Trends and Innovations. Center of International Health, Center of Advanced Studies at LMU Munich. Center of International Health, Ludwig Maximilians Universität, Munich, Germany: 06.03.2020 Further information

Alina Wernick

Personal data in eHealth
Urban Knights Salon. Prof Teresa Dillon in partnership with Southwest Creative Technology Network, Watershed and DCRC, University of the West of England. Watershed, The Workshop, Studio 5, Bristol, UK: 09.01.2020 Further information

Alina Wernick

Testing AI for health - introduction to legal questions
Workshop on Artificial Intelligence for Health & ITU. International Telecommunication Union, World Health Organization. EPFL SwissTech Convention Center, Lausanne, Switzerland: 22.01.2019

Alina Wernick

Smart Health? Zur Ästhetik medizinischer Arbeitsmedien und der „Gig Economy" digitaler Gesundheitsindustrie
Jahrestagung der Gesellschaft für Medienwissenschaft zum Thema „Industrie“. Universität Siegen, Siegen, Germany: 28.09.2018

Thomas Christian Bächle

Organisation of events

The Futures of eHealth - Social, legal and ethical challenges
From 29.04.2019 to 30.04.2019. Festsaal, Humboldt Graduate School, Berlin, Germany (International)

Niklas Trinkhaus, Irma Klünker, Alina Wernick, Thomas Christian Bächle