already familiar and is beginning to be used in routine clinical care (for example, smart inhalers,
oximeters, hand-held spirometers) while other devices (such as activity trackers) are familiar in
day-to-day life but have useful medical application. Medical assistive robots are already familiar
aids for surgeons and when designed with anthropomorphic features, are demonstrating their
potential to support social tasks for the frail or housebound [40].
We also consider the range of technology in the pipeline that could be deployed in the future to
support clinical practice. These offer exciting opportunities but may also present major
challenges whilst current practice adapts to new ways of working. The increasing collection of
data offers opportunities for observing real-world practice and may be used to improve the quality,
safety and efficiency of healthcare delivery, but collation from multiple sources is challenging,
and the format of feedback is crucial if it is to effect change [42]. AI, already a feature of
imaging and radiology, is set to “feed” on this explosion in data and will increasingly play a
role in healthcare, reassuringly facilitating rather than replacing healthcare professionals [43].
Virtual, augmented and mixed reality is another powerful tool to improve diagnostics.
In this increasingly digital world, regulation is essential to set quality standards, enable
interoperability and ensure safe use as well as protect individual privacy and prevent
inappropriate access [44].
Social challenges of digital respiratory healthcare
Underpinned by rapid technological development, and promoted by policy, healthcare in Europe
and globally is undergoing a major digital transformation [2] that will affect the historical
dynamics between healthcare professionals and patients, and will impact on the way healthcare
is delivered. The second section of the Monograph (chapters 7–12) addresses the social
challenges of digital respiratory healthcare for the individual patient, their healthcare advisor
and society at large [32, 45–49].
Increasing inequities and exacerbating the inverse care law [14] is a significant risk of
implementing digital healthcare, and effort is required to ensure fairness and that no one is left
behind in a digital world [13]. Optimising digital interfaces for individuals (which may include
healthcare professionals as well as patients) who, for whatever reason, have limited ability to
access and benefit from digital healthcare is challenging but essential. Despite being promoted
by the WHO as contributing to universal healthcare coverage [5], this will only be achieved if
the needs of remote and/or deprived communities or demographically disadvantaged groups are
addressed as a pre-requisite of implementing digital healthcare [15].
From a societal perspective, the introduction of technology challenges traditional professional–
patient relationships and raises fundamental questions about trust, regard, loyalty and knowledge
in the context of a clinician–technology–patient relationship [50] and how important aspects of
“humanness” can be optimised [47, 51]. Children and young people are a specific group in
which the technical, ethical and societal challenges raised by implementing digital health
technologies require specific consideration [48, 52]. The environmental benefits of remote
healthcare need to be balanced against the potential of technology infrastructure to increase
environmental pollution [48, 53].
Exemplars of digital respiratory healthcare
The final section of the Monograph (chapters 13–22) presents selected exemplars illustrating the
breadth of digital health initiatives in respiratory conditions [54–63]. The utility of these digital
health initiatives was particularly evident during the COVID-19 pandemic. The implemented
xii https://doi.org/10.1183/2312508X.10016623
oximeters, hand-held spirometers) while other devices (such as activity trackers) are familiar in
day-to-day life but have useful medical application. Medical assistive robots are already familiar
aids for surgeons and when designed with anthropomorphic features, are demonstrating their
potential to support social tasks for the frail or housebound [40].
We also consider the range of technology in the pipeline that could be deployed in the future to
support clinical practice. These offer exciting opportunities but may also present major
challenges whilst current practice adapts to new ways of working. The increasing collection of
data offers opportunities for observing real-world practice and may be used to improve the quality,
safety and efficiency of healthcare delivery, but collation from multiple sources is challenging,
and the format of feedback is crucial if it is to effect change [42]. AI, already a feature of
imaging and radiology, is set to “feed” on this explosion in data and will increasingly play a
role in healthcare, reassuringly facilitating rather than replacing healthcare professionals [43].
Virtual, augmented and mixed reality is another powerful tool to improve diagnostics.
In this increasingly digital world, regulation is essential to set quality standards, enable
interoperability and ensure safe use as well as protect individual privacy and prevent
inappropriate access [44].
Social challenges of digital respiratory healthcare
Underpinned by rapid technological development, and promoted by policy, healthcare in Europe
and globally is undergoing a major digital transformation [2] that will affect the historical
dynamics between healthcare professionals and patients, and will impact on the way healthcare
is delivered. The second section of the Monograph (chapters 7–12) addresses the social
challenges of digital respiratory healthcare for the individual patient, their healthcare advisor
and society at large [32, 45–49].
Increasing inequities and exacerbating the inverse care law [14] is a significant risk of
implementing digital healthcare, and effort is required to ensure fairness and that no one is left
behind in a digital world [13]. Optimising digital interfaces for individuals (which may include
healthcare professionals as well as patients) who, for whatever reason, have limited ability to
access and benefit from digital healthcare is challenging but essential. Despite being promoted
by the WHO as contributing to universal healthcare coverage [5], this will only be achieved if
the needs of remote and/or deprived communities or demographically disadvantaged groups are
addressed as a pre-requisite of implementing digital healthcare [15].
From a societal perspective, the introduction of technology challenges traditional professional–
patient relationships and raises fundamental questions about trust, regard, loyalty and knowledge
in the context of a clinician–technology–patient relationship [50] and how important aspects of
“humanness” can be optimised [47, 51]. Children and young people are a specific group in
which the technical, ethical and societal challenges raised by implementing digital health
technologies require specific consideration [48, 52]. The environmental benefits of remote
healthcare need to be balanced against the potential of technology infrastructure to increase
environmental pollution [48, 53].
Exemplars of digital respiratory healthcare
The final section of the Monograph (chapters 13–22) presents selected exemplars illustrating the
breadth of digital health initiatives in respiratory conditions [54–63]. The utility of these digital
health initiatives was particularly evident during the COVID-19 pandemic. The implemented
xii https://doi.org/10.1183/2312508X.10016623