We are currently experiencing one of the most extensive societal transformations in modern history. The ongoing process of digitalization changes not only the way we interact in healthcare but also heavily influences research and daily routines in medicine. The interdisciplinary “Bridging the Baltic network” funded by the German Research Foundation brings together historians, philosophers and physicians in the Baltic Sea region to discuss challenges and opportunities of digital health developments. Digital health and ehealth in a broad sense include new methods of processing and analyzing patient data and symptoms. Moreover, wearable devices and telemedicine offer new ways of reaching out to patients. These technologies aim at improving our abilities to diagnose, treat and to deliver healthcare whilst enhancing quality and cost-effectiveness.
After opening words by Jonatan Wistrand and Nils Hansson, HEINER FANGERAU (Düsseldorf) gave an introduction into the history of digital health. Even though digital health is often assumed to have emerged only in the 21st century, its roots can be traced back over a hundred years. The idea of characterizing health and disease by counting heartbeat and measuring blood pressure revolutionized the relationship between patient and doctor. As early as the 1920s first visions portrayed the doctor collecting and analyzing patient data from a distance. Striving for objectivity and suffering from a shortage of healthcare workers intensive care units established centralized monitoring of vital signs in the 1960s. Simultaneously the fear of the mechanization of patient care and the loss of jobs emerged in the public. Nowadays the ethical debate about chances and risks of digital transformation takes patients, physicians and politics into responsibility.
In Section I, ANETTE GRØNNING (Odense) presented a novel scheme established in Denmark in which patients can contact their general practitioner by email instead of visiting the doctor’s office. Analyzing these emails, her research focuses on the perspective of elderly patients on digital health technologies. She found many senior citizens to use this new opportunity without hesitation. Denmark currently has the highest number of email consultations per GP sent and received in Europe. Still, accessing digital technologies and using digital communication is not without challenges for some older patients. The way patients express their symptoms changes in digital communication will be further examined in the project HEIDI in collaboration with Lund University. Among participants from other countries, this interesting presentation sparked discussion in the coffee break whether answering emails could be very time consuming for GPs and whether doctors might oversee issues with patient’s health not especially mentioned in the email as GPs could get to see their patients less frequently. The concern was also raised that increased access for some patient groups might lead to decreased access to health care for other patient groups due to crowding out effects.
JOHAN NORDENSVÄRD (Linköping) shed light on how social citizenship changes when digital health becomes available from outside the country. He highlighted that digitalization might withdraw our current social contract by changing the relationship of citizens and states. It has to be taken into account that some people are still unable to access digital services, that ehealth could be used as a means of surveillance, and reduce human contacts. Liberal, social democratic and autocratic governments interpret the potential of digital health in different ways. Further research needs to analyze their different approaches to ehealth. This talk was followed by a lively discussion on differences between theory and practice.
Section II was opened by VASILIJA ROLFES (Düsseldorf). Her presentation highlighted the potential of ehealth to reduce the stigmatization of obese patients as an example of how ehealth can help in coping with today‘s challenges in healthcare. The prevalence of obesity tripled in the last 30 years. The stigmatization of patients leads to inadequate screening, prevention and treatment, further increasing the morbidity and mortality. Digital health offers the chance to include previously excluded patients by reducing stigmatization and discrimination. To reach this goal marginalized patient groups should participate in research activities.
IDA MELANDER (Örebro) used a linguistic approach to present the influence of social media on patient’s self-perception and narratives. Today patients share their experience of illness online. Their stories organize into a new narrative of disease. Narratives are changing from retrospective patient records to ongoing day-to-day broadcasting. New narratives are created emphasizing empowerment, activism and patient advocacy.
FANNY EDENROTH CATO (Stockholm) linked to the previous presentation by analyzing the way highly sensitive persons define themselves and interact on new digital platforms. Online communities in chats and blogs offer support and guidance for marginalized patient groups.
To contrast current developments in the Baltic Sea region, section III focused on international developments. NIKLAS FEIX (Düsseldorf) focused on the transformation of digital health in sub-Saharan Africa, a region that new studies describe as a breeding ground for digital health. The world‘s biggest medical drone network is located in Ghana. On one hand, patients benefit from faster and more economical deliveries of medical goods, including perishable materials like blood, while the number of staff needed is reduced. On the other hand, a critical approach is needed as African countries may turn into a testing ground for future legalization of drones in other countries. The unknown flow of data and the centralization of necessary infrastructure threaten a sustainable development of healthcare in African countries by creating dependency on private companies from abroad.
FANG YING (Düsseldorf) picked up concerns about the digitalization of healthcare by presenting a thorough analysis of the current use of electronic health systems in China (PRC). The number of users of telemedicine apps is rapidly growing, lately enhanced by the COVID-19 pandemic. Centralized power in authoritarian states can speed up digitalization. Meanwhile contact and location tracing for health purposes can transform into a mean of surveillance. Current protests against surveillance and COVID-19 policies may hinder the further digitalization of the Chinese health sector.
IDA ARVIDSSON (Lund) opened Section IV. Her talk offered an insight into the ongoing research on artificial intelligence in diagnostic use. Artificial intelligence in medical image analyzing is currently being tested in many diseases from breast, skin or prostate cancer to Alzheimer’s disease. Most common challenges in today’s development are the limited amount and variation of data, further the subjectivity of certain diagnoses based on images.
Additionally, LARS HAGANDER (Lund) explained the opportunities of using large language models in daily healthcare routines. By submitting an abstract written by chatGPT and using pictures created with the help of artificial intelligence to illustrate his slides, he demonstrated vivid examples of what AI can already achieve today. Large language models are rapidly evolving, already being able to pass major written exams. The way patients and physicians interact with and access healthcare is changed. A transformation of scientific writing and an influence on the value of written thesis’ can be expected in the near future.
The final section V was opened by JURIS SALAKS (Riga), presenting how archival work is influenced by information technology. Today huge amounts of data in archives and on the Internet promote the trend of over-information. Quantitative information itself is not of value anymore. Archives respond to this trend by using digitalization to shift from sheer data quantity to a focus on data quality. Moreover, the need for preservation, accessibility and economy enhances this development. Digitalization in archives has so far taken place in three phases. Early efforts in the 1990s were caused by newly arriving cameras, scanners and computers. Archivists developed new methods of preserving material in the 2000s, whilst the focus of digitalization shifted towards improving accessibility and user-friendliness about a decade later. Several national and international electronic archive networks are in use in the Baltic Sea region nowadays.
FELICITAS SÖHNER (Düsseldorf) and THORSTEN HALLING (Düsseldorf) aim to study the ongoing digital revolution in medicine in the Baltic Sea region with an oral history project. They trace trends of the digital development with a multidisciplinary approach through interviews, discussions, diaries and documents. Having experience and expertise from a current oral history project concerning the transfer of knowledge in the Baltic Sea region, they target to preserve first-hand reports of actors involved in the digital transition. Interested researchers are welcome to submit suggestions and to engage.
GIACOMO PADRINI (Düsseldorf), STEFAN STEHL (Düsseldorf) and NILS HANSSON (Düsseldorf) presented the curriculum they developed for an elective ehealth course at the University of Düsseldorf and for a future textbook. A successful and sustainable implementation of digital healthcare requires educating medical students. As there are currently very few courses on ehealth offered for medical students and hardly any educational resources, their planned hybrid format will make the new class one of the most innovative concepts. The course plans to include voices from scholars from Scandinavia/the Baltic Sea region.
Overall, the sixth Bridging the Baltics Symposium was a success for scientific discussion, exchange and future research collaboration. Past meetings resulted in several publications and special issues of scientific journals.1 The different perspectives on the ongoing transformation in the health sector highlighted the need for a multidisciplinary scientific approach. Further meetings are needed and planned to stay up to date with new developments and to give guidance for shaping the digitalization in healthcare in the Baltic Sea region.
Conference overview:
Nils Hansson (Düsseldorf) / Jonatan Wistrand (Lund): Welcome greetings
Key-note
Heiner Fangerau (Düsseldorf): The digitalisation of health. A historical and ethical perspective
Section I: Digital health among the elderly patients
Chair: Jonatan Wistrand (Lund)
Anette Grønning (Odense): Digital consultations in Denmark. E-mail to the general practitioner
Johan Nordensvärd (Linköping): Is there a digital transformation of elderly social citizenship and social services? The case of digitalisation and community aged care in the Baltics
Section II: Patient perspectives on digital health
Chair: Anna W Gustafsson (Lund)
Vasilija Rolfes (Düsseldorf): Stigmatization of overweight and obese patients in the Baltic Sea region. Chances and risks of digital medicine
Ida Melander (Örebro): Patient narratives on Instagram. Sharing the experience of endometriosis
Fanny Edenroth Cato (Stockholm): Biosociality in online interactions. Youths’ positioning of the Highly sensitive person category
Section III: International perspectives beyond the Baltic Sea region
Chair: Thomas Wegener Friis (Odense)
Niklas Feix (Düsseldorf): Digital health and drones: What can the Baltic Sea region learn from Subsaharan Africa?
Fang Ying (Beijing / Düsseldorf): Digital health in authoritarian states
Section IV: Opportunities and challenges with artificial intelligence
Chair: Martin Garwicz (Lund)
Ida Arvidsson (Lund): Applications of AI in medical image analysis
Lars Hagander (Lund): Attitudes towards large language models in digital health in the Baltic Sea region
Section V: Digital health in research and teaching
Chair: Erki Tammiksaar (Tartu)
Juris Salaks (Riga): Digital research of the pharmaceutical industry archives in the Baltic countries
Felicitas Söhner, (Düsseldorf) / Thorsten Halling (Düsseldorf): The oral history of ehealth
Giacomo Padrini (Düsseldorf) / Stefan Stehl (Düsseldorf) / Nils Hansson (Düsseldorf): Teaching eHealth in the Baltic Sea Region
Online talks:
Jennifer Apolinario-Hagen (Düsseldorf): Individual determinants of the acceptance of digital health interventions in Germany
Steffen Fleßa (Greifswald): Estonia as an eHealth pioneer
Nils Hansson (Düsseldorf) / Jonatan Wistrand (Lund): Publication and future perspectives
Note:
1 Nils Hansson, Medizin im Ostseeraum: Deutsch-skandinavischer Wissenstransfer im Kalten Krieg. Medizinhistorisches Journal 57,2 (2022); Nils Hansson (Ed), History of Medicine in the Baltic Sea Region. Acta medico-historica Rigensia. Special Issue, 14 (2021); Nils Hansson / Jonatan Wistrand (Eds.), Explorations in Medical History in the Baltic Sea region 1850-2015, Rochester 2019.