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      The Riyadh Declaration: the role of digital health in fighting pandemics

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          Abstract

          The COVID-19 pandemic has exposed weaknesses in health and care systems and global public health responses, some of which can be addressed through data and digital science. The Riyadh Declaration on Digital Health was formulated during the Riyadh Global Digital Health Summit, Aug 11–12, 2020, a landmark forum that highlighted the importance of digital technology, data, and innovation for resilient global health and care systems. Our panel of 13 experts articulated seven key priorities and nine recommendations (panel ) for data and digital health that need to be adopted by the global health community to address the challenges of the COVID-19 pandemic and future pandemics. Panel Recommendations from the Riyadh Global Digital Health Summit 1 Implement data-driven and evidence-based protocols for clear and effective communication with common messaging to build citizens' trust 2 Work with global stakeholders to confront propagation of misinformation or disinformation through social media platforms and mass media 3 Implement a standard global minimum dataset for public health data reporting and a data governance structure tailored to communicable diseases 4 Ensure countries prioritise digital health, particularly, improving digital health infrastructure and reaching digital maturity 5 Enable health and care organisations by providing the necessary technology to collect high-quality data in a timely way and promote sharing to create health intelligence 6 Cultivate a health and care workforce with the knowledge, skills, and training in data and digital technologies required to address current and future public health challenges 7 Ensure surveillance systems combine an effective public health response with respect for ethical and privacy principles 8 Develop digital personal tools and services to support comprehensive health programmes (in disease prevention, testing, management, and vaccination) globally 9 Maintain, continue to fund, and innovate surveillance systems as a core component of the connected global health system for rapid preparedness and optimal global responses The first priority is for the health and care sectors to adopt applied health intelligence (HI). HI represents a systematic approach and comprehensive methodology applied to the collection, linkage, analysis, and use of appropriate health data. HI is used for the surveillance, monitoring, and improvement of population and patient outcomes, and for assessing the efficiency and effectiveness of policies, programmes, and services. 1 The second priority relates to interoperable digital technology and for this technology to be scaled up and sustainable. Digital health tools and services require a secure, trusted flow of data with scalability and interoperability support. The advent of commercial cloud computing services and distributed systems has paved the way for scalable, cost-effective service provision. The third priority is to support the adoption of artificial intelligence (AI). Use of AI in health systems demands rapid access to various data types, often not possible in health-care settings with slow data flows. 2 AI also requires vast amounts of high-quality data to achieve acceptable accuracy and validity. Health-care organisations and systems need to provide the necessary technology to collect and share high-quality data. Effective communication about public health crises and risk is the fourth priority. Such communication requires an understanding of risk and the timely dissemination of information; seamless digital integration of case reports and deaths; and effective data visualisation tools such as map-based dashboards. 3 Effective communication to change knowledge, attitudes, and behaviours mandates the systematic exploration of diverse digital channels and the innovative design of digital tools for citizen engagement. 4 The fifth priority concerns health data governance, quality, policy, regulation, and use. Passively generated digital location data from mobile phones and internet services provide crucial information about human mobility and interactions. 5 However, ethics and privacy are essential and must be adhered to when using these ubiquitous data. Projections about disease epidemics require human mobility and interaction data that are aggregated in time and space to reconstruct population-level behaviour. 6 The sixth priority relates to the quality and effectiveness of digital technology for improved patient and population outcomes. Digital technologies offer many opportunities to improve the quality and effectiveness of care, patient outcomes, and population health. 7 Digital health systems should be designed and implemented to maximise data quality and access for clinicians and patients and these systems should be interoperable. The seventh priority is research and innovation. Investing in, conducting, publishing, and promoting transparent research are foundational to digital health advances that leverage data, analytics, and AI. 8 It can take an average of 17 years to translate a major medical research discovery to widespread delivery. 9 The competitive, commercial culture of technology revolves around disruptive innovation, iterative discoveries, and the delivery of new technologies over months, not years. To translate life-saving innovations in digital health into widespread applications, collaboration across the best of research and innovation in health and technology is essential. The Riyadh Declaration on Digital Health is a call to action to create the infrastructure needed to share effective digital health evidence-based practices and high-quality, real-time data locally and globally to provide actionable information to more health systems and countries. Digital and data technologies have a role in promoting the coordinated development of shared global public health policies and resilient health and care systems. These technologies can support health systems and governments to perform better in future pandemics and other global health challenges. We call on state actors to ensure that digital technology and innovation become the cornerstone of a resilient global health and care system that places individual and population health at the forefront of our future endeavours.

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          Artificial intelligence vs COVID-19: limitations, constraints and pitfalls

          Wim Naudé (2020)
          This paper provides an early evaluation of Artificial Intelligence (AI) against COVID-19. The main areas where AI can contribute to the fight against COVID-19 are discussed. It is concluded that AI has not yet been impactful against COVID-19. Its use is hampered by a lack of data, and by too much data. Overcoming these constraints will require a careful balance between data privacy and public health, and rigorous human-AI interaction. It is unlikely that these will be addressed in time to be of much help during the present pandemic. In the meantime, extensive gathering of diagnostic data on who is infectious will be essential to save lives, train AI, and limit economic damages.
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            Current challenges in health information technology–related patient safety

            We identify and describe nine key, short-term, challenges to help healthcare organizations, health information technology developers, researchers, policymakers, and funders focus their efforts on health information technology-related patient safety. Categorized according to the stage of the health information technology lifecycle where they appear, these challenges relate to (1) developing models, methods, and tools to enable risk assessment; (2) developing standard user interface design features and functions; (3) ensuring the safety of software in an interfaced, network-enabled clinical environment; (4) implementing a method for unambiguous patient identification (1-4 Design and Development stage); (5) developing and implementing decision support which improves safety; (6) identifying practices to safely manage information technology system transitions (5 and 6 Implementation and Use stage); (7) developing real-time methods to enable automated surveillance and monitoring of system performance and safety; (8) establishing the cultural and legal framework/safe harbor to allow sharing information about hazards and adverse events; and (9) developing models and methods for consumers/patients to improve health information technology safety (7-9 Monitoring, Evaluation, and Optimization stage). These challenges represent key "to-do's" that must be completed before we can expect to have safe, reliable, and efficient health information technology-based systems required to care for patients.
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              Communicating in a public health crisis

              Despite previous pandemics and reports on pandemic preparedness, 1 many countries struggle to prevent and manage public health emergencies. 2 A key component of an effective pandemic response is communication between governments, health professionals, scientists, the media, and the public. 3 A potential concern is how to maintain public trust in science and high levels of support for control measures, such as contact tracing, especially if they potentially challenge personal privacy. 4 Despite only having a short time to accumulate, the volume of published evidence on COVID-19 is extensive, making it difficult to manage and verify. Development of systematic reviews, supported by artificial intelligence and crowdsourcing, could support the rapid analysis of evidence-based measures to help communicate the need for control measures to mitigate COVID-19. 5 The COVID-19 pandemic has encouraged a new phase of real-time, peer-to-peer sharing. Data concerning diseases and outbreaks are communicated through multiple channels, providing a view of global health that is fundamentally different from that provided by traditional public health organisations. Use of online information is becoming a dominant method for the surveillance of emerging public health threats. For example, a widely used information source on the numbers of global COVID-19 cases and deaths is an interdisciplinary collaboration between several groups at Johns Hopkins University (The Johns Hopkins Coronavirus Resource Center). 6 Similarly, HealthMap concatenates information from disparate data sources, including online news aggregators, eyewitness reports, expert-curated discussions, and validated official reports, to achieve a unified and comprehensive view of current infectious diseases. 7 Global communication for future pandemics requires a novel framework. Although formal international agreements and agencies play an important part in communicating information, non-governmental groups might be able to perform a critical function in the global response to emerging diseases, and we encourage expanded use of consortia to take advantage of the strength of diverse electronic information sources and innovative means to compile and communicate information. Poor health media literacy is common, and likewise a paucity of scientific knowledge has undermined responses to the COVID-19 pandemic. We have witnessed the amplification of unverified information, which has triggered misunderstandings, reactions of fear, and a loss of trust, which can inhibit effective responses to the pandemic. In preparation for the possible resurgence of COVID-19 or the occurrence of new infectious diseases, proactive public health investment in mechanisms for compiling, verifying, and communicating information is of paramount importance to ensuring public health. Emphasis should be placed on understanding specific factors, such as how the interplay between infectious agents and humans facilitates transmission through travelling and social activities in confined environments. During periods of uncertainty, strategies for communicating evolving information need to be developed and assessed. New curricula in systems medicine and effective communication strategies that examine the factors affecting preventive behaviour should be developed and used to train health-care professionals, researchers, teachers, media professionals, and decision makers with active involvement in communicating with the general public.
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                Author and article information

                Journal
                Lancet
                Lancet
                Lancet (London, England)
                Elsevier Ltd.
                0140-6736
                1474-547X
                22 September 2020
                22 September 2020
                Affiliations
                [a ]King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia
                [b ]Public Health Scotland, Glasgow, UK
                [c ]Digital Health and Care Institute, Glasgow, UK
                [d ]IBM Watson Health, Cambridge, MA, USA
                [e ]Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
                [f ]Ministry of Health, Riyadh, Saudi Arabia
                [g ]Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
                [h ]Korea Advanced Institute of Science and Technology, Daejeon, South Korea
                [i ]University of Washington, Seattle, WA, USA
                [j ]Australasian Digital Health Institute, Melbourne, VIC, Australia
                [k ]Ministry of National Guard–Health Affairs, Riyadh, Saudi Arabia
                Article
                S0140-6736(20)31978-4
                10.1016/S0140-6736(20)31978-4
                7508497
                32976771
                c8ac8fbb-c3a5-4708-8f21-b7be1be03aab
                © 2020 Elsevier Ltd. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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