France’s digital health revolution: Ethics, innovation, and policy in action

Public value is a fundamental concept in public policy, referring to the benefits that government actions create for society as a whole. In digital health, public value goes beyond efficiency and cost-effectiveness - it encompasses ethical considerations, equity, trust, and governance. The study identifies two broad categories of public values: democratic values and managerial values.

The rapid expansion of digital health solutions is reshaping healthcare landscapes worldwide. From electronic health records to telemedicine and AI-driven diagnostics, digital transformation is enhancing patient care, improving efficiency, and expanding accessibility. However, the effectiveness of digital health strategies is not solely determined by technological innovation—it also hinges on their alignment with public values. What makes digital health strategies truly valuable to society? How can policymakers ensure that digital healthcare meets the diverse needs of all stakeholders, from patients to healthcare professionals and private sector innovators?

A recent study, “Public Value and Digital Health: The Example of Guiding Values in the National Digital Health Strategy of France”, authored by Simon Lewerenz, Anne Moen, and Henrique Martins, and published in the International Journal of Medical Informatics, explores these critical questions. By examining the French National Digital Health Strategy (NDHS) through the lens of public value, the study provides a framework that could guide digital health policies across Europe and beyond.

Understanding public value in digital health

Public value is a fundamental concept in public policy, referring to the benefits that government actions create for society as a whole. In digital health, public value goes beyond efficiency and cost-effectiveness - it encompasses ethical considerations, equity, trust, and governance. The study identifies two broad categories of public values: democratic values and managerial values.

Democratic values include principles such as ethics, security, sovereignty, and patient-centricity. These values ensure that digital health policies are aligned with societal expectations, safeguarding individual rights while fostering inclusivity. On the other hand, managerial values focus on governance, interoperability, and sustainability, which are essential for the practical implementation and long-term success of digital health initiatives.

The French healthcare system, characterized by a mix of centralized and regional governance, presents an interesting case study for analyzing how public values shape digital health strategies. France has actively promoted digital health innovation while emphasizing ethical principles, inclusivity, and citizen participation. However, balancing these priorities remains a complex challenge, as revealed by the study’s analysis of stakeholder perspectives.

Stakeholder perspectives: Bridging the gaps in digital health strategy

To assess how different stakeholders perceive public value in digital health, the researchers conducted three focus group discussions with 19 participants, categorized into three groups: public clients (patients and citizens), healthcare professionals, and private sector representatives. Each group provided unique insights into the challenges and expectations surrounding digital health implementation.

Public clients emphasized ethics, patient empowerment, and data security. Many participants expressed concerns about privacy risks associated with digital health platforms, citing the need for greater transparency and control over personal health data. They also highlighted the importance of interoperability - seamless communication between different healthcare systems - to enhance patient care. However, they noted that digital literacy remains a barrier, with many patients struggling to navigate complex digital health tools.

Healthcare professionals, while recognizing the potential of digital health, raised concerns about the practicality and usability of digital solutions. Many felt that ethical considerations, though crucial, are often too abstract to be effectively applied in clinical settings. A recurring theme in their discussions was the digital divide - some healthcare providers embrace digital tools, while others resist them due to concerns about workload, insufficient training, or a perceived loss of professional autonomy.

Private sector participants focused on efficiency, innovation, and regulatory challenges. They underscored the importance of striking a balance between security and usability, warning that excessive security measures could hinder adoption. Additionally, they highlighted the tension between public health interests and commercial imperatives, particularly regarding data ownership and monetization. While they acknowledged the need for ethical and regulatory frameworks, they also emphasized the importance of fostering a dynamic, innovation-friendly ecosystem.

These insights underscore the complexity of digital health policy-making. While all stakeholders agree on the importance of security, interoperability, and ethics, their interpretations and priorities vary. Addressing these divergent viewpoints is essential for designing digital health strategies that maximize public value.

Key challenges and recommendations for digital health policy

The study identifies several challenges that must be addressed to enhance the public value of digital health strategies. One of the most pressing concerns is the fragmentation of digital health systems, both within France and across Europe. Despite efforts to standardize digital health policies, many healthcare providers still struggle with interoperability issues, limiting the seamless exchange of medical data.

Digital sovereignty is another significant issue, particularly in the context of the European Health Data Space (EHDS). Ensuring that patient data remains protected while enabling data sharing for medical research and policy-making requires a delicate balance between security and accessibility. The study suggests that clearer regulations and governance mechanisms are needed to prevent conflicts between national and supranational policies.

Another key takeaway is the importance of co-production in digital health policy - engaging diverse stakeholders in the design and implementation of digital solutions. The study advocates for a participatory approach, where policymakers, healthcare providers, patients, and private sector representatives collaborate to develop policies that align with public needs and values. This approach not only fosters trust but also ensures that digital health innovations are both technologically sound and socially acceptable.

Additionally, the researchers stress the need for greater investments in digital literacy programs. While digital health tools offer tremendous potential, their benefits are limited if patients and healthcare providers lack the skills and knowledge to use them effectively. Training initiatives, public awareness campaigns, and user-friendly interface designs are essential to bridge the digital divide.

Conclusion: Toward a more inclusive and ethical digital health future

The study by Lewerenz and colleagues offers valuable insights into the complex interplay between technology, policy, and public values in digital health. As digital health strategies continue to evolve, the concept of public value should remain at the heart of policy-making. By prioritizing ethics, security, interoperability, and inclusivity, policymakers can ensure that digital health solutions serve the common good rather than narrow commercial or bureaucratic interests.

France’s approach provides a useful model for other nations seeking to refine their digital health policies. However, the study also highlights the need for continuous adaptation and stakeholder engagement. Digital health is not just about technology - it is about people, trust, and shared societal goals.